The rise of Dental Insurance
Health insurance is a common practice in current times and many have reaped benefits in emergencies and other health conditions. But, a relatively new kind of health insurance has emerged which has demanded attention due to massive appeal and specificity to problems that health insurance does not cover.
Although, it has been there since quite a while, it has become much more noticeable in the current decade. Dental insurance is rapidly spreading its roots in the U.S. It is often provided by the employers to their employees as an added bonus or perk.
Lets look at what exactly is Dental insurance and how it differs from a Dental Health Plan.
What is Dental Insurance?
Dental insurance involves a pre-determined coverage for fixed premium paid monthly to the dental insurance company. It covers cost for most procedures except prior conditions. The conditions are specific to each company and there might be quite a variation between different companies or different plans by the same companies.
Dental insurance is generally given out to employees by their employers but is very costly if taken out for an individual and most companies prefer not providing it to individuals. They are happy to accept families or groups though. The reason for the reluctance of insurance companies to provide true dental insurance to individuals is because of the predictable nature of dental requirements. The insurance company would probably run in to losses if they provided complete cover for individuals.
As Dental insurance involves paying a fixed premium, it is considered as a true type of dental insurance.
What is a Dental Health Plan?
Dental Plan is a type of dental coverage that involves discounted rates for most procedures when you visit specific dentists that are taking part in that program. Now putting that in simple words, it simply means that the insurance company is willing to pay part of your expenditure on dental health. There is usually a cap placed on the maximum amount that the company is willing to pay per year and is generally around $1000-$1500.
What are the types of Dental Plans?
Broadly categorizing the dental plans, there are of two types:
Open Panels and Closed Panels
1.Open Panels: These do not have specific dentists in their network. They do not recommend or give preference to treatment from particular dentists. You can get yourself treated by the dentist of your choice and the insurance company will pay for the part of the treatment as according to the rates in the dental plan. Note that some treatments might be covered completely where as no coverage will be provided for treatments like teeth whitening. It is hence essential to look for a dental plan specific to your needs.
2. Closed Panels: These recommend you to a group of dentists that are affiliated with the insurance company. These are of two types.
2.1 Exclusive Provider Organization (EPO): They will only provide coverage if you get treated from the dentists in their network. If you seek dental care from a dentist out of their network, be informed that they will not cover any costs. There might be exceptions such as emergencies and while you are traveling.
2.2 Preferred Provider Organization (EPO): These are quite popular in current times. They have a group of dentists affiliated to the insurance company and will cover your incurred costs by a specified percentage. When you get treatment from a dentist outside their network, you still get the coverage but at a lower percentage.
How Dental Plans reimburse?
Dental plans reimbursement is specific to different kinds of procedure. Some procedures might be covered completely (you pay nothing!) and some procedures might not be covered at all which means you have to bear the entire cost.
The Dental Plans generally reimburse like the following
Class I : The procedures that fall in the category are covered completely and you have to pay nothing. Basic diagnostic and preventative Dental care procedures such as cleanings and X-rays tend to fall in this category.
Coverage: 100%
Class II: Common treatments such as RCTs, Extractions and Tooth fillings tend to be covered by this procedure
Coverage: 70-80%
Class III: This includes treatments such as Crowns, dental bridges and dentures
Coverage: 40-50%
Class IV: These are not covered at all by the insurance company and you need to incur the costs completely. Cosmetic procedures such as dental veneers, lumineers, tooth whitening fall in this category. Although, the insurance company might not tell you all what they don’t cover, you should make it a point to read the fine print and ask them directly.
Note: The above figures are based on speculation and are stated as an example. Different companies have different coverage plans and hence coverage may fluctuate accordingly.
Choosing a Dental Health Plan
There are plenty of things to consider when choosing a dental health plan and mainly depends on your requirements. It is essential that you get the right which is suited for your needs else you might be wasting a lot of money on a plan that you don’t need.
First ask yourself the reason for getting a dental plan. Is it a specific procedure you want to undergo? A specific problem? Or for basic dental care.
If you are getting a dental health plan for basic requirements such as cleanings, you should not waste your money on an expensive dental plan. You could choose cheaper alternatives which cover basic dental care completely.
If you have a specific condition that you want to get treated, it might be worthwhile to note that most companies do not cover pre-existing conditions. Other conditions such as not covering anything up to a year might also be present.
Some Tips for choosing a Dental Health Plan
- Determine your needs and choose a plan accordingly
- Don’t go for dental plans if you want to get cosmetic procedures done. They are almost never covered.
- Read the fine print and ask the company questions on specific procedures.
- Ask around, getting feedback from existing customers is the best way.
- Ask your dentist, although he might be biased if he is associated to a particular Insurance company.
- Get dental insurance quotes from different companies and compare them before making a decision.
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