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Dental Coverage Choices: What To Look For When Shopping Around

You hate going to the dentist, but you know you need to get those teeth cleaned. What about the costs? Most people don’t have a dental plan that covers it all. Here’s what they don’t know, that you should.

The Basics

Before you buy anything, you should know what you’re getting yourself into. Dental plans are not really insurance. They’re more like prepaid medical plans. That’s not bad, but it does help explain why many of them are unaffordable. If you want to know how these costs break down, go to: mydental.guardianlife.com/blog/.

With dental plans, and dental insurance, the premiums can be broken down into one of several types of plans. Some can be more expensive than others. If you’re one of the millions who doesn’t have coverage, then a policy for your teeth might be worth the expense. But, it all depends on whether you expect to need to use it or not.

Most insurers emphasize and really push for patients to get diagnostics done and preventative measures are emphasized over more extensive treatment options.

According to Evelyn Ireland, the executive director of the National Association of Dental Plans (NADP), it’s easier to prevent dental-related problems than to treat them after the fact.

The real benefit of being covered, however, is when you do need such treatments, like fillings and root canals, caps, crowns, and bridges, braces, and cosmetics, like veneers.

Most people who have insurance get something called “100-80-50” coverage. What this means is that the coverage pays 100% of routine costs associated with preventative medicine. But, they only pay 80% for things like fillings, and 50% for things like crowns, bridges, and other major procedures. The benefits really drop off a cliff once you get to serious dental care.

And, most coverage is offered through employer group plans, meaning that you have to get it from your employer if you want any coverage at all. Out of pocket coverage usually costs more, however. With average costs between $200 and $250 for premiums, most out of pocket costs for the same services would set you back about $370, according to the American Dental Association.

And, unlike old health insurance plans, dental plans don’t bar preexisting conditions.

Plans can generally be broken down into two different types of plans: HMO and PPO. Before you sign up, however, you should ask a few questions, like:

  • How much is the premium?
  • What is the deductible?
  • What’s covered, what’s excluded?
  • Are there discounts for paying annually or quarterly?
  • What happens if I go out of network?
  • What’s my coinsurance?
  • Are there any maximums or limits to coverage?

Dental Plans

An HMO plan is a “health maintenance organization.” These plans restrict coverage to dental professionals within a specified network. Travel outside of this network and you may get little or no coverage for services.

PPOs are more popular because they allow you to see a dentist outside of your preferred network. However, you’re typically charged a reduced rate if you stay in-network. Most dental plans are PPOs. And, seeing as they cost about the same, go with this option if you can.

A third option is called an indemnity plan. These plans allow you to see any dentist you want, and the insurer will pay for a percentage of the costs for service. It eliminates the need to stay in a network of providers. The benefit to this is obvious – you get coverage regardless of where you go. But, you will generally pay more under this plan. So, for example, a bridge that costs $1,000 under a PPO plan might cost $1,200 under an indemnity plan.

Terms You Need To Know

Deductibles – A deductible is an amount that you have to pay before an insurer will pay anything towards the cost of covered services.

Coinsurance – This is the amount you’ll pay after you meet your deductible. In many plans, the deductible may be $500 and the coinsurance will be 80%. This means you must pay $500 before the insurer pays anything. And, then, you must pay 20% of the final cost of the services, while the insurer pays for 80% of the services. You’re sharing the responsibility for the cost in these arrangements.

Maximum benefits – Under the affordable care act, there are no maximums for child care or pediatric dental plans. Under some adult plans, this will be a maximum amount that a plan will pay out during the year. So, for example, if your maximum coverage is $2,500, and your expenses are $4,000, you would be responsible for the remaining $1,500.

Pre-existing Coverages – Your dental plan might exclude some kinds of conditions, but it’s unlikely. Most plans will cover you regardless of previous dental problems. For example, you may have a missing tooth, or gum disease and you need treatment. You plan likely covers this amount. Most of them have to.

Alfie Bolton has worked as a dental assistant for several years. He enjoys the work, both technical and chatting with patients. He enjoys writing articles in his spare time, these mostly get published on health and lifestyle blogs.

1 Comment

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