Many dental procedures come at a high cost due to the high level of expertise and equipment required. Fortunately, a good dental insurance plan can help you maintain good oral health and a great smile without knocking your budget completely off track.
Like other health insurance plans, dental insurance policies are designed to protect you from huge unexpected health care bills. Having an insurance plan also helps you get the dental care you need without putting it off due to a lack of funds. But dental plans are not created equal, and they cover various procedures differently.
If you are looking for a dental insurance plan, it is crucial to choose one that fits your needs and budget. Let’s look at what you need to know when selecting a dental insurance policy that will provide you with the coverage and level of care you require.
How Do Dental Insurance Plans Work?
Ideally, your dental plan is supposed to provide coverage for your dental care and provide access to an extensive dental network. However, because of how different policies are designed, you may be limited in the types of covered procedures. Most dental plans work based on one or more of the following:
The 100/70/50 Formula
Most dental plans will cover 100 percent of the cost of most preventive procedures such as checkups, x-rays and cleaning. Typically, you do not have to pay a deductible (a certain amount of money you must spend out-of-pocket before insurance starts covering you) on these preventive services.
A typical plan will then cover 70 percent of all minor procedures such as extractions and fillings, and 50 percent for complex procedures such as root canals, bridges and crowns.
The exact percentages of coverage may vary from one company to another. An insurance policy should outline what is considered to be basic and major procedures, as well as covered services offered for each. Be sure to look at the policy’s fine print to know what to expect.
Dental Insurance Caps and Deductibles
Deductibles are the out-of-pocket payment you have to make before the dental insurance coverage kicks in. This usually ranges from $50 for an individual and $150 for a family.
On the other hand, the dental insurance cap is the total amount that your insurance plan will pay per year for every member covered. The dental cap varies depending on the company. If you exceed your insurance cap, you are supposed to pay any amount spent over this cap.
Insurance plans have a waiting period requirement that states how long you should wait before you can start using your newly-purchased insurance policy. The waiting period can range from a few months to a year. This helps to limit the number of people who want to purchase an insurance plan when they need a dental procedure and plan to stop the premium payments afterward. However, some companies may offer dental insurance with no waiting period, so you can start using the plan almost immediately.
Types of Dental Insurance
There are different types of dental insurance plans. These include the following:
Dental Preferred Provider Organizations (DPPO)
A dental PPO is one of the most common plans. It allows you to see any licensed dentist who is in the plan’s network or even those who are outside of the network. In-network dentists partner with the insurance companies, allowing you to have lower-cost services whenever you see a dentist or specialist within this network. If you choose to use an out-of-network dentist, you may need to pay more from your pocket.
Most dental PPOs have an annual deductible and an annual cap.
Dental Health Maintenance Organizations (DMHO)
These plans may require you to choose a dentist that is within the plan’s network. They may not cover services sought from other dentists outside of your network.
Most dental HMOs do not have an annual deductible. However, you will have to pay a percentage of your dental costs along with the insurance company. Most DHMO plans do not have an annual cap.
Dental Indemnity Plan
Commonly known as a fee-for-service plan, the indemnity plan gives you the freedom to seek services from any dentists. You must pay for all services until you meet the deductible, after which your insurance coverage kicks in. After that, you will pay a percentage of the costs for your dental services, and the company will pay the remaining percentage.
Due to its convenience and fewer requirements, dental indemnity plans are often more expensive than other plans.
How to Choose the Best Dental Insurance Policy
1. When possible, consider choosing a group coverage policy
Group coverage plans are an affordable dental insurance option. They include employer-sponsored dental insurance or other group plans such as AARP. If you are eligible for any of these group plans, you’re more likely to get better benefits and more affordable premiums than you would with an individual plan.
2. Go for a plan with affordable premiums
This is the monthly fee you will need to pay each month to keep your insurance policy active. It is important to look for an insurance plan with affordable premiums that you can pay comfortably. Ensure that you check the amount you will need to pay and compare it with the service you will receive.
3. What is the company’s waiting period
If you are looking for an insurance plan to cover an urgent dental procedure, you need to look for one with a short waiting period. Many insurance plans will provide waiting periods ranging from a few months up to a year.
4. Look for a plan with a large dental network
This is perhaps one of the main considerations when choosing the right dental insurance policy. You want to make sure there are plenty of in-network dentists to choose from in your local area.
5. Know what the policy covers
It is important to review various policies and consider which expenses each one covers. Some policies will only cover basic procedures such as x-ray, cleanings and teeth removals. On the other hand, full-coverage dental insurance can offer extended services for root canals, denture repairs and implants. It is advisable to choose a dental plan that covers the three degrees of dental procedures: routine and preventative care, emergency care and complex care.
Important Questions to Ask When Researching Dental Plans Options
Here are a few questions you should ask when looking for the best dental insurance plan:
- What is the monthly premium?
- How much will the plan cover? Will it cover your spouse and kids?
- Are there procedures not covered by the plan?
- What are some of the out-of-pocket costs that you’ll be responsible for paying? Are there deductibles, coinsurance or co-payments?
- Are there limits on the amount of times you can see the dentist?
- Does the policy limit you to the cheapest treatment options available?
- Is it easy to get in touch with the company? Do they have good customer service? Be sure to check reviews.
The Bottom Line
When looking for a suitable dental insurance plan for you and your loved ones, it is vital to go through your options and look for one that gives you the most comprehensive coverage at the best premium rates. You should choose an insurance plan that offers maximum benefits and low deductibles.
Besides, the insurance company should be licensed to operate within your area and have an extensive network of approved dentists. Start by getting a quote from the various providers and narrow your choices to a plan that offers the best value for your money.