Let’s face it: Dental surgery is really expensive. Even the most basic cleaning can leave a dent in your wallet. Having comprehensive dental insurance can mean the difference between putting off important oral care or living with gum problems or a mouth full of cavities. However, due to the way some strategies are designed, you may not be able to do what you can.
Some people put off treatment because their insurance doesn’t cover it at all, while others put off treatment because they’re using their own money for the highest coverage for the year. Most agree, though, that some coverage is better than nothing no good. So how do you get started? Here are four key steps to take when buying dental insurance to avoid unexpected expenses;
- Dental insurance gives you coverage to help pay for certain dental work;
- Compensation plans are more expensive because they don’t have a network.
- PPOs and HMOs are generally cheaper but require patients to remain in their network.
- Compare Group Policy and Personal Policy to make sure you understand how networking works.
- Be sure to know what the insurance policy covers and how much you’ll need to pay out of pocket.
Basics of Dental Insurance
Dental insurance provides you with coverage to help you pay for certain dental work. These insurance policies can help the insured pay for all or part of the work their dentist does, from routine cleanings and X-rays to more complex work such as implants things.
While dental insurance is a bit like health insurance, the premiums are usually much lower, but, of course, there’s a catch. Most health insurance policies even cover a sizable percentage of high costs once you’ve paid the deductible, and many have a maximum deductible each year, as well as a $50 to $100 deductible. This is not the case with dental insurance, which generally follows a 100-80-50 insurance structure.
If you’re at a network dentist, dental plans generally pay 100% for preventive care exams, X-rays, cleanings. However, basic procedures such as fillings, root canals, and tooth extractions only pay 80%, while major procedures such as crown bridges, implants, and gum disease treatment may only be 50% of the cost. Orthodontics and cosmetic dentistry, which are treatments not considered medically necessary, usually do not cover all. 1; this means you may still have to pay a high price to get the job done.
Older adults, in particular, may benefit from the protection provided by dental insurance. Dental insurance for seniors often focuses on the type of coverage seniors may need. These include crowns, root canals, dentures, and tooth replacements. While these procedures are not unique to older patients, older adults are more likely to require one or more.
Dental insurance ranges from group coverage to individual and family plans and is divided into three categories.
Indemnity Dental Plan
These plans tend to be the most expensive and less common in the market. They are also often referred to as “fee service plans,” and insurers limit the amount they pay for various procedures, which is the usual and customary amount prescribed by the American Dental Association. If your dentist charges more, you’ll have to pay this out of pocket.
Most insurance company compensation plans require you to pay the full cost and file a claim. Once the claim is approved, the insurance company will reimburse you for that portion. The main benefit of having such a plan is that it has no internet, so you are free to choose any dentist you like. 2
Preferred Provider Organization (PPO)
A Preferred Provider Organization (PPO) is one of the most common types of plans available. Dentists join the PPO network and negotiate fee structures with insurance companies. If you decide to use an internet provider, you will have to pay more cash.
These plans can be more expensive due to the associated administrative costs. They do offer more flexibility than other plans, though, as they tend to have a wider network. 3
Health Maintenance Organization (HMO)
With a health maintenance organization (HMO), you will pay monthly or annual premiums, but only online, and you may have to live in an area that offers the HMO. This is usually the cheapest of the three plans, and dentists agree to charge for specific services. 4
1 See if you can get group insurance
Most people who have dental insurance do so through their employer or other group insurance plans (such as AARP, Affordable Care Act, Marketplace Health Insurance Policy) or public plans (such as Medicaid, Children’s Health Insurance Plan, and Tricolor for the Army.
These plans are often cheaper than buying individual insurance and may also have better benefits. However, you should take a good look at even an employer-sponsored plan to decide whether the premium is worth paying for someone in your situation.
While group coverage through an employer-sponsored plan is often the best way to get dental coverage, it doesn’t mean the plan is right for you, so be sure to check the specifics before joining.
2 If not, look at individual policies
Individual policies are more expensive than group policies, and whether you’re buying one policy or one for your entire family, there are downsides to this type of coverage. They provide more limited benefits, and the insured often has to wait for major procedures to be approved. If you plan to enroll in a plan in time because you need implants or a new set of dentures, it won’t fly. Insurance companies are well aware of this tactic and often place a waiting period before you start using certain benefits, which can last anywhere from a few months to a year, depending on the procedure. 5 However, some plans do not have a waiting period, although they are usually more expensive.
Before you make a decision, it’s best to compare. Get quotes and policy details from the insurance company’s website, or speak with a knowledgeable insurance agent.
- Find out which dentists are in your network
If you have a dentist you like, ask them which insurance plans they accept. As mentioned above, indemnity insurance plans allow you to use the dentist of your choice, but PPO and HMO plans limit you to their network of dentists. If you don’t mind using a new dentist, a PPO or HMO may suit your needs.
Still, it’s wise to remain vigilant. The new dentist you see may say you need a lot of unexpected work. A revelation to Vox by Joseph Stromberg, the son of a dentist, describes how some network dentists may recommend unnecessary procedures to make up for lost revenue from preventive services because they get low rates from dental insurance companies Rate compensation. Ask health professionals, neighbors, and friends if they can recommend a local dentist they trust. Then check what insurance and discount plan those practitioners accept.
4 Do you know what the insurance policy covers?
It is important to carefully review the policies you are considering to budget for your dental expenses for anticipated and possible emergency expenses. For example, AARP Delta PPO Plan B includes inspections, cleanings, X-rays, fillings, extractions, root canals, gum cleaning, and denture restorations from the beginning of the policy. However, you’ll need to wait until your second year to get the benefits of dental implants, crowns, gum disease treatment, complete dentures, and treatment of the temporomandibular joint (the joint that connects your jaw to your skull). Even so, the benefit is limited to 50% of the cost. 6
Your out-of-pocket costs should help you decide which type of plan to choose.
If you or your child needs to do a lot of dental work, be aware that you may be paying a lot of money. Whether it’s a group policy or an individual policy, keep in mind that benefits are limited and can vary widely. Team plans may also have waiting periods, and almost all plans pay a fraction of the cost of the main job, so check for details. Your co-workers or friends may be insured by the same company, but their benefits package is different from yours.
The highlight of dental insurance is that coverage is good for preventative care, such as exams, cleanings, and dental x-rays, although these items may be covered less frequently than the dentist would like. Adults and children with dental benefits are more likely to visit a dentist, receive restorative care, and experience greater overall health. Buying insurance can be a great incentive to get preventive treatment and avoid more expensive and uncomfortable procedures.
When purchasing personal dental insurance, keep in mind that major surgery may not be covered for the first year, and even then the benefit maybe half what the dentist charges. You need to put your money in a health savings account or a personal fund so you don’t run out of money when you need a big job.