Dental Insurance Options

tooth
 

InsuranceUnlike many medical insurance plans, dental insurance plans encourage preventative measures. They generally encourage regular dental visits, and provide basic preventive dental care, in the hope that more serious dental problems may be prevented later on. Their theory is that dental preventive care results in both cost savings for the plan’s provider and improved dental health for patients.

Dental plans vary widely in their approaches to dentist selection, payment options, costs and benefits. The coverage you receive and the costs you incur will largely depend on the choices you and/or your company make. Many businesses let their employees choose between two or more plans. Differences between plans can be significant. Any plan is likely to have both benefits and drawbacks. Your company will likely provide you with the information you need to compare the dental insurance plans. If a choice of plans is available to you, there are a number of important questions to consider before deciding which one is best for you and your family.

Consider These Issues

-Are there fixed dollar limits on coverage?
-Are any forms of treatment excluded from coverage?
-Are there participating dentists within a reasonable distance of your home or office?
-What co-payments are required?
-Does the plan cover adequate preventive care, such as cleanings?
-Does the plan cover emergency care?
-Does the plan cover emergency care when away from the home or office?
-How important is it to choose your own dentist?
-Will the plan cover all of your family members?

The front office staff at your dental office are familiar with most dental insurance plans. Give them a call to see if they can help you decide which plan to choose.

Types of Dental Insurance Plans

Dental Discount

This type of dental plan is not insurance. The managing organizations have negotiated with local dental offices to establish a set price for a particular dental procedure and offer deep discounts (some up to 70%) off the regular ADA pricing code. This plan has several advantages over traditional dental insurance plans, namely, there are no exclusions for pre-existing conditions. This allows a patient to receive immediate coverage for work without meeting any waiting period requirements.

Indemnity - Dental Insurance

This is the plan where you choose your own dentist. The dental insurance plan pays the dental office (dentist) on a traditional fee-for-service basis. A monthly premium is paid by the client and/or the employer to an insurance company, which then reimburses the dental office (dentist) for the services rendered. An insurance company usually pays between 50% - 80% of the dental office (dentist) fees for a covered procedure; the remaining 20% - 50% is paid by the client. These plans often have a pre-determined or set deductible amount which varies from plan to plan. Indemnity plans also can limit the amount of services covered within a given year and pay the dentist based on a variety of fee schedules. Some typical features of these plans:

High deductibles before coverage begins (well-designed plans don't apply the deductible to preventive services)

Probationary periods on certain procedures that last up to a year

Annual dollar limit on benefits

Chose your own dentist

Your average monthly cost: $15 to $25

Companies selling these plans are regulated by state insurance departments.

Dental HMOs

These insurance plans, also known as "capitation plans," operate like their medical HMO cousins. This type of dental plan provides comprehensive dental care to enrolled patients through a designated provider office (dentist). A Dental Health Maintenance Organization (DHMO) is a common example of a capitation plan. The dentist is paid on a per capita (per person) basis rather than for actual treatment provided. Participating dentists receive a fixed monthly fee based on the number of patients assigned to the office. In addition to premiums, client co-payments may be required for each visit. Some typical features of these plans:

Monthly premiums (some require you to prepay a year's worth)

Co-payments for office visits

Free preventive or routine care

You must select from an approved network of dentists

May have an initial enrollment fee

Annual dollar cap

Your average monthly cost: $5 to $15

Companies selling these plans are regulated by state insurance departments.

Preferred Provider Organizations

A preferred provider organization ( PPO) falls somewhere between an indemnity plan and a dental HMO. This plan allows a particular group of patients to receive dental care from a defined group of dentists. The participating dentist agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser. If the patient chooses to see a dentist who is not designated as a "preferred provider," that patient may be required to pay a greater share of the fee-for-service. A group of dentists agrees to provide services at a deeply discounted rate, giving you substantial savings — as long as you stay in their network. Unlike the more restrictive DHMO, though, you can go out of network and still receive some benefits. Some typical features of these plans:

Monthly premiums

Annual dollar cap

You must stay within the approved network of dentists or pay higher deductibles and co-payments

Your average monthly cost: $20-25

Companies selling these plans are regulated by state insurance departments.

Direct Reimbursement Plan

A dental care plan now coming into vogue is the direct reimbursement plan. This is a self-funded benefit plan — not insurance — in which an employer pays for dental care with its own funds, rather than paying premiums to an insurance company or third-party administrator. You, the patient, pay the full amount directly to the dentist, then get a receipt detailing services rendered and the cost, which you show to your employer. The employer reimburses you for part or all of the dental costs, depending on your specific benefits plan.

Your company might reimburse 100% of your first $100 of dental expenses and then 80% of the next $500, and 50% of the next $2,000, with a total annual maximum benefit of $1,500. Or it might reimburse only 50% of your first $1,000, resulting in a $500 yearly cap.Some typical features of a direct reimbursement plan:

Neither you nor your employer pay monthly premiums

Freedom to choose any dentist

Typical employer cost: depends on the number of employees and benefit caps

Benefits usually capped at $500 to $2,000 annually.

Dental Insurance

A variety of dental insurance programs are available.The following programs may be reviewed on their web sites.Some will require you to call and other will allow you to apply on line:NOTE:The San Fernando Valley Dental Society does not endorse any one insurance program over another.Please review all of your options carefully and select a program that suits your needs best.

Company Name

Web Site

Type of provider

     

Dental Insurance.com

www.dentalinsurance.com

Free service that allows you to compare dental insurance programs from the leading insurance carriers

Dental insurance Helper.com

www.dentalinsurancehelper.com

Free service that allows you to compare dental insurance programs from the leading insurance carriers

Dental Plans.com

www.dentalplans.com

Free service that allows you to compare dental insurance programs from the leading insurance carriers

Humana Healthcare

www.humanadental.com

Varies

United Concordia

www.ucci.com

Varies

Delta Dental

www.deltadental.com

Varies

Insurance Company.com

www.insurancecompany.com

Varies

Aetna Insurance Company

www.aetna.com

Varies

Caetus Media Group

www.yourdentistryguide.com/insurance

Educational site for understanding dental insurance plans

Safeguard insurance Company

www.safeguard.net

Varies (includes recently acquired Smilesaver)

E health Insurance

www.ehealthinsurance.com

Web based broker representing numerous carriers

Dr Dental Plan.com

 

Broker representing various carriers


Back to Top

For technical questions and comments regarding this website,
please contact the Webmaster.