Dental insurance plans vary, but most have a deductible and/or coinsurance and policy maximums. Some limit coverage to certain procedures, while others exclude them completely.
Dental insurance companies negotiate discounted rates and fees with network dentists, which can save subscribers money. These networks also tend to have lower monthly premiums.
Costs
Many factors affect the cost of dental insurance. Besides the premium, you also have to consider the deductible, copayments and annual maximums. These factors are not only important for choosing the best plan but also to know whether the coverage is worth the money. A good way to compare different plans is to tally up the costs and benefits.
Preventive treatments like regular cleanings, X-rays and fluoride treatment are usually covered at 100% or close to it in most dental insurance plans. These procedures prevent larger and more costly issues down the road. Basic treatments include fillings, tooth extractions and root canals. Major treatments are procedures such as crowns, bridges and implants.
Depending on the type of plan, you may have to pay a flat fee for each visit or a percentage of the total cost after your deductible has been met. For example, a 20%/80% coinsurance means that you and the insurer each pay 20% or 80% of the cost, respectively. You should always check your insurance card or policy to determine the specific copayment rates.
Benefits
There are a wide variety of dental plans available. Most plans cover preventive care, and they can save people money on expensive procedures down the road. Preventive care includes regular visits to the dentist, which can help detect and treat problems before they become serious. Dental insurance can also reduce the cost of major services, such as a root canal or crown.
Unlike health insurance, which has a single set of rules and regulations, dental insurance is subject to a wide range of variations. The most common type of plan is a preferred provider organization (PPO). These plans offer a network of providers that agree to charge a discounted rate for their services. Patients can choose to see providers outside the network, but those fees will be higher.
Another type of dental plan is a dental health maintenance organization (DHMO). These plans offer lower premiums, and they typically do not have a deductible. They are similar to health care HMOs, and they require that members select a Primary Dentist who will coordinate all of their care. DHMOs usually have smaller networks than PPOs, and they are less flexible.
Co-pays
Co-pays are a fixed dollar amount that you pay for each treatment. They are usually due at the time of the service and don’t count towards your deductible. Preventive care typically doesn’t require a copay, but basic and major care usually does.
Unlike copays, which are fixed dollar amounts, coinsurance is a percentage of the cost that you are responsible for paying after you have met your deductible. For example, if your plan pays 80% of the cost for fillings, then you will be responsible for the other 20%.
If you want a dental insurance plan with lower monthly premiums and a low annual maximum, consider a Dental Health Maintenance Organization (DHMO) plan. These plans offer predictability and low out-of-pocket costs, and they only work with a network of providers. In contrast, a Fee-for-Service dental insurance plan (also known as traditional or indemnity dental insurance) doesn’t have a provider network and requires you to pay a higher coinsurance percentage. Indemnity dental plans aren’t as common as DHMOs, but they can be a good option for those who don’t want to pay a high monthly premium.
Deductibles
The number one concern of consumers about dental coverage is cost. It’s important to understand how deductibles, copayments and coinsurance work before selecting a plan. You should also read the fine print of any individual or family plan before enrolling to make sure you’re familiar with all the terms and conditions. eHealth’s team of licensed insurance agents can help you navigate these complex issues.
Most dental plans have a deductible amount, which is the minimum cost you’ll pay out of pocket for procedures until your plan starts covering costs. The deductible may be a set dollar amount or a percentage of the covered service, depending on the plan. For example, a filling with an insurer-covered cost of $150 might have a deductible of $50 and coinsurance of 20%.
Deductibles are often set for 12-month periods, which is why many dental plans are purchased on a group basis by employers. These groups can negotiate prices that are much lower than what you might find on the marketplace or individually. Most dental insurance plans also have annual coverage maximums, which means once you reach the coverage limit, you’ll need to pay for any additional expenses.
Networks
Many people are confused about the terms “in-network” and “out-of-network” when it comes to dental insurance. In-network dentists have contracts with the insurance company and agree to offer services at pre-established rates. This helps the insurance company keep premiums lower and gives patients a more affordable option for their care. Unfortunately, the contracts can restrict dentists as far as what types of treatments they will perform and could even dictate some of the methods or materials used.
It is important for employers to understand the ins and outs of their dental plans to make sure they are getting the best value. Some of the most common types of dental insurance are Preferred Provider Organization (PPO), Health Maintenance Organization (HMO) and Indemnity (fee-for-service). The latter offers a larger selection of providers but typically have higher monthly fees. It’s also not uncommon for these plans to have a deductible, copays and limitations on minor and major coverage. Dental practices that choose to be in-network with insurance companies find it is often easier to attract and keep patients.