Dental insurance can help provide for the common
expenses associated with dental work. Here's what
you need to know when selecting a plan.
The American Dental Association recommends visiting the dentist twice a year for a checkup. Dental
insurance can help offset the costs of these checkups. Not only that, if you need other work done to your
teeth, your dental insurance plan may cover some or all of the costs.
Basic Types of Dental Insurance
There are two major types of dental plans: managed care dental plans and fee-for-service plans.
Managed care dental plans place limits on the services that are covered, the amount paid for those
services, and the dentists you can choose.
Fee-for-service plans reimburse patients based on the amount that’s spent on dental care. Note this is
different from managed care plans, which base payments on the type of service that’s provided. Patients
can choose any dentist, but they’re typically required to pay for services upfront. Then, employers
reimburse the employee a percentage of the treatment. There may be an annual limit on the amount of
dental coverage an employer will reimburse.
Two Types of Managed Dental Care Plans
Preferred Provider Organization (PPO) programs are a type of managed
dental care plan that have a network of dentists and dental providers. Much
like health insurance PPO plans, some PPO dental plans will allow you to
receive treatment from a dentist outside the network, but you’ll have to pay
higher deductibles and co-payments for those services.
Dental Health Maintenance Organization (DHMO) plans are another type of
managed dental plan in which subscribers don’t pay anything for certain
types of treatments. Other treatments may only require a co-payment. The
plan itself has a number of contracted dentists who are paid a fixed amount
based on the number of individuals and families enrolled in the plan.
How to Choose a Dental Insurance Plan
When you’re choosing a dental insurance plan, there are some things you
want to consider.
Will you be able to choose your own dentist? If you already have a favorite
dentist, make sure his/her services will be covered by the dental plan you
choose. Your plan might allow you to choose any dentists you like, or it may
restrict your choices to a list of dentists.
What services are covered? At the very least, you should be able to receive
two annual checkups at no cost. Find out what other services are covered
and how much you would be responsible for paying.
How much will you pay? With managed care plans, you’ll be responsible for
a monthly premium and possibly co-payments at the time of service. Make
sure you understand the total cost of your dental plan.
What major dental work is covered? These types of services are the most
expensive. Find out how much, if anything, will be covered by your dental insurance plan if you have to
have major dental work done.
Watch out for least expensive alternative treatment (LEAT) clauses. Some dental insurance contracts will
only pay for the treatment that costs the least amount of money, even if you and your dentist agree that a
more expensive treatment is the best option.
Some plans use a usual, customary, and reasonable (UCR) type of analysis to figure out how much they
will pay for certain dental services. The UCR limits on certain plans could be rather low compared to the
price charged by area dentists, increasing the amount you have to pay for services.
Often, dental insurance doesn’t fully cover treatment, even those recommended by the dentists. There
may be gaps between what dental services costs and what your insurance company is willing to pay. Try
to choose a dental insurance plan that covers as much as possible to reduce the amount you have to pay
out of pocket for dental services.
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