Oral & Vision Health Blog

Losing Health Insurance? Tips For Finding Affordable Coverage.

Losing health insurance can create challenges. There may be ongoing health issues to manage and unexpected times when you need to go to urgent care or the hospital.

A loss of benefits can occur due to changes in employment, income, or federal and state guidelines. A large example is the winding down of automatic Medicaid enrollment. An estimated 95 million low-income Americans were enrolled in benefits through Medicaid and CHIP (the Children's Health Insurance Program) as of March 2023. They now run the risk of having to look for new outside insurance options.

Regardless of how your insurance changes, navigating the process of finding new coverage can be confusing and daunting. Ultimately what is most important is to ensure you still have insurance in place for you and your family.


Key takeaways:

  • Anyone can sign up for their own health benefits directly through an insurance company.
  • You can also use the state and federal marketplace websites to find insurance – they have specific enrollment dates.
  • Take time to compare insurance options by cost and what they cover.
  • Make sure your regular doctors and dentists accept the insurance you’re looking at.

Outside of getting insurance through an employer, you can shop for your own plan. Medical, dental and vision insurance are all available by going directly through an insurance company. You can also look for individual and family insurance through the federal and state marketplaces. You will just need to keep note of the enrollment dates – that is when you are allowed to start a new insurance plan or change plans.

Looking for insurance is a double-edged sword. There are many plan types to choose from, but there are differences to keep in mind. To help you make the best choice possible for you and your family we have some tips and tricks you can use.

What features you should be looking for in a plan:

When it comes to any type of health care, the bottom line is you will save money on each visit by having insurance. And you can get the most out of your insurance by knowing how the plan works. Here are some key points to consider when browsing health insurance plans:

  • Is your doctor in-network?
    For dental, medical and vision insurance, you will receive the best discount or rate by going to an in-network provider. Some plans do not provide coverage for out-of-network providers. So, you will want to make sure your provider accepts your insurance. Some providers only take certain insurance plans or do not take insurance at all.

Will you have a deductible? What is the out-of-pocket maximum?

Knowing this information will really help you narrow down your choice of insurance. Your plan may have a deductible amount you have to pay before the insurance will start paying a share for your services. You will also want to know what the out-of-pocket maximum is. This is how much the insurance will pay in total over the year. Any expenses over the maximum would be coming out of your pocket.

What services are covered as preventive care?

Medical and dental plans can vary depending on which services are considered preventive care. In many cases, these services may be available at no cost to you. They can include routine checkups and dental cleanings. And they can be allowed once or twice per year, depending on the plan. Preventive care can lead to early detection and treatment of medical and dental conditions. It can reduce the need for expensive services and possible emergency room visits in the future.

What other services are covered under the plan?

  • Basic dental services: This can include extractions, deep cleanings, and fillings for cavities. You will typically split the cost with the insurance, which could be anywhere from 50-80%.
  • Major dental services: The most extensive dental procedures include bridges, crowns, oral surgery, and dentures. They will have the highest out-of-pocket cost, which the plan will split with you by 30-50%.
  • Anesthesia: Before going in for any treatments or procedures, ask your doctor or dentist if anesthesia will be needed. The plan may have an allowance, or you will have to pay the costs in full. Your dentist may suggest or strongly recommend anesthesia for procedures like tooth extractions, dental implants, and jaw surgery.
  • Restorative care: This involves extensive dental work, like crowns and fillings.
    Orthodontics: This treats teeth problems with braces, wiring or brackets. Not all dental plans cover orthodontia, so you will want to be aware of any lifetime maximums, age limits or other restrictions.
  • Endodontics: These focus on caring for the pulp and roots of your teeth and are generally more complex. A root canal is an endodontic procedure.
  • Periodontics: Having this coverage will protect your wallet if you need to treat gum infection and gum disease. Scaling and root planing (or deep cleaning) is the most common type of periodontic treatment.
  • Prosthodontics: These procedures are typically for missing teeth or for people who do not qualify for dental implants.

Are there waiting periods?

You will want to know if you can start getting medical, dental or vision care immediately or if you must wait. Some insurance plans require you to wait until they cover certain treatments or surgeries. Waiting periods can also extend to how often you are able to receive routine care.

Types of plans:
The process of choosing insurance can be a lot easier when you know what you’re looking for. Imagine what pirates could have achieved if they had GPS on their ships. Some of the plan acronyms do sound like ship names. With that in mind, we will look at the types of plans out there:

  • Medical insurance plans have four common types: EPO, HMO, POS, and PPO.
  • Dental insurance can be provided in iterations of these six plan types: DPPO, DHMO, DEPO, DPOS, DMPO, and Dental Indemnity.
  • Dental Preferred Provider Organization (DPPO): On these plans the insurance will have a contract with the dentist who agrees to set a fee for each service. If the dentist is not contracted with the insurance your costs can be higher.
  • Dental Health Maintenance Organization (DHMO): These plan types require you to choose a primary dentist. If you go to your assigned dentist, you will have no cost or a reduced amount for each visit, depending on the service.
  • Dental Exclusive Provider Organizations (DEPO): These plans are like DHMO plans. However, DEPO plans can offer a larger choice of in-network providers. You may need a written referral from your assigned provider to see a specialist.
  • Dental Point of Service (DPOS): You will have the option of going to an out-of-network provider. It is worth keeping in mind that you will likely pay more for services.
  • Discount Dental Plan (DMPO): Unlike a typical insurance plan, you will instantly receive discounted rates without needing to pay a deductible or out-of-pocket maximum. You can use a DMPO on top of an existing dental insurance plan to save more money.
  • Dental Indemnity: These plans are less common. They involve reimbursing the patient instead of the provider. The dollar amount will be based on the “usual, customary and reasonable” rates determined by the insurance.

And here are some common insurance terms for good measure. Anchors away!

Saving on cost:
Some people look at insurance as a financial commitment they can live without. Luckily, there are multiple types of medical and dental insurance to suit your specific needs and budget. These plans cost less compared to paying dental fees without insurance. Insurance is also helpful during an emergency. You never know when you’ll need medical or dental care. And paying the full fees upfront can be stressful.

Working with an insurance broker:

You can also work with an insurance agent or brokerage that is familiar with the health insurance marketplace. This could be one of the best ways to receive guidance as they will be able to hear your unique needs and lead you to a plan that suits. They would have already vetted many of the benefits programs out there.


So, yes losing health insurance is a headache. But you can see there are plenty of reasons to forge ahead and make sure you still have a form of coverage. It allows you to take care of your overall health, provides easier access to necessary treatments, and offers financial protection for unexpected health issues. Remember that dental insurance plans vary in terms of coverage and cost. We hope these tips will make it easier for you to navigate and review the different plans available to you.