Dental Insurance Plans & Programs
Open wide, please: Dental insurance offers jaw-dropping options
Ever wonder why it’s taken so long for health coverage to begin paying for dental health? So have many other people, because dental health is as important to overall fitness as exercise, eating right and getting regular physical check-ups.
These days, most individuals and families who have even minimal dental insurance have it through a group plan sponsored by a family member’s employer. However, as employers cut back on workers’ benefits, dental insurance can be among the first benefits to be dropped. This is more than unfortunate; it’s unhealthy, because poor dental health can lead to other physical ailments as well.
As employers drop dental insurance ? or health insurance coverage altogether ? many individuals and families are turning to the Internet to seek out some kind of alternative dental coverage. This is where many people enter a jungle of bewildering terms and conditions on coverage, along with the growing reluctance of many dental practices to accept some kinds of insurance plans because low payments or claim performance issues. These problems can make individual dental insurance unworkable, no matter how low the monthly premium may be.
Here’s how consumers can sort through the many dental insurance plans and programs available in order to find coverage that benefits them, their families and their dentists as well.
Discount Dental Plans
A Discount Dental Plan closely resembles membership in a buying club, such as the big warehouse stores where you can purchase large quantities of limited items. With a discount dental plan, a family or individual pays a flat fee yearly for access to a network of dentists who participate in the plan.
These dentists have agreed to provide dental services such as teeth cleaning, exams including X-rays, cavity fillings, root canal treatments, crowns, orthodontics and other procedures at pre-arranged rates. The dental plan negotiates common rates for these services with all the dental providers in the network. These fees typically are made known to plan participants before they sign up.
This arrangement can benefit both plan participants and provider dentists in many ways.
Participants without dental insurance get access to common dental services at substantial discounts, sometimes as high as 60 percent over non-plan dentists’ fees. Other benefits of a discount plan include:
- No problems with long wait times for dental care
- Prompt activation of benefits, lessening the wait to see a dentist
- Easy application process with no exclusions for pre-existing dental or medical conditions.
- No dental care paperwork or claim forms.
To get the best coverage from a discount insurance dental plan, participants should carry their plan membership card with them at all times. Being able to show your membership card helps ensure getting discounts on dental services, even in emergencies. In addition, most discount dental plans require showing a membership card on each visit to verify plan participation.
Discount dental plans also benefit dentists as well. Like patients, they’re relieved of the burden of filing claims paperwork as with a traditional insurance plan. Plus, dentists are assured of constant revenue for services without being at the mercy of insurance companies that may refuse all or part of a procedure’s coverage.
There are also drawbacks to this arrangement. For participants, it means that they are limited in their choice of dental practices to visit. For providers, it means that their fees are locked in for a specified period, usually one year, no matter how much the cost of providing that service may increase during that time.
However, there are also advantages and disadvantages to other, more traditional dental insurance programs as well.
Full Coverage Dental Insurance
Many people understand the term ?full coverage dental insurance? to mean that this program covers all dental care costs. However, this is not accurate.
This standard form of coverage is like a traditional health insurance program, but for dental care. Participants pay a premium, and the insurance company pays for all or part of the cost of dental care. The higher a participant’s premiums and deductibles, the larger a portion of costs will be paid by the insurance company in most cases.
Traditional dental insurance such as this is really a form of contract, or legal agreement. The participant chooses an insurance company (or has one chosen by his or her employer) and purchases a policy by paying premiums on a periodic basis, usually a month at a time. When dental work is needed, the participant is responsible for checking the insurance policy to see what’s covered, and whether deductibles must be met before the insurance company begins paying for the service.
To obtain the insurance company’s share of dental care costs, the participant must fill out claim forms to send to the company. Often the dentist’s office will fill out the forms on the participant’s behalf, using information obtained from the participant’s insurance identity card. With some plans, a participant must pay the cost of the dental service first, and then be reimbursed by the insurance company. With other plans, the dentist’s office files the claim on behalf of the patient, and is reimbursed directly by the insurance company. Then the patient is sent a bill for whatever portion of the charges not paid by the insurance company.
