Dental insurance

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Dental insurance is insurance designed to pay the costs associated with dental care. Dental insurance pays a portion of the bills from dentists, hospitals, and other providers of dental services. By doing so, dental insurance protects people from financial hardship caused by unexpected dental expenses.

The American Dental Association states that more than half of the population in the United States are not covered by any dental insurance plan. Those who do have dental coverage often get it through their employer as part of their health insurance plan. Depending upon the type of medical coverage you have, it may be a good idea to have a compatible program to eliminate any gaps or overlap within the two plans. That may save money while allowing you to take advantage of receiving necessary preventive care.

A conventional dental insurance plan may not necessarily be the most cost effective type of coverage. Discounted dental insurance has become quite popular, and there are plenty of companies competing for your business. Compare features of both categories to decide the best choice of dental insurance plan for your situation.

Not all dentists are pleased about participating in a dental insurance plan. It means more work for them (and especially more paperwork), and less pay. It's also important to have adequate coverage for your situation, so you can access the features you need and aren't paying for something you won't use. Also, insurance plans have restrictions, such as pre-existing conditions and annual maximum payments.

1 Types of Dental insurance
2 Dental Insurance vs. Dental Plans
3 dental insurance in us

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Types of Dental insurance

The most common types of dental insurance plans are either Preferred Provider Organization (PPO) or Dental Health Maintenance Organization (DHMO). Both types are considered managed care, and each dental insurance plan has benefits and disadvantages.

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Dental Discount

This type of dental plan is not insurance. The managing organizations have negotiated with local dental offices to establish a set price for a particular dental procedure and offer deep discounts (some up to 70%) off the regular ADA pricing code. This plan has several advantages over traditional dental insurance plans, namely, there are no exclusions for pre-existing conditions. This allows a patient to receive immediate coverage for work without meeting any waiting period requirements.

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Dental HMOs

These insurance plans, also known as "capitation plans," operate like their medical HMO cousins. This type of dental plan provides a comprehensive dental care to enrolled patients through designated provider office (dentist). A Dental Health Maintenance Organization (DHMO) is a common example of a capitation plan. The emergency dentist is paid on a per capita (per person) basis rather than for actual treatment provided. Participating dentists receive a fixes monthly fee based on the number of patients assigned to the office. In addition to premiums, client co-payments may be required for each visit.

A Dental Health Maintenance Organization is another dental insurance plan option, based on the model of medical HMOs. Here, too, the patient is enrolled in a program, and can visit any dentist in that program. However, dentists may end up having to provide services at 'below cost' rates, and not be able to spend as much time with each person as a PPO could offer. Working in an HMO setting, the dentist has many more people to see and is compelled to function in an environment where volume matters. Although a patient will be seen and treated, the relationship with the dentist isn't developed due to lack of time. If you want to be seen by a dentist who takes time with his or her patients, this may not be your optimum dental insurance plan.

Some typical features of these plans:

Monthly premiums (some require you to prepay a year's worth)
Co-payments for office visits
Free preventive or routine care
You must select from an approved network of dentists
May have an initial enrollment fee
Annual dollar cap
Your average monthly cost: $5 to $15
Companies selling these plans are regulated by state insurance departments.

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Dental PPO

Another true insurance plan, a Preferred provider organizations ( PPO) falls somewhere between an indemnity plan and a dental HMO. This plan allows a particular group of patients to receive dental care from a defined panel of dentists. The participating dentist agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser. If the patient chooses to see a dentist who is not designated as a "preferred provider," that patient may be required to pay a greater share of the fee-for-service. A group of dentists agrees to provide services at a deeply discounted rate, giving you substantial savings as long as you stay in their network. Unlike the more restrictive DHMO, though, you can go out of network and still receive some benefits.

Dentists participating in the PPO plans have negotiated their fees with the administering company, and provide their services under the plan, but this usually doesn't cover all fees. There are deductibles to consider and most of these types of dental insurance plan only pay a percentage of the charges, leaving the patient with a co-pay. There may also be a maximum amount they will pay annually.

If your employer is paying the monthly premiums for the dental insurance plan and the dentist you use is part of the PPO, this might be an attractive option. However, if you are responsible for payment, this might be more expensive and certainly less flexible than a discounted dental insurance plan.

Some typical features of these plans:

Monthly premiums
Annual dollar cap
You must stay within the approved network of dentists or pay higher deductibles and co-payments
Your average monthly cost: $20-25
Companies selling these plans are regulated by state insurance departments.

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Dental Insurance vs. Dental Plans

Traditional dental insurance, once the only dental benefit option available, features many drawbacks including costly deductibles, tedious claim forms, long waiting periods and other limitations. On the other hand, discount dental plans are affordable, easy-to-use and free of these hassles.

Some of the characteristics of Dental Insurance include:

Limitations, deductibles and annual maximums
Waiting periods for major dental procedures
Tedious and time-consuming written claims process
Limitations/exclusions on pre-existing conditions
Certain dental specialties, such as cosmetic dentistry, are rarely covered
Consumers pay expensive monthly premiums for defined coverage
Typically inaccessible to individuals and families unless provided by their employer

Some of the characteristics of Discount Dental Plans include:

No annual limits, members enjoy discounts on most dental services all year long
Most plans activate within 1 - 3 business days
No tiresome paperwork hassles, plan membership card is presented for discounts on most dental services
No health restrictions
Select plans include discounts on dental specialties, including cosmetic dentistry and orthodontics
Consumers pay affordable membership fees for access to a network of providers offering discounts on most dental procedures
Available directly to individuals, families, businesses and groups

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