How To Select Dental Insurance?

Dental insurance plans work like any other medical health insurance.  Most health plans or insurance policies are essential and specific services that are covered under specific plans based on an individual’s requirements.  These can vary based on an individual’s health.  Plans may offer additional benefits such as vision and dental coverage.

What does dental insurance offer you?

Through dental insurance, you can avail routine check-ups, emergency medical assistance that also includes dental accidents covered under the policy. You can claim the amount covered under insurance after you make the payment for the treatment. 

Dental policies may have set annual premiums or limits. These depend on the coverage of the plan. Most policies have an age range starting from around 18 years (although some providers offer insurance to children from the age of 6).

Nevertheless, finding the best dental insurance plan is not as easy as visiting the dentist.

Several health factors and your dental care needs determine the cost of treatment. The type of coverage provided to you can depend on several factors including — who is covered, how many people are covered (individual or family), what are the treatments included, and so on. Another critical factor is the area or the region where insurance is provided. The cost of insurance varies according to the city and the network of dentists available in that region.

According to the American Dental Association, one-third of Americans don’t go to see a dentist due to its high-cost factor. However, this need not be the case. Dental care is easily affordable provided one chooses the right service provider in addition to the insurance plan that is uniquely suited to his or her needs. For instance, in the state of California, several dental insurance service providers offer unique insurance packages for both individuals and households.

You can get dental insurance coverage in two ways:

  1. As part of a health plan: Many health plans cover or include some form of dental treatment.  When purchasing dental insurance, you should compare and review the entire plan and pay attention to the overall dental coverage. If the plan includes dental coverage, then it follows that the premium covers both general health problems and specific dental issues.
  2. As a stand-alone dental plan: Stand-alone plans are those where you choose a separate or singular dental plan and pay an additional premium for that plan separately. 

What happens if you don't have dental insurance?

Many folks at the age of 50s and 60s today do not have dental insurance.  As you get older, the teeth become vulnerable to fracture, and there has been evidence of a higher risk of decay.  Also, old fillings can weaken the teeth.  Moreover, as we know, Medicare does not cover most dental care like fillings, cleaning, dentures, and other dental services. Problems can build up as one gets older and you may need dental emergency treatment that would cost a considerable sum of money. People who maintain excellent dental care at home can develop severe gum diseases because of plaque and accumulation of tartar causing gingivitis. Minor cavities can turn to major cavities if not treated and eventually a root canal or extraction would cost you a huge sum of money.  Also, there are clear links between gum disease and heart disease, diabetes and respiratory diseases.  Oral cancer, including cancer of the tongue, gums could be identified in the regular dental care visits, and proper treatment would keep you healthier. Early detection and on time treatment would have not only saved money but also give you comfort and stress-free treatment if invested in a good dental insurance plan.  As the saying goes “ Preventive care can be expensive, but it comes at a far lesser price than treatment after something goes wrong.

Dental insurance comes in many types:

1. Dental Health Maintenance Organization (DHMO or HMO)

The health maintenance organization (HMO) or the dental health maintenance organization (DHMO) as it is now known, are usually used by corporates or businesses to protect their employees. In some cases, this can also be used by family members and on an individual level.  Under HMO dental insurance plans an individual must select a dentist from a pre-approved list.  Insurance companies have direct contracts with a network of dentists, who offer special dental services to insured members usually at pre-determined rates.  Moreover, HMOs are typically cheaper and are a feasible option due to their low cost, when compared to PPO dental insurance plans.

2. Dental Preferred Provider Organization (DPPO or PPO’s)

By far the most popular dental insurance plan, Preferred Provider Organization (PPO) plans offer better services with flexible time-periods. However, they require higher premium payments due to their promise of providing better dental care. Additionally, patients have the freedom to choose their dentists outside the ‘preferred’ registered network.

3. Dental Indemnity Insurance Plan

Dental indemnity insurance plans require patients or insured members to pay dentists directly for any dental service rendered. In this case, patients have the freedom to choose a dentist, change their dentist, or walk in without a referral.  Although the premiums are usually costlier than HMO and PPOs, indemnity plans are typically preferable for groups. 

4. Direct Reimbursement (DR)

Here the benefits are based on money spent on treatment then the type treatment. DR is a self-funded plan where you can choose your dentist and pay the dentist directly. Sometimes, there is a dental office where you make payments and then submit a paid receipt as proof of treatment received.

