DENTAL INSURANCE
What is Dental Insurance?
Dental insurance is designed to pay a portion of the costs associated with dental care. Generally dental offices have a fee schedule, or a list of prices for the dental services or procedures they offer.
Types of Dental Plans
Preferred Provider Organization (PPO)
A PPO is a dental plan that uses a network of dentists who have agreed to provide dental services for set fees. The number of dental services covered depends on the plan. If you have a PPO plan and see a dentist out of the network, you will most likely have more out of pocket expenses.
Dental Health Maintenance Organization (DHMO)
A DHMO is like an HMO. Network dentists are paid a set fee every month to provide covered dental services to you whether you see the dentist or not. Some of the covered services have no cost to you, while other services require a co-payment on your part.
What Does (And Doesn't) A Dental Plan Cover?
Even for covered services, most dental plans share the costs of treatment with you. If you have an individual plan, the terms will be spelled out in a contract.
Although you may be tempted to make dental care decisions based on what your plan will pay, the least expensive option is not always the healthiest option. Before committing to a plan, make sure you understand how you and your plan share costs.
Deductibles
A deductible is the amount you’ll have to pay for treatment before your plan coverage starts to pay. Most plans don’t require a deductible for preventive and diagnostic services.
Co-Insurance
In most cases, you will be expected to pay a percentage of the dentist’s charges or allowed benefit amount. This is called coinsurance. For example, your plan may pay 80 percent and you pay the remaining 20 percent owed to your dentist.
Annual Maximums
This is the maximum amount a plan will pay during the plan year. You pay anything over that dollar amount. For example, if your annual maximum is $1,500 and your dental expenses top $3,500, you are responsible for that additional amount. If the annual maximum of your plan is too low to meet your specific needs, you may want to ask the plan how you can get a higher annual maximum
Pre-existing Conditions
Your dental plan may not cover conditions you had before enrolling even through you may still need treatment. You are responsible for paying these costs. For example, benefits may not be paid for replacing a tooth that was missing before the effective date of coverage.
This information is obtained from the American Dental Association.
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