Going to the dentist can be a pain. No one likes to have metal utensils shoved in their mouth when their eyes only have a few choices to gaze at: a bright overhead light shining in their mouth, the dull white ceiling, or making awkward eye contact with the dentist that is shoving the utensils in their mouth. After all is done you get to walk out of there with a sore mouth from the aggressive flossing, some numbness from that Novocain used to fill a cavity, but a healthy smile and a clean set of teeth. Let’s just hope you have good dental insurance.
Going to the dentist may not be all that fun, there is no getting around that, but it is just as important as your routine doctor visits.About 36 percent of Americans avoid going to the dentist because of the costs. With the right insurance, you no longer have to worry. Dental insurance is a type of health insurance that pays for a portion of the costs associated with any type of dental care. Like health insurance, dental insurance is offered in various types including individual, family, or group insurance plans. There are three primary forms of coverage including Indemnity, which allows you to see any dentist you want as long as they accept dental insurance; Preferred Provide Network Dental Plans; and Dental Health Managed Organizations, which you are assigned to an in-network dentist and/or in-network dental office and use the dental benefits offered within that network. A more in-depth break down of these options is listed below.
Indemnity Dental Insurance Plan: This plan is helpful when you have a dentist that you are loyal to but he or she does not participate in a dental network. Generally the insurance company pays the dentist a percentage of your services according to the policy you purchased. With this plan you will want to review the co-payment requirements and the stated deductible, annual limitations, graduates scales based on the type of procedure and the length of time you have owned the policy prior to starting your dental work.
Dental Health Managed Organization: What happens when a dentist signs a contract with a dental insurance company is that the provider agrees to accept an insurance fee schedule and give their customers a reduced cost for services as long as they are an in-network provider. With this plan there is often no waiting period, no annual maximum benefit limitations, and most major dental work is covered as soon as the policy is in place. This plan is sometimes purchased to help clear the high cost of dental procedures including things from fillings, crowns, implant of dentures and other procedures.
Participating Provider Network: Depending on the plan, a Participating Provider Network works similar to the dental health management dental insurance plan while using an In-Network Facility. The difference is that it will allow you to use an out-of-network or non-participating provider. Any difference in fees will become the financial responsibility of the policyholder unless otherwise specified on the dental policy itself. Some dental insurance plans may have an annual maximum limit, which means that once the limit is reached an additional treatments to follow will need to be paid for directly out of pocket.
What exactly does dental insurance cover?
There are several ways in which dental insurance can be provided as listed above, but what does a dental insurance plan actually cover? For the sake of giving an example we will use a basic employer dental plan used in the example by About.com’s article on dental insurance coverage. The dental plan in this example provides the following features:
- A maximum benefit of $1,000 to $1,350 per year.
- Diagnostic and preventative care is paid in full by the insurance plan.
- Periodical maintenance and cleanings are paid up to 80 percent.
- Repair of dentures is covered for up to 80 percent of the costs.
- Basic restorative fillings are covered up to 50 percent of the cost.
- Oral Surgery or teeth pulling are covered for up to 50 percent of the costs.
- Root Canals are covered for up to 50 percent of the costs.
After the policy has been in place for a year, the plan may also pay up to half of the costs for treatment for chronic gum disease, crowns, dentures and temporomandibular joint dysfunction (the ball and socket joint that connects the lower jaw to the bone on each side of the head).
Delta Dental breaks dental insurance down a little bit more generically to understand plans basics. The dental plans basics include:
- Insurance companies are going to offer a variety of benefit plans with different features. Just like the bells and whistles of a car insurance policy, there are basic insurance options, to more in-depth coverage options that will cost more.
- Your dentist may not participate in the network that your dental coverage is a part of. If they do then they will submit your claim, if not you may be responsible for paying the dentist and submitting your claim to your insurance carrier on your own or with the help of a local independent dental insurance agent.
- If you have benefits from more than one group dental plan, the amounts paid by the combined plans cannot exceed 100 percent of your medical expenses.
- Dental benefits are calculated within a benefit period, which typically is one year, but not always a calendar year.
Much like most insurance polices, dental insurance does have its maximums. Most dental plans will have an annual dollar maximum, like the $1,350 limit in the About.com example policy. This maximum dollar amount will pay toward the cost of dental care within a specific benefit period. Any care that is needed that exceeds this limitation will be the policy’s responsibility to pay for.
