Dental insurance is generally not part of medical insurance coverage. Instead, it’s usually an optional plan that can be purchased separately, and it doesn’t always work exactly the way medical coverage does.
Dental insurance is a policy that helps cover the cost of services administered at a dental office for a monthly premium similar to what you pay for medical insurance. “But it’s not insurance in the traditional sense,” says Alex Karrenbrock, sales associate at Apollo Insurance Group in Lees Summit, Missouri. “It’s a discount plan with a limited benefit. This means that if you go to a dentist who is part of the network, they are contractually obliged to give you the reduced insurance costs and not the office costs, which are generally 20% to 40% higher, ”says- she. Your dental insurance coverage helps pay some or all of the costs – the amount paid depends on your specific plan and the benefits offered.
Even though dental insurance doesn’t always cover your entire bill, many people find it helpful when it comes to saving on preventative care and dental procedures that may be needed. Dental care can get very expensive very quickly, and insurance can often help ease that financial burden.
Different types of dental insurance
There are eight basic types of dental insurance, according to the American Dental Association (ADA). If you’re looking for coverage, it’s essential to know the differences.
Preferred Supplier Organizations (PPOs) The plans are like health insurance in that they provide a network of dentists who are covered by the insurance company to perform dental work for a flat fee. According to Yenile Pinto, DDS, these plans generally offer stronger coverage for more expensive procedures like implants, braces and surgery. owner of Deering Dental in Miami. “PPOs also tend to have better doctors in their networks, and you usually have the ability to use your out-of-network benefits as well,” she explains. “The downside of a PPO is that most plans have a benefit of $1,000 to $2,000, after which you are responsible for paying the full amount, although you pay the reduced insurance rate, which can save you up to 40%,” says Dr. Pinto.
Dental Health Maintenance Organizations (DHMO) the plans give dentists a certain amount of money each month for each patient assigned to them. They are then required to provide certain services free of charge or at a reduced cost to these patients. “DHMO plans typically have unlimited benefits, but there’s a copay for all procedures, and they tend to have more restrictions and lack coverage for high-end procedures,” Dr. Pinto says. “Also, because reimbursements to dentists are relatively low, many choose not to participate in DHMOs, which may limit your access to better, more experienced providers.”
Compensation plans are closest in structure to a traditional health insurance plan. The insurance company pays claims based on the procedures performed and generally allows patients to choose their own doctors. “This policy pays the dentist a percentage of the bill on your behalf according to plan guidelines,” says Karrenbrock.
Direct Reimbursement (DR) The plans are exactly what they sound like: “These types of plans require you to pay the bill up front, then file a claim with the insurance company to receive a reimbursement check in the mail later” , explains Karrenbrock.
Point of Service (POS) plans are arrangements where patients who have a managed dental plan can receive treatment from an out-of-network provider. The patient is generally reimbursed, but the benefits are considerably reduced compared to what they would be if the patient saw a provider who was in the network.
Discount or sponsorship plans technically not insurance plans: “There are other types of plans called discount dental plans that only give you a discount on dental services, like a coupon at the grocery store,” explains Karrenbrock. “But you are still responsible for the full cost of the discounted invoice.”
Exclusive Provider Organizations (EPO) the plans only allow patients to use participating dentists in order to be reimbursed. Because of this restriction, these plans severely limit access to dentist choices and care.
Table or schedule of compensation plans require users to pay a fixed amount for each procedure. Patients must pay the difference between the fee and the carrier’s payment.