Is Dental Insurance Right For Your Family?

Leslie is deciding whether dental insurance is worth it for her family. She knows that dental procedures can cost hundreds of dollars.

She also knows that most dental plans have deductibles and coinsurance. Some have annual maximums, while others cap costs for specific procedures like fillings or oral surgery. 韓国歯科

Many people get their dental coverage through their employer or as a rider on a health plan. Others purchase individual dental insurance.

Preventive care

Most dental insurance policies cover cleanings, exams and X-rays at no extra cost from in-network providers. Basic services typically include fillings and non-surgical extractions, and major services include crowns, bridges and root canals. Dental plans can be separate from health insurance or included as a supplemental benefit. Many employers offer dental insurance as part of a benefits package, while some individuals purchase stand-alone dental coverage through the ACA marketplace or private insurers. Many of these are indemnity plans that reimburse dentists based on a maximum allowance – commonly referred to as “usual, customary and reasonable” – for each procedure.

Some of these plans have a waiting period before coverage begins, while others do not. Regardless of which type of plan is selected, it’s important to consider how much coverage one needs. If a person has a low tolerance for cost-sharing or is interested in selecting a network of dentists, then an insurance policy with a dental PPO may be appropriate. These plans typically have a yearly maximum on how much they will pay, and some even roll over unused annual maximums from year to year. However, these plans typically require a higher monthly premium than a dental indemnity product or dental HMO.

Basic care

Dental insurance focuses on preventative care, including routine visits to the dentist for check-ups (usually twice per year), cleanings, fluoride treatments and sealants and basic X-rays. It also covers some of the cost for more expensive services like fillings, extractions and root canals. It’s important to understand the difference between the types of procedures covered by a plan, as different plans treat certain services differently.

For example, some plans cover a composite (white) filling but not an amalgam one for the back teeth; they may limit coverage to the fee that is considered “customary and reasonable” for the area, which may or may not accurately reflect actual fees charged by dentists. The ADA’s website provides information on the average provider rates for various procedures.

Most dental insurance plans offer a choice between a preferred provider organization (PPO) or a dental health maintenance organization (DHMO). A PPO plan allows patients to choose any licensed dentist, but they pay lower fees when they stay within the PPO network. A DHMO plan typically has a smaller network and requires that you see a designated dentist or pay a fixed copayment for each service.

Another option is a capitation program, which pays contracted dentists a monthly amount per patient or family enrolled in the plan, regardless of the amount they actually charge for services. Indemnity and PPO plans often cover Basic services at a rate of 70 to 80%, but they do not usually pay benefits until the policyholder has met their deductible.

Major care

Generally, dental insurance policies divide procedures into three major categories: preventive care, basic care, and major services. Preventive care includes procedures such as routine cleanings, dental exams, and X-rays to identify problems before they get worse. In addition, it can include fluoride and sealant treatments. Basic care includes fillings and non-surgical extractions. And, finally, major procedures include crowns, bridges, and implants, among others.

In general, dental plans cover a certain percentage of each type of procedure, with patients paying the remaining amount. This is true for both dental PPO and indemnity products. But, the exact breakdown of coverage will vary by policy. Additionally, each plan will have a deductible, copays, and/or coinsurance that determine the patient’s out-of-pocket costs.

Dental insurance is typically available as a standalone product or as an add-on to other health plans, such as Medicare Advantage. If you have both a Medicare Advantage and a separate dental plan, check each to see how they overlap, as some will only cover certain categories of care (for example, composite fillings might not be covered for back teeth, but amalgam fillings would be). In such cases, you may be responsible for the additional cost of any procedure that exceeds the coverage limit set by your insurance company. This is an important consideration because dental services can be quite expensive.

Out-of-pocket expenses

Many dental insurance plans include deductibles, copayments and annual maximums that can make out-of-pocket expenses a significant burden. The amount of these expenses can vary widely depending on the type of plan you have and the dentist you visit. For example, a fee-for-service plan may allow you to go to any dentist, but typically has higher premiums and a yearly maximum. While an HMO plan may only cover visits to a list of approved providers and requires a referral for specialty care, it generally has lower costs and a lower yearly limit.

Deductibles are a fixed dollar amount that you must pay before the insurance company begins to cover your expenses. Most plans also have coinsurance, which is a percentage of expenses that you and your dental insurance company share after you meet the deductible. For instance, a 20%/80% coinsurance means that you will pay 20% of the costs and your plan will cover 80%.

Some dental insurance plans require a deductible for basic or major procedures, but most waive it for preventive services like annual exams, cleanings and X-rays. In addition, many dental discount plans have no deductible or low deductibles to encourage patients to get the preventive care they need. However, if you have two or more dental insurance plans that overlap, you must determine which plan pays first via coordination of benefits contractual language in the plans.