If you are like most people, you need to visit a dentist at least twice a year, just to check-up on your teeth. Unfortunately with the sugary beverages, candy, and lack of good oral hygiene in our society, many people need to visit the dentist frequently to fix painful toothaches. For some people, dental insurance is a must-have, while for others it is an added expense they opt to live without. Dental insurance is a great thing to have if your teeth are prone to cavities and decay. Many companies recognize the importance of dental insurance and are able to offer it to their employees. In return, the employees pay a small monthly premium (usually $25.00 or less) and receive around $1,000 to $1,500 in dental insurance benefits each year.
For those who cannot afford dental insurance, there are other options available that are proving to be an affordable alternative to dental insurance. A dental plan provides holders with low-cost dental care for all dental work, including cosmetic procedures. There are several different plans available with benefits that vary depending upon how much you can afford to pay.
Dental Plans versus Dental Insurance
How do dental plans differ from dental insurance? Dental plans are a service in which patients will receive discounts for all dental care. For a monthly fee, you can receive discounts on root canals, crowns, bridges, and other dental procedures. Here are a few benefits of a dental plan versus dental insurance:
- No deductible. Dental plans are not insurance, you will receive a discount on the dental procedures performed.
- Low monthly premiums. Dental plans tend to have smaller monthly premiums than dental insurance policies.
- If you move, you can switch to another participating dental plan provider.
- No limit on how much you can spend. Unlike dental insurance, dental plans do not have a limit on how much dental care you can receive during the year. Most dental insurance policies will only cover up to $1,000 to $1,500 of dental care per year. Dental plans allow you to receive a discount no matter how many dental visits you make.
- No waiting period. Once you have a dental plan, you can use it the day you receive your card. You do not have to wait 3 to 12 months before going to the dentist like you need to with some dental insurance companies.
- No-exclusions. Dental insurance companies typically have a clause about pre-existing conditions. This means, they will not pay for a bridge, implant, or other procedure if you were missing the tooth prior to service. Dental plans do not exclude pre-existing conditions and allow you to receive discounts for these dental procedures.
Dental insurance plans are typically divided into a few different categories: indemnity plans, PPOs, and HMOs.
Indemnity dental insurance plans are the traditional forms of dental insurance. The plan allows you to select a dentist of your choice without a penalty. The plan will then pay all or part of the dentist’s fee. The insurance company usually has a set UCR fee (usual, customary and reasonable). This is an established set price for every dental procedure they cover. The dentist may charge more for a certain procedure, but your insurance company will only pay what their UCR guide states.
If your policy requires you to go to an in-network provider, you will not be charged the difference between the dentist’s price and the UCR price. Typically, the contracted dentist and the insurance company write off the difference in charges. If your insurance allows you to pick your own dentist, you may need to check the UCR guide against the dentists charges to make sure you have enough money to cover the out-of-pocket expenses.
Typically, indemnity plans will pay 100% on preventative treatment, 50% to 80% on basic procedures, and 25% to 40% on major treatments. Preventative dental procedures are considered to be routine cleanings, x-rays, sealants, fluoride, and any preventative dental care. Basic or restorative dental procedures are described as fillings for cavities or simple extractions. Root canals are also considered basic procedures. Major dental procedures are considered to be crowns, bridges, dentures, partials, surgical extractions, and dental implants.
Indemnity plans are limited by a yearly maximum amount around $1,000 and there is sometimes a deductible the patient must pay before coverage can begin. The patient will be responsible for any fees not paid by the dental insurance company.
Participating or Preferred Provider Plans (PPOs) are similar to indemnity plans. The patient must select their dentist from a listing of dentist’s who have signed an agreement with the insurance company to accept a pre-set fee. The dentist agrees not to charge the patient for any amount that their normal fee exceeds the pre-set fee. This means that under a PPO plan, you will have a pre-set fee of $100, the insurance will pay $80, the dentist will write off $5 by which their fee exceeds the UCR amount, and you will be responsible for $20.
Dental Health Maintenance Organization plans are not dental insurance. They are plans in which you must choose a participating dentist in order to receive benefits. There are 2 different types of HMOs: Capitation and Fixed fee for service.
Capitation is when the dentist receives a small monthly payment for each patient they are assigned. The dentist is not paid for preventative care or restorative treatment they provide. However, they are paid the small monthly fee whether they treat you or not.
Fixed fee for service plan provides a fee schedule for the patient they see. The fee schedule sets the fees so that the dentist can cut costs. This may result in you having a cheaply made crown or silver fillings versus porcelain.
Before you select a dental insurance plan, you should ask yourself a few key questions:
- Can I choose my own dentist? If you have a close friend or relative who is a dentist, you probably want to go to them. Since most dental insurance plans only allow you to go to in-network dentists, you may decide it is worth the extra money to go to a dentist of your choice.
- Can I select my treatment? If your dentist has recommended a certain procedure, check to see if your insurance company covers it. Many insurance companies will not pay as much money for a root canal that is done by an endodontist. Be sure you are getting the best treatment options for the price your insurance company is willing to pay.
- What is covered? Most dental insurance plans will pay 100% for preventative care procedures such as check-ups, cleanings, and fluoride treatments. After this, the cost is usually split 50/50.
- What will I pay? If your employer is sponsoring the dental insurance plan, you can’t go wrong with the small premium cost you are paying. If you elect to choose dental insurance on your own, you will find that you have a much higher monthly premium amount.