By Chuck Smith-Dewey
You’re reclined in the dentist’s chair. The nitrous oxide is beginning to kick in and suddenly you are floating. Ahhhh. Modern dentistry can take a lot of pain out of a simple filling.
Unfortunately, it does little to dull the pain you’ll feel in your wallet when you climb out of the dentist’s chair.
The good news is that dental patients have two distinct options designed to help grind down the kind of bills that can really strike a nerve. They’re dental insurance and discount dental plans, and the main thing they have in common is that folks who have chosen either option tend to get more treatment and have fewer teeth extracted. (The top reason Americans don’t go to the dentist is that they don’t have dental coverage.)
Individual dental insurance is similar to individual health insurance in that plan buyers can choose from managed-care options – a dental health maintenance organization (DHMO) or dental preferred provider organization (DPPO) – or dental indemnity insurance, also known as traditional fee-for-service insurance. Each option has its strengths and drawbacks.
If given the three options, plan buyers generally make a choice based on such factors as access to particular providers, price of their premiums and deductibles, types of services covered and annual maximums paid.
With fee-for-service, you have much wider latitude on the amount of dental services you consume. Think of the managed care option like a personal trainer, who makes those decisions for you. They may save you from some unnecessary x-rays, but you may have longer waits between checkups or reduced access to other services.
Under the DHMO option, plan buyers typically can expect the lowest of the insurance plan premiums, no annual maximums paid by the carrier and usually no deductibles. The trade-off? The policyholder is restricted to dentists within a network.
DMHO policyholders can expect a schedule of co-payments for individual dental services or office visits, making it easy for policyholders to predict their out-of-pocket costs.
Under the DPPO option, premiums are higher and there is an annual maximum – between $500 and $1,000 – that the carrier will pay for services, but more of cost of dental may be covered. The policyholder is again incentivized to use a network of providers, but can pay more to go out of network.
DPPO policyholders can expect to see the amount paid by their carrier represented as a percentage of the procedure cost. Typical plans pay 100 percent ofo preventative services (routine exams and cleaning), about 80 percent of basic services (such as extractions, fillings and root canals), and 50 percent of major expenses (such as crowns, bridges, dentures and sometimes implants).
Those who choose dental indemnity insurance may doing so for the complete freedom of choice of providers, but that freedom comes at a cost. Indemnity insurance – or traditional fee-for-service insurance – has the highest premiums, an annual maximum payment from the carrier, and a small deductible.
What dental indemnity policyholders pay for procedures is stated in a percentage (just like DPPOs). Because there is no network, there is no established discount from providers.
If you’re thinking of enrolling in dental insurance because you know you’ll need expensive work soon, it’s likely already too late. Nearly all dental insurance plans have waiting periods for pre-existing conditions and – in any case – will not pay for teeth you are already missing before you enroll. (That’s a gap in both your mouth and your coverage.)
Dental discount plans are conspicuously different from dental insurance. In fact, the first thing buyers need to be aware of is that dental discount plans are not dental insurance. These plans are more like buying a club membership with specified discounts for each procedure you may need. You always pay the dentist when service is performed, but with your card, you receive a designated discount off the dentist’s rack rates, depending on the plan chosen and services rendered.
The plans aren’t insurance, but they do resemble dental insurance. One obvious similarity is that if you have a dental discount plan, you can only receive discounts from providers within a plan’s network – similar to the managed-care dental plans mentioned earlier.
And the plans do offer attractive features, which may explain why they are widely available for consumers. Among those pluses? In most case, the absence of many factors that make insurance unattractive: deductibles, coinsurance, waiting periods, annual maximums and insurance claim forms. (You simply pay and the dentist simply provides a discount at the time of the procedure.) The cost of a dental discount plan is also typically lower – and comparable to a dental HMO – and plan holders can usually see procedure costs and their discounts ahead of time.
One issue to research before purchasing one of these plans is whether the plan does have a waiting period. (You certainly don’t want to learn while sitting in the dentist’s chair that the root canal you need isn’t covered for another six months.) Also check for a pre-existing condition clause that may nix coverage of a dental problem.
Another issue to definitely consider with these plans is the type of coverage you need. A typical dental discount plan will provide better coverage of procedures performed by a general dentist than by a specialist.
One of the least expensive sources of dental insurance and discount plans is through a group – your employer or an association – so you may want to look there first. In a tight economy, employers are trimming benefits, and dental is often one of the first to go, so your employer may not sponsor coverage.
But remember: if your employer doesn’t provide dental coverage now, it doesn’t hurt to ask for it. More and more employers now consider dental coverage as essential for their employees.
Editor's Note: Opinions expressed on these pages are those of the individual author(s) and do not necessarily reflect the views of the management or ownership of healthinsurance.org.
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