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Let’s face it: dental work can be expensive. Even the most basic cleaning can put a dent in your wallet. Having full dental insurance can be the difference between postponing important oral health care or living with gum problems or a bite of cavities. However, due to the way some policies are designed, you may be limited in the work you can do.
Some people postpone care because their insurance does not cover treatment at all, while others do because they have used their maximum coverage for the year. Yet most people agree that having some coverage is better than none at all. So how do you get started? Here are four key steps to take when purchasing dental insurance to avoid getting caught up in unforeseen expenses.
Key points to remember
- Dental insurance provides you with coverage to help pay for certain dental services.
- Compensation plans are more expensive because they don’t have a network.
- PPOs and HMOs are often cheaper but force patients to stay in their networks.
- Compare group and individual policies and make sure you understand how the network works.
- Make sure you know what costs are covered by the policy and how much you will need to pay out of pocket.
The basics of dental insurance
Dental insurance provides you with coverage to help pay for certain dental services. These policies can help insureds pay for all or part of the work done by their dentists, from routine cleanings and x-rays to more complicated things like implants.
Although dental insurance works much like health insurance, the premiums are usually much lower, but, of course, there is a catch. Most health insurance policies cover a high percentage of even huge expenses once you’ve paid off your deductible, and many have an annual maximum amount, as well as a deductible of $ 50 to $ 100. This is not the case with dental insurance, which typically follows a 100-80-50 coverage structure.
If you use dentists from the network, dental plans generally pay for 100% of preventive care: examinations, x-rays and cleanings. However, basic procedures, such as fillings, root canals, and extractions, pay only 80%, while major procedures such as crowns, bridges, implants, and gum disease treatment may not account for much. that 50% of the cost. Orthodontics and cosmetic dentistry, which are not considered medically necessary treatments, are generally not covered at all. This means that you may still have to pay a premium price to get your job done.
Seniors in particular can benefit from the protections offered by dental insurance. Dental insurance for the elderly often focuses on the types of coverage that seniors may need. These include crowns, root canals, dentures, and dental replacements. Although these procedures are not unique to older patients, older people are more likely to need one or more. Note that seniors with Medicare may need a different dental insurance plan than one who does not.
Dental policies range from group insurance to individual and family plans, and they fall into three categories.
Dental compensation plans
These plans tend to be the most expensive and are not as common in the market. They are also often referred to as “fee-for-service plans”. Insurers cap how much they will pay for various procedures, a customary and customary amount set by the American Dental Association. If your dentist charges a higher amount, you will have to pay that amount out of pocket.
Most insurance companies that offer compensation plans require that you pay the full cost and file a claim. Once the claim is approved, the insurance company will reimburse you for its share. The main advantage of having a plan like this is that it does not come with a network, so you are free to choose any dentist you want.
Preferred Supplier Organization (PPO)
A Preferred Supplier Organization (PPO) is one of the most common types of plans available. Dentists join a PPO network and negotiate their pricing structure with insurers. If you decide to use an off-grid provider, you will have to pay more out of pocket.
These plans can be more expensive due to the associated administrative costs. Nonetheless, they offer more flexibility than other plans, as they often come with a larger network.
Health Maintenance Organization (HMO)
With a health maintenance organization (HMO), you will pay monthly or annual premiums, but you are limited to the network and you may need to live in the area where the HMO is offered. It is generally the cheapest of the three types of plans, with dentists agreeing to charge fees for specific services.
1. Find out if you can get group coverage
The majority of people with dental insurance receive benefits through their employer or other group coverage programs such as AARP, Health Insurance Act market policies. affordable care or public programs such as Medicaid, Children’s Medicare Program (CHIP) and TriCare for the military.
These plans are generally less expensive than purchasing individual insurance and may have better benefits as well. However, you should carefully consider the details of even an employer sponsored plan to decide whether the premiums are worth it for someone in your situation.
While group coverage through an employer-sponsored plan is often the best way to get dental insurance, it still doesn’t mean the plan is right for you, so always check the details before signing up. .
2. Otherwise, check individual policies
Individual policies are more expensive than group policies, whether you buy a single policy or a policy for your whole family, and there are certainly downsides to this coverage. They come with more limited benefits and policyholders often have to wait before major procedures are approved. If you are considering signing up for a just-in-time plan because you need implants or a new set of dentures, it won’t fly. Insurers are well aware of this tactic and usually institute a waiting period before you can start using certain benefits, ranging from a few months to a year, depending on the procedure. However, there are some plans without a waiting period, although they usually cost more.
Before making a decision, it is best to shop around. Get quotes and policy details from insurance company websites or speak to a knowledgeable insurance agent.
3. Find out which dentists are in your network
If you have a dentist you like, ask what insurance plans they accept. As mentioned above, indemnity insurance plans allow you to use any dentist you want, but PPO and HMO plans limit you to dentists in their networks. If you don’t mind getting a new dentist, a PPO or HMO might meet your needs.
Still, it is wise to be wary. It’s possible that a new dentist you visit will tell you that you need a lot of unexpected work. A revealing tale of Vox by Joseph Stromberg, the son of a dentist, describes how some dentists in the network may recommend unnecessary procedures to compensate for lost income on preventive services, for which they are reimbursed at a low rate by dental insurers. Ask healthcare professionals, neighbors, and friends if they can recommend a local dentist they trust. Then check the insurances and discounts that these practitioners accept.
4. Know what the policy covers
It is important to carefully consider the policies you are considering in order to budget for your dental expenses, both expected and possible emergency costs. For example, the AARP Delta PPO Plan B covers exams, cleanings, x-rays, fillings, tooth extractions, root canals, gum cleanings and denture repairs from the start of the policy. However, you must wait until your second year to get benefits for dental implants, crowns, treatment of gum disease, full dentures, and treatment of TMJ (which involves problems with the temporomandibular joint, which connects the jaw to the skull). Even then, the benefit is limited to 50% of the costs.
Your out-of-pocket expenses should help you decide which type of plan to choose.
If you or your child needs major dental care, be aware that you will likely have to pay a significant portion of the costs. With group and individual policies, remember that the benefits are limited and can vary widely. Group plans can have waiting periods as well, and almost all plans pay a fraction of the cost for major jobs, so check the details. Your colleagues or friends can be insured by the same company but benefit from a different benefit package from the one offered to you.
The bottom line
The good thing about dental insurance is that the coverage is good for preventative care, such as dental exams, cleanings, and x-rays, although they may be covered less often than enthusiastic dentists would like. Adults and children receiving dental benefits are more likely to go to the dentist, receive restorative care, and have better overall health. Buying insurance may well motivate you to seek preventative care and avoid more expensive and uncomfortable procedures.
When purchasing individual dental insurance, be aware that major procedures may not be covered in the first year, and even then, benefits are likely to be only half of what the dentist bills. You’ll need to put money aside in a Health Savings Account (HSA) or personal fund so that you don’t get caught out if you need major work.
