After the bustle of Labor Day deals and sales comes the time to consider your options for health insurance and dental insurance for 2015 as well as to make sure that any medical or dental benefits for 2014 do not remain unused. While River Dentistry accepts most PPO dental plans, we want to help you make dental insurance choices that are right for you and your family. Of course, we will always perform complimentary dental benefits verification on your behalf and work with any dental insurer to make sure that you get the most out of your dental benefits.
What is Dental Insurance?
Dental insurance works in much the same way that health insurance works. For a specific monthly premium, you can be entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and other services promoting general dental health. Some plans will provide wider coverage than others. Some will require higher co-pay when services are rendered. Some plans may also provide coverage for oral surgery, dental implants, or orthodontia. So, making the right choice of your dental insurance provider is not always easy.
What Dental Insurance Plans Are Out There?
Like medical insurance plans, dental insurance plans are usually categorized as either indemnity or managed-care plans (dental HMO and dental PPO). The major differences are in choice of dental care providers, out-of-pocket costs, and how dentist bills are paid.
Typically, indemnity plans offer a broader selection of dental care providers than PPO or HMO plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill, which means that you have to pay up front and then get reimbursed by insurance company.
Dental PPO and HMO plans typically rely on dental provider networks. Dentists participating in networks agree to perform services for patients at pre-negotiated rates and usually will submit claims to the dental insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed-care dental plan.
What Are Dental HMO Plans?
HMO dental insurance plans typically require that members obtain services only from a select group of dental providers in order to be covered. The easiest way to find the dentist for the plan is to go to the provider’s website. Dental HMO plans usually offer smaller monthly premiums, but they also allow you less freedom to choose your own dentist or treatments you want to have done. Many dentists do not work with HMOs, because of the restrictive fee schedules and procedure allowances, so make sure that your favorite dentist does accept the plan you are about to choose on your own or that is offered by your employer.
What are Dental PPO Plans?
Dental PPO plans are perhaps the most common type of managed care dental insurance plans. Most dental PPO plans require you to pay a monthly fee and a deductible. With a Dental PPO plan the patient typically obtains care through a network of dentists and dental providers who sign up to serve the PPO plan’s members at reduced rates. When you use a network provider, you will typically pay a percentage (e.g. 20%) of the reduced rate as your deductible, and the insurance company will pay the rest (e.g. 80%). As a dental PPO member, you can sometimes use a dentist outside of the dental PPO plan network, but you will typically only get reimbursed the amount that a network dentist would have charged. The rest of the total charges will be the patient’s responsibility and the dentist will not be obligated to follow your plan’s fee schedule, so the bill you may end up paying can be more or less than what you have paid when visiting an in-network dental office.
What are Dental Discount Cards?
The dental discount cards are not a form of or replacement for dental insurance, but if you do not have or cannot purchase dental insurance, they may provide you with discounts for dental services when you visit a participating dentist. The key difference with insurance is that like any cash patient you must pay the dental office directly at the time dental services are rendered. The discount cards do not pay any money to the provider. You will pay a monthly membership fee to the discount program in exchange for discounted rates at participating dental providers. Frankly, by the end of the day, you may be better off just scouring Groupon, Amazon, and dentist websites for dental deals and specials, unless of course you have a true dental emergency.
What Is the Best Dental Insurance for Me?
While here is no one “best” dental insurance plan, some plans may work better for you and your family than others. Plans differ primarily in how much you’ll have to pay monthly for your coverage and how much you’ll have to pay at the dental office when dental services are rendered. Some dental plans may require that you pay a certain co-payment for services. Some plans will require you to meet a specific deductible before the dental insurance company starts paying. Some dental plans may limit coverage to a specific maximum per year (e.g., $2000).
When choosing a dental insurance, here are a few questions to ask:
- How much will it cost me on a monthly basis?
- Will I be required to meet a deductible before the dental insurance company pays?
- Once the deductible is met, how much will the dental insurance provider pay for my services and what will be my co-pay or deductible?
- What dentists participate in the plan’s network? Are these dentists that my family and I would like to see? Is my current dentist in the network for the dental plan I may purchase?
- If I used a dentist outside the plan’s network, how much will I have to pay?
- Are there waiting periods for certain procedures?
And then of course also the difficult choice between different provides: is Delta Dental insurance, MetLife Dental insurance, or Aetna Dental insurance the best choice for you and your family? Stay tuned for our posts as over the next month we will be reviewing all major dental insurance providers to help you make the right decision for yourself and your family. Like/share this page and follow us on Google+, Facebook, and Twitter not to miss our dental insurance reviews. Share with everyone you know. Friends do not let friends to pick a wrong dental insurance!