5. An Alternative to Dental Insurance – Dental Savings Plans

Dental savings plans sometimes known as dental discount plan provide members with discounts on most dental services.  Members who choose savings plans pay low annual memberships. The amount of savings depend on the treatment required and the location (especially in the USA) as prices vary by location. Individuals or families that do not receive any dental insurance from their employers turn to dental savings plans. More often than not, businesses today are switching over to dental savings plans as an affordable and yet easy way to provide their employees with dental benefits. The reason for this is that businesses can avoid unnecessary paperwork, save time, and manage their organizations effectively. 

When choosing dental insurance, there are essential points to consider:

Choosing the right dental insurance can be a real drag. One has to battle and figure out the best between the deductibles, co-pays, and premiums. Sometimes it gets complicated and confusing. Nevertheless,  you've to reach a point in your life where you've no choice than to figure out what is best for you.  Most health insurances cover dental problems, but you must also check the relevant deductibles.  In most cases, dental insurance policies have limited coverage; Crowns, root canals and gum-disease treatments have high costs and are not covered by your general health plan. 

To avoid getting caught with unexpected expenses, here are some critical steps you can take when you choose a plan:   

Decide what coverage will suit your needs

In dental insurance, the big catch is “deductible” What is a deductible?  In dental insurance, a deductible is an agreed amount you must pay yourself before your dental insurance comes to play or kicks in.  This assured amount is paid upfront to the dentist before your coverage starts to pay you anything.  Some plans won’t have a deductible.  It depends on your health conditions, treatment hours and how good or bad is your dental condition.

Choose between DHMO and PPO

Dental Health Maintenance Organisation (DHMO) focuses on low-cost dental treatments like cleaning and x-ray. In Preferred Provider Organisation (PPO) you will pay a little more but gives you the freedom to choose.  If there is a large number of dentists registered than PPO is a better choice.

Look out for yearly caps while you pick a dental plan

Check how much the insurance company will cover for a single year.  Higher premiums will offer more caps, but caps don’t usually cover dental maintenance work. Therefore, it is vital to pick a plan that has the coverage you need.

Group coverage offers more

Group coverage is provided by employers who extend insurance as benefits to their employees. It usually includes Medicaid, Family Health Insurance Program, to name a few.  These plans are generally cheap when compared to buying individual insurance.   It is useful to see the details of an employer-sponsored policy beforehand, and then decide if that is worth the money in your situation.

Individual policies should be carefully studied

Individual policies are more expensive than employer-sponsored group policies.  It is also good to compare and get quotes and policy details from company websites and get an opinion from insurance agents.  Orthodontics and cosmetic dentistry are usually not covered.

You should study the list of dentists in the network

Some policies or plans such as indemnity insurance allow one to choose the dentist of their choice. PPO and HMO plan force you to choose the dentist in their networks. Moreover, the area might influence the cost of treatment as well.

Know what the policy covers

Carefully examine and review the policies and coverage. Take a look at the procedures in the initial years.  Does the dental policy or plan you are purchasing cover gum cleaning, denture repairs, restorations of oral surgery and root canals? Are Orthodontics and cosmetic dentistry included?

Selecting the right insurance companies

Most difficult and tricky.  You tend to pick the lowest premiums for the best coverage.  You must note that services can vary from company to company and the region as well.  Online reviews and customer rating might help to narrow down the choices.

Does dental insurance cover dental implants?

Most dental insurance companies do not cover tooth implants or dental implants because the majority of the dental insurance companies consider tooth implants as cosmetic procedures. The best option here would be using medical insurance, but you will have to pitch in some out-of-pocket expenses. Usually, medical insurance considers dental implants essential because any treatment of jaw is deemed to be necessary for eating and speaking.

Finding the right dental plan can be uphill and overwhelming.  It would be best if you took the advice and recommendations of a reliable dentist. You should check what is covered under the plan and pay attention to claims, coverage limitations, and reimbursements. Check for hidden exclusions and exceptions.

The digital world has made it easier for you to check your plans online and compare. Look at your current plan and see if you can get an alternative that covers your dental needs.  Carefully examine and review the policies and coverage. Take a look at the procedures in the initial years. Watch out for the plan and check if it covers gum cleaning, denture repairs, restorations of oral surgery and root canals are covered or not.  Orthodontics and cosmetic dentistry included or not included in the plan. 

At Implants Pro Center™, San Francisco, we accept all major dental and medical PPO insurances, thereby reducing your worry about the cost of dental implant treatment or any oral surgeries. We also have a tremendously experienced and caring staff who will provide life-long care, maintenance, and support. Implants Pro Center™, San Francisco, is also equipped with all the modern technologies like CT-Scan, Intravenous Sedation, Platelet Rich Fibrin, etc. in order to provide nothing less than the best of services. You will be completely at ease for any of your procedure. Feel free to get in touch with us to schedule your free consultation.

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