Dental Insurance is generally thought of in two ways, as a dental plan and as dental insurance.
Dental Plan: These are the kinds of programs you have if your employer has a group health plan that includes dental. You elect to take the coverage, become a member of the plan and pay via payroll deductions. The plan usually covers a full or a portion of the costs of teeth cleanings, root canals, fillings, dental checkups and any injury that causes trauma to your teeth. The forms you complete are usually minimal.
If your employer does not offer a dental plan, you can lobby them to look into getting one.
Dental Insurance: Dental insurance is dental coverage sold to you by an insurance company. They idea behind it is for you to count on affordable dental costs while they make money like all insurance companies do—take in more premium than they pay out in losses.
There is more paperwork to complete with dental insurance. It could also be some time before you find out whether or not you will be reimbursed for the cost. You might need a medical exam to qualify and you will need to prove you have no preexisting conditions.
Neither plan will cover you if you decide to have cosmetic dentistry done like teeth whitening or porcelain veneers.
What Dental Insurance Covers
Dental insurance coverage varies widely from policy to policy and from company to company. In all of the policies, however, you will be paying for part of the coverage. You will want to factor in the premium costs which could be substantial.
Basic Dental Care: Most insurance companies will pay for dental care that is designed to prevent serious dental problems down the road. These include checkups and cleanings. Most dental plans and insurance pay for the majority or all of the costs of these procedures.
Minor Dental Work: Depending on your policy, you may be reimbursed for the next level of dental care. This includes filling, caps, root canals and non-cosmetic implants. However, the insurance company will definitely pay less on this type of dentistry.
Major Dental Work: Most dental insurance will cover a small portion of specialized procedures like dentures, surgery and orthodontia. Some companies put a cap on what they will pay or may not offer benefits for major dental work at all.
As suggested above, dental insurance will generally not pay for what are considered cosmetic dentistry procedures. These could include, teeth whitening, veneers or dental facelifts.
Why Get Dental Insurance
According to the American Dental Association, less than half of the people in the US have either dental insurance or a dental plan. People run the risk of having serious dental problems if they do not visit the dentist because of cost. However, costs will continue to rise for dental work and it may be difficult to afford it. This is why dental insurance may be necessary.
Four Types of Dental Insurance
Direct Reimbursement Plan: This is a self-funded plan where you pay the full amount and obtain a receipt your dental services. Show the receipt to your employer and you will be reimbursed for a portion of the service. For example, the first $100 of your dental services might be reimbursed at 100%, then 80% of the next $500, etc.
No premium is paid. You can select any dentist you like. The benefits are usually capped from $500 to $2000 annually.
Indemnity Plan: You select your own dentist. Then the insurance plan pays the dental office by service. You also pay a monthly premium.
In general, a dental insurance company pays between 50% to 80% of the dentists fees. You as the client pay the remaining 20% to 50%. There is usually a deductible. However, good plans will not apply that to preventive services like cleaning or yearly exams.
PPO (Preferred Provider Organizations): A PPO allows you to choose a dentist from a defined group of them. Dentists from this group charge less for the services. If you select from a dentist not in that group, the insurance will pay, just at a lower rate.
DHMO (Dentists Health Maintenance Organization): In an HMO, the patient must choose a dentist from the HMO network. In fact, the HMO will not pay for any dentist outside of the network.
In a DMHO, the dentists are paid via a set fee for each service. In the other plans, the dentists receive the full charge for the services they provide.