If you have been thinking about getting dental insurance, then you should know the ins and outs of what it entails. Dental insurance is a program that pays a portion of the costs associated with preventative, minor and major dental care. When you have dental insurance, you must pay a premium, which is a set amount that you pay each month for coverage. You must also pay a deductible, which is a certain annual amount that you pay before your insurance kicks in.
After your deductible is met, you then become responsible for a percentage of covered expenses. This is known as your co-insurance. Depending on the dental plan, there may be a fixed cost for certain services, which is your copayment or copay. Once you pay your copay, you can receive services like X-rays, teeth cleanings and more. In this article, you will learn how dental insurance works, the difference in dental insurance plans, how to find the right dental insurance plan for you and more.
How Dental Insurance Works
If you are looking for a dental insurance policy that can help you budget your dental visits effectively, then you may want to know how the insurance works. Compared to medical insurance, dental insurance is a lot easier to understand. Many of the policies are straightforward and clear when describing which procedures are covered and which are not. There are some procedures that have to be paid out of pocket. If you already have medical insurance, then there is a possibility that your dental insurance is a part of that. There are also dental insurances that have standalone policies.
If your dental insurance is a standalone policy, then there will most likely be a waiting period before procedures can be done. This wait time ranges from six to 12 months and applies to standard procedures. For major work, the wait time can be increased to two years, depending on circumstances.
In order for your dental insurance to assist you, you must pay a deductible. If your deductible is higher than the actual cost of the procedure, the insurance will not assist you in paying for it. A copay may also be required.
There are three categories in which your procedure may be grouped. Your procedure could fall under the preventative, basic or major categories. For your preventative procedures, your bill will be covered fully. Basic and major procedures are covered partially.
There are many different dental insurance plans available to you and it is important to know how dental insurance works, which one works for you and the differences between them.
Types of Dental Plans
Before choosing dental coverage from a provider, it is important to know the difference between the types of dental plans available. Each coverage type may have different stipulations on the specific dentist you may receive treatment from as well as what costs are associated with services rendered.
A preferred provider organization (PPO) is a plan that grants indemnity while the dentists are contractually tied to the insurance company to provide services for set fees according to the contract.
You also have the option to choose dental health maintenance organizations (DHMO). This is also known as the Capitation Plans. Under the DHMO, dentists who are under contract are pre-paid each month for the patient’s services.
Indemnity plans allow insurance companies to pay claims based on the client’s procedure. The claims are usually just a percentage of the bill. This plan is also known as traditional insurance because it is one of the most common for patients to have.
A direct reimbursement plan includes benefits based on spent dollars instead of the procedure done. With this plan, patients can go to the dentist of their choice.
Another plan is the point of service plan, which offers patients the option of seeking treatment from out-of-network providers. This plan has fewer benefits than those with in-network providers.
Insurance vs. Savings Plans
Dental insurance and dental savings plans are very different in terms of the benefits you receive and the amount you are paying for coverage. However, they are similar in that they both lower the overall costs associated with dental care.
As stated above, dental insurance involves deductibles, copays and co-insurance. No matter the insurance plan you receive, these aforementioned components will be a part of it. When it comes to dental savings plans, nothing is covered by the insurance provider. You are simply offered a discounted price from dentists involved. With savings plans, you will not have waiting periods or annual maximums like you do with insurance plans. Discount plans offer savings that range from 10 to 60 percent for average dental procedures. Dental savings plans are best suited for you if you need to have a lot of work done because there is no benefit cap. It is important to note that although you will receive discounts, there will still be dental work fees that you will have to pay, especially if the work falls under the extensive category. If you are considering a discount plan, then examine the costs of procedures with network dentists.
Finding the Right Dental Insurance Plan
Now that you have an overview of different types of insurance plans and how they differ, it is best to choose the one that is right for you. While this decision can be challenging, it does not have to be. If you currently have a dentist who you go to for small procedures like X-rays and teeth cleaning, then be sure to assess how you like the dentist and the way they perform. If you enjoy their services, then ask what plans they take and services they cover.
If you do not have a dentist already, then you need to determine what kind of coverage you need. You should make sure the coverage plan you are considering makes sense in regard to the amount of coverage being offered. There are different ways that you can buy dental insurance, including through both independent insurance agents and online marketplaces.
There is no specific insurance plan that works for everyone. Choose an insurance plan that works with your needs and income level. Dental savings plans should also be considered. There are websites that rank dental insurance and dental insurance savings plans based on dentists in the network, the procedures covered and the costs of coverage. Your dental plan options and benefits will vary based on the number of people you are expecting to cover.
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