Most dental insurance plans cover one preventive dental care visit every six months. However, 28% of consumers with dental insurance visit the dentist once a year or less. These consumers aren’t getting the most out of their dental benefits. Results of a new study suggest that one in four employed adults who have dental insurance aren’t using their benefits due to concerns about cost. It is important to know how dental insurance works and what your specific insurance covers. If you remain ignorant of your dental insurance coverage, you could be wasting money, as well as putting yourself at risk for dental problems in the future.
What is Dental Insurance?
Dental insurance is a form of health insurance designed to pay a portion of the costs associated with preventive, minor, and some major dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories: Dental Health Managed Organizations (DHMO), Preferred Provider Network (PPO), and Indemnity.
Types of Coverage
Dental insurance comes in three varieties: DHMO, PPO and indemnity plans.
- DHMO: Dental insurance plan which restricts coverage to dental professionals within a limited network.
- PPO: Plan which allows patients to see dentists outside the “preferred” network. However, patients are typically charged reduced rates if they see an in-network dentist.
- Indemnity Plan: Dental insurance plans in which the policyholder chooses any dentist he or she wishes. The patient pays the dentist directly for services, and is then reimbursed by the insurance carrier by means of a claims process. Typically, these plans cover 50%-80% of the cost of dental work, and the remaining amount is paid by the patient.
DHMO Pros and Cons
- Less expensive than indemnity plans
- Basic services are often provided without a co-pay.
- It is in the provider’s best interest to help the patient maintain solid dental health.
- Individual needs vary, and certain treatments are not covered.
- Providers may focus more on efficiency than the most appropriate treatment.
- Dentist selection is limited to the network, and in some cases, there may be very few providers to choose from.
PPO Pros and Cons
- Plans have a negotiated fee schedule that is lower than regular dental fees.
- There are more providers to choose from.
- Your dentist does not get paid until you have treatment done.
- You must choose from a preferred provider list to receive the maximum benefit from your plan.
- Because PPO plans are so popular, dentists who accept this type of insurance may be busier, making it more difficult to get an appointment.
Indemnity Pros and Cons
- Use the dentist you want to use, as there is no exclusive "network."
- See a specialist without a referral
- Your dentist is paid based on work completed, so no need to fear that he or she will minimize your treatment to save time or resources.
- If UCR is used, it is difficult to know if the calculation is accurate.
- You must pay out-of-pocket and wait for reimbursement.
- Claims paperwork take time and energy.
- Indemnity plans have more expensive premiums and higher deductibles in most cases than some other forms of dental insurance.
People with dental insurance commonly have what’s described as “100-80-50” coverage, meaning it pays 100 percent of the cost of routine preventive and diagnostic care, such as checkups and cleanings; covers 80 percent for fillings, root canals and other basic procedures; and 50 percent for crowns, bridges and major procedures. So, while Insurance companies will cover many of the costs associated with dental care, each plan has its own out-of-pocket costs that patients should be aware of. Under PPO, patients must pay a co-payment for procedures and are required to reach a deductible and have a maximum before insurance companies will begin to cover any procedures. DHMO insurance plans require no deductibles or maximum, and though patients may pay a co-payment for certain procedures, some procedures are have zero out-of-pocket costs.
Dental coverage is so important because taking proper care of your teeth and gums requires more than brushing and flossing every day. You also need to see a dentist at least twice a year for a thorough cleaning and check-up. However, this coverage is only effective if you remember to use it.
For more information on how Anderson & Atkins can help you take advantage of your dental plan, or if you have any questions about our practice, please feel free to contact our office at (979) 846-1813 or email us at email@example.com.
Sources: https://budgeting.thenest.com/ppo-vs-dhmo-dental-25015.html , https://en.wikipedia.org/wiki/Dental_insurance