Dental Insurance

What type of dental insurance is right for you?

Your dental health is an important part of your overall physical health. A dental problem can be painful and debilitating. Not going to the dentist for regular, preventative care, greatly increases the chances that you will need more invasive, painful, and costly care later.

Dental insurance is separate from medical insurance; you need to purchase a separate policy. Dental insurance plans are varied, but are far less complex than medical insurance plans.

Understand What your Policy Includes and Excludes

Dental insurance reduces your exposure to very high out-of-pocket expenses. Like any insurance policy, you pay a premium in order to protect yourself from events that you hope will never happen. Because most dental insurance includes coverage for check-ups and X-rays that you will regularly need, you should get some use out of your dental insurance even if you do not need additional procedures.

Dental insurance covers a limited number of visits to your dentist. For instance, teeth cleaning and X-rays are covered, but most plans cover only two cleaning appointments a year and one set of X-rays a year. Some types of dental treatment are excluded from most dental plans, such as cosmetic care. Other types of care, such as orthodontic or periodontal care may be excluded or limited, depending on the policy you purchase.

There are a variety of dental insurance plans. You want to choose the one that best fits your family’s needs. Some employers offer subsidized dental care. If your employer does, you should look at the choices available through your employer as your first option.

If an insurance company offers different levels of dental insurance, the more you pay in premiums, the more coverage you get. A higher premium will buy you a plan you with fewer limitations on the types of procedures covered, greater dollar coverage for the procedures covered, and it may have smaller co-payments.

Types of Dental Insurance

Different types of dental insurance plans include.

1. Indemnity Plans - You get to choose your dentist with an indemnity insurance plan. You pay your dentist on a fee-for-services basis. Your insurance company pays a certain portion of the dental care and the remaining portion is your personal responsibility. How much the insurance company agrees to pay for any procedure or what procedures they cover vary from plan to plan. With most indemnity plans, some specific procedures are limited and others are excluded. There is also a maximum annual dollar amount limit to your coverage.
2. Dental Preferred Provider Organization (DPPO) - A DPPO is a network of dentists that agree to accept payment for your dental care according to the fee structure determined by the insurance plan provider. Your costs are usually lower in a DPPO than in an indemnity plan. The dentist is charging less, but increases his or her number of patients by being a member of the network.
3. Dental Health Maintenance Organization (DHMO) - In a DHMO, you select a primary care dentist. Your dentist receives a monthly fee whether or not you see him or her. You may pay a co-payment for your visits or your standard preventative care may not require any co-payment, depending on the rules of your plan. If you need coverage that your primary dentist does not offer, your dentist will refer you to a specialist. The specialist does not necessarily accept your DHMO coverage. It is prudent for you to speak to any potential primary care dentist and see what kind of specialist referral network he or she has and whether or not the specialists accept the DHMO coverage. Your DHMO will publish a list of benefits that describe included and excluded procedures as well as the amount of the co-payment you will be required to pay. DHMOs have a limited number of member dentists. Check your options for dentists in your area, before selecting a DHMO.

To avoid costly surprises, work in concert with your dentist’s billing specialist. Different insurance plans offer different levels of coverage. Have your dentist’s billing specialist check with your insurance provider to determine the level of coverage, before you receive your dental care. This way, you will know your share of the costs.