Dental Insurance

Introduction

To carry insurance or not to carry insurance? This is the question that almost all of have had to ask ourselves at one point or another. Paying monthly premiums for services that we may or may not need is certainly a consideration worth much deliberating. Some find that it is more expensive to have insurance than it would be to pay for all medical and dental expenses out of pocket. Whatever your situation, be sure that you deliberate carefully and evaluate all of the benefits and disadvantages to having dental insurance.

Why choose to have dental insurance?

Some of us were born with better teeth than others. You may be the kind of person who sees the dentist twice a year and cannot remember the last time that you had to have even a filling. On the other hand, there are those who frequent their dentist’s office and have had so much work done on their teeth that they cannot remember which teeth they were born with and which ones were provided by the dentist. Regardless of which type of dental patient you are, there are benefits to having dental insurance.

Dental work can quickly and easily become very expensive. Even a routine cleaning, when paid for out of pocket, can cost close to $100 depending on the fees of the dentist that you choose to visit. Not to mention the thousands and thousands of dollars worth of dental work that you could find yourself responsible for if something unexpected were to occur. If you have the opportunity to get dental insurance (whether through your employer or with an individual dental policy) changes are that you will be better off if you elect to pay for a policy. It is relatively standard practice for insurance companies to completely cover the costs of preventative care (routine cleanings and check-ups). So even if you hardly visit the dentist at all, there are benefits that you can receive. As with any insurance policy, you are also purchasing peace of mind. You never know when you might be in an accident and need dental work done or you may be surprised when you need even common dental work that you did not plan for.

So while paying upwards of $300 a year for some routine dental visits may sound like a manageable fee for some, consider the possibility of paying $25,000 or more for restorative dental work and re-consider whether or not you may be better off carrying dental insurance.

Employer provided dental benefits

According to the National Association of Dental Plans(NADP), “about 96 percent of dental benefits are currently provided through the workplace or other group coverage, such as AARP.” If you are in a position where you can take advantage of employer provided dental benefits there are few that would argue that taking an alternative approach to obtaining dental insurance is preferable. There are two main reasons why employer provided dental benefits are best. The first reason why is because the employer will pay a portion of the monthly premium and the second reason is that participating dentists under that employer provided plan are monitored more closely to ensure that they are providing quality care.

Insurance premiums are typically a monthly set amount that the individual with the policy is required to pay in order to have the insurance coverage. There are typically a variety of policies to choose from and naturally the policies that are perceived as better will require a higher monthly premium. When an employer offers dental benefits, they are offered several different plans by the insurance company. Because obtaining the business of thousands of employees is something that the insurance company wants, they will offer their best policies at lower rates, counting on the fact that the volume of customers will more than make up for the discount. The employer is happy with these discounts because they need only pay a portion of those premiums while the employee pays the other portion. The result is that the employee with the policy not only gets a portion of their premium paid by the employer but they also get a better policy for their money.

Those who receive their dental benefits under the umbrella of their employer’s policy are required to choose from a list of participating dentists in order to obtain the full benefit of their policy and not be charged more for seeing an out of network dental provider. These dentists agree to offer discounted benefits to those on the plan. This discount can be as much as thirty-five percent. The dentists benefit from the increased business of being a “preferred provider” and therefore do not mind having to provide a slight discount in exchange for a great deal more business. Dentists are also monitored to ensure that all patients are receiving quality care.

Dental insurance for orthodontia work

The cosmetic costs associated with dental work may or may not be included in your dental insurance policy, so it is important to keep these costs in mind as you shop around for a policy. Many people are surprised to find out that their individual plan or employer provided insurance plans do not cover the cost of braces. Before you start taking your children or yourself to see an orthodontist, carefully review your plan benefits. You may want to consider a supplemental plan or changing plans and shopping for a new dental insurance that will cover the cost of braces.

What is a full coverage dental plan?

In summary, a full coverage dental plan includes all normal dental procedures. Normal dental procedures typically include two routine cleanings a year and apportion of other more substantial procedures such as fillings, root canals, and even extractions.

When you purchase full coverage for your dental needs, you choose an insurance company if you are looking for an individual plan or you elect to go with the insurance company that you employer has entered into a benefits arrangement with. You and the company enter into an agreement about what specifically your insurance policy will entail. You will need to pay the premium, usually on a monthly basis or other incremental amount if it is taken directly from your paycheck, in order to keep the policy. You will receive an explanation of benefits which tell you what is and is not covered. A "full coverage" plan does not mean that every dental service is completely covered nor does it mean that all services are covered exactly the same. Claims are sent to the insurance company, and you pay a portion of the claim as a co-pay or deductible.

Dental fees for those with dental insurance

Even for those with dental insurance the fees that you may be required to pay on some procedures can be significant. This is why it is always a good idea to speak with the dentist’s finance manager about dental treatment costs prior to receiving treatment. This individual can contact your insurance company and help you to determine how much you will be personally responsible for. Some dental insurance plans will have a waiting period before certain dental treatments are rendered. Additionally, plans typically have what they call “exclusions.” This means that costs for certain dental procedures will not be reimbursed. Based on this information, you may want to postpone a procedure or work out a payment plan in advance to ensure that there are no unexpected financial burdens.

What are Usual, Customary, and Reasonable (UCR) fees?

As you look at your dental bills and notice fees that you are responsible for after the insurance company has paid their part it is helpful to know that the most common term used to identify the fee for dental treatment is called Usual, Customary, and Reasonable (UCR). UCR fees are determined by insurance providers based on the typical costs associated with various dental procedures. The UCR cost is there to protect the insurance company from being responsible for paying an extraordinary amount for a typical procedure. The insurance company is willing to pay only certain amounts for certain services partly to discourage policy holders from seeking out lavish or experimental procedures that can be very costly.

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Dental financing and other options for those who do not have dental insurance

Of course not everyone can afford the dental insurance premiums that they need and not everyone is accepted into an individual dental insurance plan. Fortunately, not having insurance does not always have to mean that you cannot receive some help in paying for necessary dental procedures. