4 Important Steps to Choosing Dental Insurance

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Let’s face it: getting dental care can be expensive. Even the most basic cleaning can put a dent in your wallet. Having comprehensive dental insurance can be the difference between postponing major oral care or living with gum problems or a bite of cavities. However, due to the way some policies are designed, you may be limited in the work you can do.

Some people postpone care because their insurance doesn’t cover the treatment at all, while others do so because they’ve used up their maximum coverage for the year. Still, most people agree that having some coverage is better than none at all. So how do you start? Here are four key steps to follow when shopping for dental insurance to avoid ending up with unexpected expenses.

Key points to remember

  • Dental insurance provides you with coverage to help pay for certain dental care.
  • Compensation plans are more expensive because they don’t have a network.
  • PPOs and HMOs are often less expensive but require patients to stay within their networks.
  • Compare group and individual policies and make sure you understand how the network works.
  • Make sure you know what costs are covered by the policy and how much you will have to pay out of pocket.

The basics of dental insurance

Dental insurance provides you with coverage to help pay for certain dental care. These policies can help policyholders pay for all or part of the work done by their dentists, from routine cleanings and x-rays to more complicated ones like implants.

Although dental insurance works much like health insurance, the premiums are generally much lower, but, of course, there is a catch. Most health insurance policies cover a high percentage of even the largest expenses once you’ve paid your deductible, and many have a yearly out-of-pocket maximum, as well as a deductible of $50 to $100. This is not the case with dental insurance, which generally follows a 100-80-50 coverage structure.

If you use in-network dentists, dental plans generally pay 100% of preventive care: exams, X-rays and cleanings. However, basic procedures such as fillings, root canals, and extractions only pay 80%, while major procedures such as crowns, bridges, implants, and gum disease treatment may only account for 80 percent. only 50% of the cost. Orthodontics and cosmetic dentistry, which are not considered medically necessary treatments, are generally not covered at all. This means that you may still have to pay a high price to do your job.

Elderly people in particular can benefit from the protection offered by dental insurance. Dental insurance for seniors often focuses on the types of coverage seniors may need. These include crowns, root canals, dentures and tooth replacements. Although these procedures are not unique to elderly patients, older people are more likely to need one or more of them. Note that seniors with Medicare may need a different dental insurance plan than those without.

Dental policies range from group insurance to individual and family plans, and they fall into three categories.

Dental Compensation Plans

These plans tend to be the most expensive and aren’t as common in the market. They are also often referred to as “fee-for-service plans”. Insurers cap the amount they will pay for various procedures – a usual and customary amount set by the American Dental Association. If your dentist charges a higher amount, you will have to pay that amount out of pocket.

Most insurance companies that offer indemnity plans require you to pay the full cost and file a claim. Once the claim is approved, the insurance company reimburses you for its share. The main benefit of having a plan like this is that it doesn’t come with a network, so you’re free to choose any dentist you like.

Preferred Provider Organization (PPO)

A Preferred Provider Organization (PPO) is one of the most common types of plans available. Dentists join a PPO network and negotiate their fee structure with insurers. If you decide to use an out-of-network provider, you will have to pay more out of pocket.

These plans can be more expensive due to the associated administrative costs. Still, they offer more flexibility than other plans, as they often come with a larger network.

Health Maintenance Organization (HMO)

With a health maintenance organization (HMO), you’ll pay monthly or annual premiums, but you’re limited to the network and may need to live in the area where the HMO is offered. It’s usually the cheapest of the three types of plans, with dentists agreeing to charge a fee for specific services.

Investopedia / Alison Czinkota


1. Find out if you can get group coverage

The majority of people with dental insurance receive benefits through their employer or other group coverage programs such as AARP, Affordable Care Act market health insurance policies, or public programs such as Medicaid, Children’s Health Insurance Program (CHIP), and TriCare for the military.

These plans are usually less expensive than buying individual insurance and may also have better benefits. However, you should carefully consider the details of even an employer-sponsored plan to decide if the premiums are worth it for someone in your situation.

While group coverage through an employer-sponsored plan is often the best way to get dental insurance, it still doesn’t mean the plan is right for you, so always check the details before joining. a.

2. If not, check individual policies

Individual policies are more expensive than group policies, whether you’re buying just one policy or one for your whole family, and there are definitely downsides to this coverage. They come with more limited benefits and policyholders often have to wait for major procedures to be approved. If you’re considering signing up for a just-in-time plan because you need implants or a new set of dentures, it won’t work. Insurers are well aware of this tactic and generally institute a waiting period before you can start using certain benefits, which can last from a few months to a year, depending on the procedure. However, there are plans with no waiting period, although they usually cost more.

Before making a decision, it is best to make comparisons. Get quotes and policy details from insurance company websites or talk to a knowledgeable insurance agent.

3. Find out which dentists are in your network

If you have a dentist you like, ask him what insurance plans he accepts. As mentioned above, indemnity insurance plans allow you to use any dentist you want, but PPO and HMO plans limit you to dentists in their networks. If you don’t mind using a new dentist, a PPO or HMO might suit your needs.

Still, it is wise to be wary. A new dentist you visit may say that you need a lot of unexpected work. A telling story on Vox by Joseph Stromberg, the son of a dentist, describes how some dentists in the network may recommend unnecessary procedures to make up for lost revenue on preventive services, for which they are reimbursed at a low rate by insurers dental. Ask healthcare professionals, neighbors and friends if they can recommend a local dentist they trust. Then check the insurance and discount plans that these practitioners accept.

4. Know what the policy covers

It is important to carefully consider the policies you are considering in order to budget your dental expenses, both expected and possible emergency costs. For example, AARP Delta PPO Plan B covers exams, cleanings, X-rays, fillings, tooth extractions, root canals, gum cleanings, and denture repairs from the start of the policy. However, you must wait until your second year to get benefits for dental implants, crowns, gum disease treatment, full dentures, and TMJ treatment (which involves problems with the temporomandibular joint, which connects the jaw to the skull). Even then, the benefit is limited to 50% of the costs.

Your personal expenses should help you decide which type of plan to choose.

If you or your child need major dental work, you will likely have to pay a significant portion of the cost. With group and individual policies, remember that benefits are limited and can vary widely. Group plans can also have waiting periods, and almost all plans only pay a fraction of the cost for major work, so check the details. Your colleagues or friends may be insured by the same company but benefit from a different set of benefits than those offered to you.

The essential

The good thing about dental insurance is that coverage is good for preventative care, such as dental exams, cleanings, and x-rays, although these may be covered less frequently than dentists want to have them. Adults and children with dental benefits are more likely to visit the dentist, receive restorative care, and have better overall health. Buying insurance can motivate you to seek preventative care and avoid more costly and uncomfortable procedures.

When buying individual dental insurance, be aware that major procedures may not be covered in the first year, and even then the benefit will likely only be half of what the dentist charges. You’ll need to put money aside in a health savings account (HSA) or personal fund so you don’t get caught out if you need major work.

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