What is Dental Insurance?
Dental insurance can seem confusing. Simply put, it is a way to offset the cost of dental care. It is meant to reduce your costs and make having a great smile more affordable, but unlike other types of insurance, It is not designed to be a pay-all.
You can get insurance in two ways: through your employer or individually. When you have an employer/group policy, it has been negotiated and contracted between your employer and the insurer. That means, your benefits are based on the package your employer selects, which are chosen based on the employer’s preferences. Individual policies are, as the name implies, bought privately and you select your own package. In both cases, it is a good idea to get an understanding of what your policy will do for you!
Basic Types of Dental Plans
- Fee for service (Indemnity)
- Managed care plans: Preferred Provider Organizations (PPO) or Dental Health Maintenance Organizations (DHMO).
How does it work?
Probably the most popular plan, PPO’s are contracted with many dentists in a network of providers. The contracted (in-network) dentists agree to offer their services at a reduced rate to those insured by the PPO. PPO’s offer the most freedom to choose your provider with a good balance of cost and choice. The good news is that even if your dentist isn’t in network with a PPO, you can still choose to see them. You just may not get the biggest price break.
- Yearly Maximum that plan will cover (Usually around $1000-1500)
- Yearly Deductible that will apply before the plan will cover basic or major work
- Benefits renew each calendar year
- Waiting periods may apply for basic and major services
- Procedures covered by percentages based on categories: Preventive, Basic, Major (usually covered at 100, 80, and 50 percent, respectively)
- Patients may go out of network, but they will be responsible for fees above the network fees
DHMO’s contract dentists who agree to accept a monthly fee to provide patient members of the DHMO with treatment at no cost or a reduced fee, depending on the procedure. What this means to you is that this plan offers a broad range of procedures at a reduced rate.The drawbacks are that you must choose a single primary provider to work with and you must request to change providers. This is usually the least expensive type of policy. This plan is a good choice if you need a procedure done quickly and don’t want a waiting period.
- No yearly maximum
- No yearly deductible
- No waiting period
- No filing
- Costs known up front
- Cleanings, x-rays and exams are at no charge
- Most other work will have co-pay
- Patient cannot change providers without request
- Patient must have referral to specialists
Indemnity/Fee for Service Plans
Also known as traditional plans, indemnity plans give you the freedom to choose any dentist you like. These plans reimburse the patient and they don’t pay until you submit the claim after the work is complete. That means, you may have to pay the full out-of-pocket expense up front and wait for reimbursement. For that reason, if you have this type of plan, it is always a good idea to file a pre-treatment estimate to make sure you know what to expect.
- Yearly deductible
- Waiting period
- Plans set upper limit for what they will pay for any given procedure and the patient may have to make up difference between the dentist’s fees and what the plan will pay
- Allows for greatest choice of dentists
- Usually pays a large portion of bill
Dental insurance can be a helpful tool to help make your oral health affordable! Let your highly trained dental team help you get the most out of your plan!