How do I select the best dental insurance plan?
Medicine and dentistry have been considered totally different practices. Perhaps that is why dental insurance is separate from health insurance, even though many illnesses start with our mouths.
About two thirds of the residents of the United States visited a dentist during the last year. Because one-third do not, nearly a million ER visits each year are because of preventab;edental problems.
Take for example the story of a 12-year-old Maryland boy who died – from a toothache. In 2007, Deamonte Driver came home with a headache. He became sicker and was eventually taken to Children’s Hospital in Washington, D.C. Over the course of several weeks, he went through emergency surgery, a series of seizures, and physical therapy. Just as he began to show signs of recovery, he died during the night. What happened? The bacteria from his infected tooth had invaded his brain.
Only Your Hairdresser Knew
This division between dentistry and the rest of medicine dates back to the dental profession’s early days, when it was actually a part of hairdressing. Until the beginning of the 19th century, your barber would be the one responsible for trimming your whiskers and for pulling teeth that ache and lancing abscesses. In fact, in earlier centuries, people would see barbers for the process of bloodletting, which was thought to be preventive medicine at the time. The barber would advertise these services with the red-and-white striped pole outside his shop. Not only that, if you had a flesh wound, your barber could serve as a surgeon, after all he was the one in the neighborhood skilled in the use of sharp knives.
A Good (Young) Dentist is Hard to Find
In fact, currently, there are 4,000 areas in the United States that have a dentist shortage. In some parts of the country, between a quarter and a third of the population still lacks access to dental care entirely. In states with fewer residents like Vermont, Maine, and Wyoming, for the dentists that are practicing, nearly half of them are near retirement age.
The Beginnings of Dental Insurance
Dentistry took a back seat in the medical profession until Congress developed public health insurance programs in the 1960s. During the creation of Medicaid in 1965, the dental market wasn’t very vibrant. Therefore, policymakers just didn’t value dental care as highly as other forms of necessary medical care. In fact, in 1960, only 2.3 percent of Americans had some kind of dental insurance.
How Does Dental Insurance Work?
Despite the fact that most dental procedures are not covered by medical insurance, dental insurance works much the same way that your medical insurance works. You pay a specified monthly premium for coverage. Your coverage could include regular checkups, cleanings, x-rays, and other services.
Is All Dental Insurance the Same?
No. Plans vary widely in coverage, deductibles, and cost. There will also be variances in annual amount of coverage allowed, waiting periods, choice of dentist, and details such as amount of paperwork you must fill out.
What Kinds of Dental Insurance Plans Can I Get?
Generally speaking, there are two kinds of dental insurance plans, indemnity plans or managed care plans. The differences are the result of three factors:
- Choice of dental providers
- Out-of-pocket costs
- How bills are paid
Let’s take a further look at the differences.
For the most part, indemnity plans offer you a wider selection of dentists. The downside is that you may need to pay for these services upfront, submit a bill to your indemnity plan, and then wait for reimbursement from your insurance company. Additionally, your reimbursement may or may not cover all of your out-of-pocket costs, since indemnity plans usually have standard rates that they pay for dental procedures.
Managed Care Plans
With a managed care plan, you will typically choose a dentist from their provider network. If your dentist participates in the network, he or she will agree to perform services for you at pre-negotiated rates. The two big benefits with a managed care plan are that you usually have lower out-of-pocket costs and no paperwork hassles – your dentist will submit the claim to the dental insurance company for you.
What is a Dental PPO?
PPO stands for either Preferred Provider Organization or Participating Provider Organization. These plans are a kind of managed care dental insurance plan and are perhaps the most common of the managed care plans.
Here is how they work: Most Dental PPO plans will require you to pay an annual deductible. Just like with other managed care plans, with a Dental PPO plan you will usually obtain care through your network of dental providers. These dentists and other dental professionals agree to serve the plan’s members at reduced rates. Then you and your dental insurance company will split the bill. For instance, your dental insurance company may pay 80% of the reduced rate, while you would be responsible for the remaining 20%.
I Like My Dentist, Yet She is Not a Member of the Network. What Can I Do?
If you belong to a Dental PPO plan, you may use a dentist outside of your dental PPO plan network. But here is the catch: you will usually need to pay the full bill upfront and only be willing to accept as reimbursement the amount that an in-network dentist would have accepted as payment in full.
Okay, So Which Dental Insurance Plan is Best for Me?
Plans vary by your premium, how much you’ll need to pay each month for your coverage. Plans also vary by how much you’ll have to pay when you get dental services. Some plans will require that you pay a co-payment in the dental office for those services. Others will require you to meet a certain annual deductible before the dental insurance company kicks in with their payment. Other plans may only allow you a maximum of a certain amount of dollars to spend on dental services each year. Further, some plans may require a waiting period before you can get certain dental procedures. An additional consideration: does the plan include the dentist that you and your family like?
As you can see, many considerations go into purchasing a dental insurance policy, those decisions are based on your personal preferences.
Choosing is as easy as One – two – three. One – decide what you want in a plan. Two Assemble your options. Three – Set your priorities.
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Enhanced Insurance is not written by attorneys. If you’re looking for legal advice, you need to contact a lawyer. Further, insurance practices and forms change constantly and are varied from state to state. For definitive answers in your area, contact a local agent.
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