People need dental insurance – whether they are single or have a family. Otherwise they could face out-of-pocket fees for routine dental procedures. When they do sign up, they need to carefully look at all the options to make a correct choice.
The first question they may pose is why dental and health insurance are separate – especially since research has shown that oral health can have a direct correlation with one’s well-being. The prevailing logic is that insurance fields view dental work as being preventative – while health insurance covers more immediate procedures. There are plenty of dental emergencies and the work that is needed can leave a large bill, though.
It takes a bit of research to fully understand how dental insurance works.
The first order of business is choosing what type of insurance plan they want. There are several:
- HMO – The patient picks a dentist who is part of this insurer’s network. This could mean lengthy travel since not many dentists take these plans and the available ones may not be nearby. They often pay less for procedures to the dentists.
- PPO – Here, there are more options, since there is a larger pool of dentists. This means more convenience. The dentist gets a reduced cut for their services. There are more out-of-pocket costs, though.
- Indemnity – These were more popular before the introduction of HMO and PPO plans. Since indemnity plans are more expensive, their popularity has dwindled. Here, the dentist gets a normal fee and the patient pays a co-payment and deductibles.
- Discount Plans – This is a plan between the dentist and patient for reduced fees. No insurance companies are involved.
This part has similarities with traditional health insurance – one pays a monthly premium to stay enrolled. The amount of the premium ties into other things mentioned later on.
Like doctors, some plans and dentists require a co-payment before any work is done. Others may bill the insurance and then later send a statement to the patient.
Deductibles and Caps
Here’s where it gets a bit complicated. Patients have to pay a certain amount before the insurance kicks. For example, If there’s a $189 procedure and the deductible is $200, then the cost falls onto the patient. Anything higher and then the insurance begins paying a portion of it.
Also, there’s a limit to how much dental insurance will cover in a given year and that amount is capped off. Anything over that and the patient pays the cost. The higher the monthly premium, the larger the cap.
This is where medical and dental insurance really diverge. Dental insurance will pay for preventive care, like regular cleanings and then usually pay roughly 80% for basic procedures like fillings and then 50% for major work like bridges or dentures. Major work can easily cause one to hit their cap very quickly.
Another thing that people have to consider is that insurance companies also mandate waiting times for getting any major work done. Once enrolled, a patient may have to wait months or even a year before they can go for a procedure.
There is a way for patients to tilt the scales more in their favor – keeping a regular check-up schedule along with maintaining a good oral health routine at home. If they properly brush and floss twice a day, that can go a long way. The twice-yearly check-ups are for far more than just ensuring that they have a glistening smile – the dentist checks out the entire mouth and looks for subtle changes that might go otherwise unnoticed.
The above paragraph also explains the philosophy of these dental insurance companies – they want to pay as little as possible and these routine twice-yearly visits can do a lot to help keep people healthy. A healthy person is much less likely to need major work. This is the way that a for-profit industry thinks.
The staff at U.S. Dental Medical operate under the motto, “No Insurance, No Problem!” They do take a wide variety of insurances, including Medicaid… plus they offer 12-month financing options. Call them at 614-252-3181.