Dental Insurance

Dental Insurance

A dental plan will help pay the high cost of dental procedures, but one must understand what is available and how each might be best for individual situations.  However, some coverage is better than none at all.

Dental insurance will usually cover a basic structure of Tier 1, 100 % for preventive care – exams, X-Rays and cleaning; Tier 2, 80% coverage for basic procedures such as fillings, full mouth x-rays and simple extractions; and Tier 3, 50% for major procedures such as root canals, crowns, bridges, implants and gum disease treatments.  Orthodontia and cosmetic dentistry, which are deemed not medically necessary treatments, are usually not covered at all. Dental insurance will usually have day one coverage for preventative insurance where there may be a six month wait for basic services and a minimum 12 month wait for major services. Covered expenses may have a deductible of $50 and a maximum benefit from $1,000 up to $5,000 per year, depending on the insurance company.

Types of Dental Plans

Preferred Provider Organization (PPO)

Dentists join the PPO network and negotiate their fees with insurers. Using an out-of-network dentist will cost more out of pocket.  PPO networks are usually larger than an HMO network, with more flexible choices of dentists, along with a higher cost.

Health Maintenance Organization (HMO)

An insured will pay a monthly fee or annual premium, but normally can only use the dental network in a smaller, given area of the country. These plans are the cheapest of the types, with dentists agreeing to charge lower fees than with other plans.

Indemnity Dental Plans

These are the most expensive, and are often called fee for service plans.  The insurance company caps the amount of money to be paid for various procedures as usual and customary amounts, based on what the American Dental Association recommends.  The dentist may charge more and the insured will pay the difference if the fees cannot be negotiated with the dentist.  They may have to pay the entire fee and then file a claim with the insurance company.

Group Dental

The employee enrolls in the group dental plan, typically after a waiting period set by the employer.  The employer may or may not pay any of the employee premiums, and it will be one of the three types of plans listed above.  Group dental is usually less expensive than an individual plan and has better benefits.

Email Tonia@dibcompanies.com for questions.

As always, take a good look at all four of these choices to see if the premiums fit the situation.  Check to see if the preferred dentist is in the network and will accept the plan being considered.  Know what the plan covers.  Does it cover emergency room visits, exams, fillings, teeth removal, root canals, gum cleaning, crowns, and implants, X – Rays?   Major procedures are usually not covered during the first year.  Having a personal fund such as a Health Savings Account (HSA) for any unexpected expense is a good recommendation as well.