Dental insurance is an insurance cover to help offset the costs associated with dental care. Dental treatments costs have skyrocketed and they can range from bare minimum like 100$ for regular dental hygiene visits to $50,000 or more for dental implants or cosmetic dentistry. Additionally, when compared with medical insurance coverage, dental insurance plans are quite different.
Types of Dental Insurance Plans
A lot of dental insurance plans are available for individuals in the U.S. and most of them are primarily designed to offset the costs associated with necessary dental care. Dental insurance plans have annual limitations on the number of dental visits, radiographs (X-rays) and treatments that are covered as well as there are other services may be excluded. Some plans do not provide coverage for pre-existing conditions only or necessary treatments, while some dental insurance plans reimburse patients only when the least expensive treatment alternative is selected;
FSA or Flexible spending Account options are available through your employer for dental or medical needs. Check with your employer to see if a flexible spending account is an option for you.
Following types of dental insurance plans are available :
- Preferred Provider Organization (PPO): PPO dental plans are limited to a group of dentists who are available to provide dental care at a reduced cost.
- Dental Care Service Plan: Dental care service plans use a group of dentists who form a non-profit organization to provide dental services at set fees.
- Direct Reimbursement Plan: Direct reimbursement dental plans allow employers to directly reimburse employees for dental services they receive.
- Capitation Plan: Capitation dental plans designate specific dentists for intervals of treatment. These dentists have a contract indicating that they will be paid a fee regardless of whether dental treatment was required.
- Indemnity Plan: An indemnity dental insurance plan allows you to select your own dentist. These plans are considered fee-for-service and come with limitations and co-payment options. This means that you pay a flat fee for the dental visit, but you have an annual limit on coverage for dental spending and specific coverage limits may apply to individual dental procedures.
- Self-Insurance Plan: Self-insurance dental plans may be similar in nature to indemnity plans, but you might not be able to select your own dentist.
- Closed Panel Plan: Closed panel dental plans limit you to using a specific group of facilities and the number of dentists available to you.
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Dental Insurance Coverage :
If you have dental insurance plan, it is very important to familiarize yourself with your plan to be aware for what you’re covered and how. For example, if you require a dental filling and would prefer a composite material, evaluate the benefits allocated in your plan for composite fillings. Many insurance companies will only reimburse composite filling costs at a rate equal to that of an amalgam filling. You would be required to pay the remaining balance as an out-of-pocket expense.
Typically dental insurance coverage does not include cosmetic dental implants. It is important to ask the dentist’s finance manager about dental treatment costs prior to agreeing to and receiving treatment. Dental finance managers can call your insurance provider to pre-determine the out-of-pocket costs associated with your planned procedure. Based on that he would be able to let you know how much would be covered and how much you’ll have to pay from your side. Dental insurance plans differ in the level of reimbursement offered for certain procedures and in annual dental spending caps. Some plans limit the waiting period before certain dental treatments are rendered. Additionally, plans typically have exclusions, meaning that costs for certain dental procedures will not be reimbursed.
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