Dental insurance plans are insurance designed to pay the costs associated with dental care. Dental care by dentists, orthodontists and hospitals will have a portion of their charges paid by dental insurance. By doing so, dental insurance protects people from financial hardship caused by unexpected dental expenses.
More than 50% of the people in the United States aren’t covered by any of dental insurance plans according to the American Dental Association (ADA). Almost all of those people that receive dental insurance sign-up for it through their employer as a secondary part of their health insurance. You should consider having a compatible program to fill in the gaps between the two plans depending upon what type of health insurance you have. By doing this, you will receive preventative dental care as well as the advantage of saving money.
That said, dental insurance plans are not highly desirable by a lot of dentists. Basically, this means less pay plus more work (especially more paperwork.) It is important to not over-insure nor under-insure so it is important to assess your situation when purchasing adequate coverage. Furthermore, you should keep in mind that all insurance plans have restrictions such as annual maximum payments and pre-existing conditions.
Common sorts of dental insurance plans are mainly Dental Health Maintenance Organizations (DHMO) or Preferred Provider Organizations (PPO). PPOs and DHMOs are both types of managed care and, therefore, both dental insurance plans have disadvantages and advantages.
All fees are generally not covered because even though dentists provide their services for these plans and have agreed upon amount that they will charge the insurance companies, there are still a few fees left unpaid. There are deductibles to consider and most of these types of dental insurance plans only pay a percentage of the charges, leaving the patient with a co-pay. Additionally, there may be an annual maximum amount that the dental insurance plans will pay.
If your employer is paying the monthly premiums for the dental insurance plan and the dentist you use is part of the PPO, this might be an attractive option.
Based on medical HMOs, DHMOs offer other dental insurance plans. Here, too, the patient is enrolled in a program and can visit any dentist in that program. However, by comparison to a PPO, dentists may not be held to spend as much time with each patient and may end up providing services below cost. In a DHMO, volume matters more than quality, and so dentists are often driven to spend less time with their patients. Due to lack of time, even though a patient will eventually be seen and treated, there is no true relationship between the dentist and the patient. If you want to be seen by a dentist who takes time with his or her patients, this may not be your optimum dental insurance plan.
Non-Insurance Dental Plans… An Alternative to Dental Insurance Plans
In these types of plans, commonly called Reduced-Fee-For-Service or Discount Plans, participating dental providers provide care at a discounted rate to the plan subscribers. These types of plans began in the early 1990s, and they offer benefits such as braces, fillings, exams, and routine cleanings in exchange for a discounted fee to its members. Members typically receive a discount of 30%-35% off retail prices.
Unlike traditional indemnity-based dental insurance, discount dental plans have no annual limits, no health restrictions and no paperwork. In addition, consumers must pay either a monthly or yearly membership fee in exchange for the ability to get these discounts on dental services. To ensure that customers receive the savings they were promised, most plans will provide a price list or fee schedule for these discounted services.
A typical discount plan, for example, would direct you to a dentist that has agreed to charge a discounted rate, say $700 for a crown instead of $800.
Discount dental plans are designed for individuals, families and groups looking to save money on their dental care needs. Dental providers participating in these plans have agreed to accept a discounted fee as payment-in-full for services performed for a plan members. In general, plans are active within five business days and sometimes even on the same business day.
Be careful; if you do not have dental insurance coverage in addition to a discount dental plan, you can be left with a substantial liability for payment to providers. For example, a 25% discount applied to a $2000 dental bill would still leave a person with a $1500 liability. In addition, because payment due at the time of service (i.e. when your dental work is completed), be prepared to pay your dental bill in full before leaving the dental office.
Before Purchasing a Discount Dental Plan
You should know the answers to all of the questions below before you purchase any type of dental coverage, whether you are choosing a non-insurance discount plan or are one of the many traditional indemnity-based dental insurance plans.
*** Ask for a list of participating providers in your area/zip code
*** Contact any providers that you plan to see to confirm they still participate in the plan
*** If you are interested in having a procedure done, ask the provider with the normal fee is
*** Make sure the provider offers the promised reduction in fees
Finally, be advised that state insurance departments do not regulate dental discount plans. That said, the fact that they are not regulated, doesn’t mean that they aren’t legitimate… just be cautious. If you are uncertain whether you are purchasing insurance or not, simply ask if a licensed insurance company is offering the plan and verify this with the insurance company. In California and Arizona, there are now state licensed dental discount plans.
Ed Brancheau, aka The Insurance Egghead [http://www.insur