Dental insurance
From Wikipedia, the free encyclopedia
Dental Insurance in the United States is insurance designed to pay the costs associated with dental care. Dental insurance pays a portion of the bills from dentists, hospitals, and other providers of dental services. By doing so, dental insurance protects people from financial hardship caused by unexpected dental expenses.
The American Dental Association states that more than half of the population in the United States are not covered by any dental insurance plan. Those who do have dental coverage often get it through their employer as part of their health insurance plan. Depending upon the type of medical coverage you have, it may be a good idea to have a compatible program to eliminate any gaps or overlap within the two plans. That may save money while allowing you to take advantage of receiving necessary preventive care.
Not all dentists are pleased about participating in a dental insurance plan. It means more work for them (and especially more paperwork), and less pay. It is also important to have adequate coverage for your situation, so you can access the features you need and are not paying for something you will not use. Also, insurance plans have restrictions, such as pre-existing conditions and annual maximum payments.
The most common types of dental insurance plans are either Preferred Provider Organization (PPO) or Dental Health Maintenance Organization (DHMO). Both types are considered managed care, and each dental insurance plan has benefits and disadvantages.
Dentists participating in the PPO plans have negotiated their fees with the administering company, and provide their services under the plan, but this usually does not cover all fees. There are deductibles to consider and most of these types of dental insurance plan only pay a percentage of the charges, leaving the patient with a co-pay. There may also be a maximum amount they will pay annually.
If your employer is paying the monthly premiums for the dental insurance plan and the dentist you use is part of the PPO, this might be an attractive option.
A Dental Health Maintenance Organization is another dental insurance plan option, based on the model of medical HMOs. Here, too, the patient is enrolled in a program, and can visit any dentist in that program. However, dentists may end up having to provide services at 'below cost' rates, and not be able to spend as much time with each person as a PPO could offer. Working in an HMO setting, the dentist has many more people to see and is compelled to function in an environment where volume matters. Although a patient will be seen and treated, the relationship with the dentist is not developed due to lack of time. If you want to be seen by a dentist who takes time with his or her patients, this may not be your optimum dental insurance plan.
Non-Insurance Dental Plans
Usually called Discount Plans or Reduced-Fee-For-Service Plans, these non-insurance programs offer subscribers access to quality dental care at a discounted rate from participating dental providers. Having been around since the early 1990s, these dental benefits programs offer their members discounts on a variety of dental services, such as fillings, braces, exams and routine cleanings in exchange for a fee. Members typically receive a discount of 30%-35% off retail prices.
Unlike traditional indemnity-based dental insurance, discount dental plans have no annual limits, no health restrictions and no paperwork. In addition, consumers must pay either a monthly or yearly membership fee in exchange for the ability to get these discounts on dental services. Most of these plans provide a price list or fee schedule with the discounted dental fees and/or costs listed either on their web site or in membership materials to ensure consumers receive the savings they were promised.
For example, your typical discount plan would point you to a dentist who has agreed to participate in the plan that would only charge, say, $650 for a crown instead of the standard rate of $800 to $900.
Discount dental plans are designed for individuals, families and groups looking to save money on their dental care needs. Participating providers have agreed to accept a discounted fee from plan members as payment-in-full for services performed. Discount plans activate anywhere from the same day one enrolls to five business days later.
Be careful; if you do not have dental insurance coverage in addition to a discount dental plan, you can be left with a substantial liability for payment to providers. For example, a 25% discount applied to a $2000 dental bill would still leave a person with a $1500 liability. In addition, because payment due at the time of service (i.e. when your dental work is completed), be prepared to pay your dental bill in full before leaving the dental office.
Before Purchasing a Discount Dental Plan
Because studies done by the *NADP show that 68% of all buyers pay too much for their dental coverage, you should know the answers to these questions before purchasing any type of dental coverage, whether be a traditional indemnity based or a non-insurance discount plan.
- Ask for a list of participating providers in your area/zip code
- Contact each provider that you intend to visit to make sure they still participate in the plan
- Find out what the provider normally charges for the services you are interested in receiving.
- Make sure the provider offers the promised reduction in fees.and
Be aware that dental-discount plans are not regulated by state insurance departments. That doesn't mean these plans aren't legitimate, but you should take precautions when buying one. If you are not sure whether the product is insurance, you should ask whether a licensed insurance carrier is offering the product and verify this information with the insurance company. There is now a state licensed dental discount plan available in California and Arizona.