The kind of coverage obtained through full coverage dental insurance varies widely. There are expensive plans available that cover virtually all dental work, including cosmetic procedures such as bleaching, implants and so on. Nonetheless, even full dental coverage still requires that participants pay a portion of the cost.
With most dental insurance providers, there are three levels of coverage:
Basic dental care:
This level typically covers dental check-ups, cleanings and other regular dentist visits, and usually is fully paid for by the provider. This can be the most important part of dental insurance, because preventive care such as this can avoid much more serious problems later on.
Minor dental care:
On top of basic care, most dental insurance covers what are considered “minor” dental procedures, such as filling cavities. Depending on the type of insurance, this level of care also may include such procedures as root canal treatments, caps, crowns or bonding. Few providers cover the complete cost of these kinds of dental work, so participants should expect to pay a portion of these fees.
Major dental care:
When specialized procedures are required, patients should expect that their dental insurance will pay only a small portion of this level of care. Major care includes orthodontics (braces), dentures, dental surgery such as the extraction of “wisdom” teeth (adult molars) and so on. Extensive dental work that results from injury or disease is included at this level. When choosing dental insurance, participants should look for a plan that includes at least some coverage for major dental care, as this type of treatment can be as expensive as major surgery.
In addition to these levels, there are several different categories of full-coverage dental insurance, the kind of traditional insurance with which many people are familiar. Here are the varieties available:
Preferred Provider Organization (PPO).
A PPO insurance plan is part of a network system. Dentists enroll in the PPO network to boost their patient loads. In exchange for referrals from an insurance company, dentists offer lower rates for the patients who have that provider’s insurance. Patients benefit from lower fees, but must choose a dentist in the network in order to get the lower fees. Otherwise, they lose benefits and have to pay more for dental care. Many participants like PPO coverage because it allows patients to choose a dentist from within a network, saves on the cost of dental care and often provides lower deductibles. Dentists prefer PPO because they get paid sooner and with less paperwork.
Naturally, there are disadvantages for both dental patients and dentists to a PPO plan. Under most PPOs, dentists can turn away patients if they won’t be adequately reimbursed by the patient’s insurance. Patients also still face deductibles, which can add up when the entire family is covered by one dental insurance plan. Some patients also don’t like having to stay in the network to receive maximum benefits, while some PPOs put a cap on the total amount of dental care allowed in a year, sometimes as little as $1,000 per covered individual.
Health Maintenance Organization (HMO).
The other type of full coverage dental insurance is known as HMO. This version of dental insurance requires some prepayment from participants, for which the participants get care from a dental provider network. The differences between HMO and PPO plans are:
- No eligible patient can be turned away.
- Dentists are paid a fixed amount per patient, usually on a once-a-month basis.
HMO dental insurance plans cover basic dental services such as regular exams, cleaning, and dental X-rays. Sometimes these services are provided without cost to plan participants, while other procedures such as bridges, crowns, dentures and so forth required at least a partial payment from the patient. With an HMO plan, patients often don’t have the privilege of going to a dentist outside the insurance network and getting at least a portion of that cost paid. Patients either see a dentist in the HMO network, or they pay the full cost of dental care themselves.
The biggest drawback to HMO dental plans is how dentists are paid. With an HMO, dentists are paid set fees on a set schedule, no matter how much the service may actually cost or when it’s performed. Some patients have complained that some HMO dentists will hold off on providing services in order to increase their profitability. As a result, patients sometimes have longer wait times for needed care, or don’t get certain necessary procedures. HMOs typically have fewer dentists in the plan than PPOs.
This overview gives a brief idea of how various dental insurance programs and discounted dental plans work. Consumers should perform their own more detailed research before choosing dental coverage for themselves and their families.
