Dental Plans 101: The Skinny on Getting Great Coverage for Your Entire Family

For some people, buying a dental plan is a no-brainer. But for most, the insurance just costs way too much money — even with subsidies. When you’re considering a plan, there are a few things to think about before you buy.

First, you’ll want to know what your planned premium will be, whether your plan is deductible, what your co-payment is, and what percentage of the treatment costs you’ll pay. This is sometimes referred to as “co-insurance.

The total cost of the insurance isn’t just the premium. It’s also the costs you bear when you factor in the deductible, co-payment, and the coinsurance amount.

Another thing to think about is how often you expect to go in for cleanings and other procedures. If you only go in once per year, it might be hard to justify the added expense of insurance premiums. If this is the case, then you might want to look up discount plans for times when you need special care, like a root canal, and then just pay for cleaning out of pocket.

But, if you use the dentist regularly, then you might want to pick up insurance.

Most people visit the dentist at least twice a year, with additional visits required if there’s a problem.

How Does It All Work?

Most people are confused by how a dental plan works. Unlike most forms of insurance, a dental plan is really a form of prepaid medical care. You pay a set premium, and then go in for services as needed. The dentist has already negotiated the rate with the insurance company, so you don’t have to worry about costs (not as much anyway). Your insurer bills the dentist, you pay any co-payments, and co-insurance, and your insurer pays the rest.

Many plans revolve around a special agreement between your employer, your insurer, and the you. However, you can also purchase an individual plan if you want something not tied to your employment. Best of all, you can pick up a policy through the Health Insurance marketplace.

While your dentist’s goal is to help you maintain good oral health, not all procedures are covered by your plan. If you want to avoid any nasty surprises, you should understand how much you’ll pay and what the plan covers, before you accept any services.

Find Out About Group Coverage

Most people with dental plans have benefits through their employer. Ask your employer if they offer a plan. If they do, you might want to pick up a subscription to it, because being a subscriber on an employer plan will often be cheaper than buying your own individual plan.

Insurance companies often give discounts or group rates to employers, which you cannot get as an individual.

The Affordable Care Act marketplace also functions similarly to a group plan, but the rates may not be as good simply because many employers pay some or all of the premium on group plans.

Other plans, like Children’s Health Insurance Program, TriCare, and Medicaid, are also options if you meet the criteria for these programs.

Individual Policies

When you don’t qualify for a group plan, and you’re not in the military or meet federal guidelines for Medicaid, then you may want to look at individual plans. Individual policies often have more limited benefits, but they are plans you can take with you, no matter what your employment situation is or where you work.

If you’re thinking of signing onto a plan “just in time,” because you need a procedure done, know that this practice is discouraged and you may not be able to enroll on time due to deadlines for enrollment.

While you cannot be turned down for pre-existing conditions anymore, you also cannot signup whenever you want. Many insurers enforce enrollment periods to try to manage the number of policyholders being added to policies

Check The List Of Network Dentists

To get the best rates on your dental plan, you need to use dentists inside of the preferred network. Indemnity insurance plans let you use the dentist of your choice, but these are rare. The most common type of plan is called a PPO, or preferred provider network. These networks are essentially insurance company negotiated groups where the dentists in the group have agreed to a discounted rate for services, which are backed up by insurance (the insurer agrees to pay the discounted rate on your behalf according to the terms of the insurance plan).

The second-most common pan is a health maintenance organization, or HMO. These are managed care plans that focus on prevention, and thus have much stricter rules about dentists you can use. Often, if you go outside of the network, you get little or no coverage for services.

Know What’s Covered

Read over your policy so you know what’s covered. Most plans are generous with coverages and procedures, but they don’t cover everything. So, to avoid getting “sticker shock” or a surprise bill for uncovered services, know what you can, and can’t, do at the dentist under your plan.

Cerys Morris is a dental hygienist by trade. She loves sharing her advice on oral health by posting on the internet. Look for her posts on a number of health and wellness blogs.

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April 28, 2016 Dental Plans 101: The Skinny on Getting Great Coverage for Your Entire Family