Dental Insurance

Your teeth help you to eat, speak and create a great first impression. But do you ever consider how important your dental health is to your overall healthcare plan?

Once your permanent teeth come in you never get a second chance to keep them perfectly healthy. That’s why regular visits to your dentist for checkups and preventative dental care are a must. While most people know and understand this, it often gets overlooked, largely because of the expense involved.

Not having adequate dental care can lead to tooth decay, tooth loss and in a worst case scenario, serious dental disease. Having dental insurance can be a tremendous benefit by making the general oral health care you need more affordable, preventing bigger problems in the future.

What follows is an overview of dental insurance, what it covers and what you need to know to find the right policy for your needs.

What is dental insurance?

Dental insurance is a type of insurance that helps the policyholder pay for the costs associated with receiving professional dental care.

Treatments and services typically covered by dental insurance policies, include but are not limited to the following:

Routine Checkups

Cleanings

X-Rays

Fluoride Treatments

Fillings

Tooth Removal

Root Canals

Services typically not covered in dental insurance plans include cosmetic procedures such as orthodontics, veneers and teeth whitening.

What types of dental insurance plans are available?

Managed Care Plans

This type of coverage works to control costs associated with dental treatment and is typically provided by a network of professionals.

Management Care Policies can be further broken down into more specific programs:

Exclusive Provider Organization (EPO) – EPO plans, which only offer services from a select few dental care providers is the most restrictive dental plan option.

Preferred Provider Organization (PPO) – PPO plans are provided by a network of dental care specialists who are contracted by an insurance company and who offer discounted services in order to be a part of the preferred provider network.

Health Maintenance Organization (HMO) – Also known as a capitation plan, HMO’s are provided by a network of dentists that receive a specific amount for each participant of the plan in exchange for providing the necessary dental treatments required over the membership term.

Traditional or Indemnity Policies

Unlike Managed Care Plans, Traditional Policies allow you to choose your own care provider, receive individual services at a set fee and then submit claim forms to receive reimbursements according to the terms of the policy. Coverage for each procedure can be partial or full depending on the features of the plan.

The cost of benefits for either type of policy are usually determined by using either a fixed-fee Table of Allowances or a percentage-based Usual, Customary or Reasonable (UCR) Fee Schedule.

In order to find the right dental plan for you and your family, you should ask the following important questions:

– What does the plan cover? Are preventative, diagnostic and emergency services included?
– Can I select my own dental care provider or are there restrictions?
– How are decisions made regarding the choice of treatment? Are they stipulated by the dental plan, the dentist or do I have input?
– Are there any limitations or exclusions for the plan?
– Am I able to get referrals for specialists?
– Is there any waiting period before I can access certain benefits?
– Which members of my family are covered under the plan?

The answers will reveal your best options and help you make the right choice.

How much does dental insurance cost?

Dental insurance can be extremely expensive because of the high costs associated with treatment. However, the majority of the costs that you will have to pay for your dental insurance plan are determined by the following items:

Deductible

The deductible is the amount that you must pay out-of-pocket before you can access benefits associated with your insurance plan. A higher deductible typically comes with a lower premium payment, while a low deductible amount typically attracts higher premium rates.

Co-Pay

Once you reach your maximum deductible the co-pay portion of your dental plan kicks in. At this point, your dental insurance provider covers a specific portion of the costs associated with the services you receive. The percentage ratio paid by you and your insurer depends on the coverage levels built into your specific plan, which typically ranges from 20 to 80 percent of the cost of each service.

Maximum Coverage

A typical dental insurance plan is tied to a maximum coverage amount. Once the services received in a single policy year reach this limit, the policy holder is responsible for any additional costs. Plans with higher premiums generally have higher maximum coverage levels.

When selecting your dental coverage, it is important to take your oral health, budget and future needs into consideration.

If you tend to have strong and healthy teeth and rarely run into serious oral care issues, you may be happy with a basic and low-cost coverage plan. However, if you are plagued by dental problems or know that you have a major dental expense approaching, having a more comprehensive plan is a good idea and will save you more money in the end.