A dental policy will also have a posted deductible that works much like a claim you would make to a car insurance agent after an accident. When you get into a car accident that causes $2,000 worth of damage to your vehicle, but you have a $1,000 deductible on your auto insurance policy you are left to pay that amount before you are able to receive money from the insurance company. The same is true for dental insurance. During a benefit period, you will have to cover the portion of your dental bill before your benefit plan will contribute to the cost of your treatment. Dental deductibles can vary from policy to policy. Some plan will apply the deductive to a diagnostic or preventative treatment and others will not. Be sure to ask your local independent dental insurance agent about your specific policy.
Many insurance plans have a coinsurance provision, which means that the benefit plan pays a predetermined percentage of the cost of your treatment (like the About.com employer plan used previously in this article). You are responsible for paying the balance: this is called the coinsurance, and is part of your out of pocket costs. It is paid even after a deductible is reached.
In terms of the reimbursement levels of a dental insurance policy there are three basic classes. Each class provides a specific type of treatment and typically covers those treatments at a certain percentage. Each class also specifies limitations and exclusions. Reimbursement levels vary from plan to plan. Delta Dental gives a good overview of these three classes:
- Class I procedures are diagnostic and preventive and typically are covered at the highest percentage (for example 80 percent to 100 percent of the plan’s maximum plan allowance). This is to give patients a financial incentive to seek early or preventive care, because such care can prevent more extensive dental disease or even dental disease itself.
- Class II includes basic procedures — such as fillings, extractions and periodontal treatment — that are sometimes reimbursed at a slightly lower percentage (for example, 70 percent to 100 percent).
- Class III is for major services and is usually reimbursed at a lower percentage (for example, 50 percent). Class III may have a waiting period before services are covered.
When you are in need of some major dental treatment, it may be smart to ask your doctor to complete and submit a request for a cost estimate, sometimes referred to as a pre-treatment estimate. This will give you a chance to figure out what procedures are covered, the amount the benefit plan will pay toward the treatment and the amount left for you to pay on your own.
What does dental insurance cost and is it worth it?
Bank Rate’s Is dental insurance worth the cost? article states that dental insurance premiums can be more expensive than simply paying out of pocket for routine checkups and cleanings. This may be true, but just like with any insurance policy, it is meant to lower your risk of having to pay high prices in the instances where you need far more than just a basic dental cleaning.
Most people do not need dental coverage to cover the cost of a routine checkup, but when it comes bigger procedures like fillings, root canals, crowns or other oral surgery, that is when you are likely going to want a dental insurance policy in place.
As of 2010, six out of 10 Americans had dental benefits according to the National Association of Dental Plans Most people have coverage provided through their employee and group policies. The cost for a employer offered dental insurance policy costs a person between $234 and $432 per person. The average cost for an individual dental insurance policy is $360 a year.
A typical dental year for a patient includes two dental checkups and maybe an x-ray to see how those wisdom teeth or doing. Paying out of pocket for these basic procedures will total nearly $400 (2011).
This puts the cost of a dental insurance policy into perspective a little bit. If you are going to pay nearly $400 for dental care anyway, you may as well get a dental insurance plan to cover those appointments as well as protect you against any other major procedures you may need.
Dental insurance is meant to give you the piece of mind that comes with knowing you are covered in the case of a surprise need for a root canal or some other costly dental procedure. It is not meant to solely help you pay for the basic trips to the dentist that you will need to make. It is far better to protect yourself from those hefty dental bills before they happen.
Getting yourself to schedule a dentist appointment is like pulling teeth, both literally and figuratively. No one likes to sit in that chair while your dentist tries to have a conversation with you while your mouth is wide open, being in no position to speak. It is rough, but going to the dentist is one of those things that need to happen. It is better to go with the piece of mind that comes with a health insurance policy than to go without one.
To learn more about dental insurance policies it is helpful to contact your local independent health insurance agent. The agent will be able to sit down with you to compare a employee offered policy to an individual policy and will be able to answer any of your questions.
Other Enhanced Insurance articles related to Miscellaneous Health Insurance:
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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- DiGiacomo, Robert. “Is Dental Insurance worth the Cost?” Is Dental Insurance Worth The Cost? N.p., n.d. Web. 10 Oct. 2013. <http://www.bankrate.com/finance/insurance/dental-insurance-1.aspx>.
- Bihari, Michael. “Dental Insurance: Beyond Medical Coverage.” About.com Health Insurance. N.p., n.d. Web. 10 Oct. 2013. <http://healthinsurance.about.com/od/dentalvision/a/dental_insurance.htm>.
- “Individuals, Families & Enrollees.” Understanding Dental Coverage. N.p., n.d. Web. 10 Oct. 2013. <http://www.deltadentalins.com/individuals/guidance/understanding-coverage.html>.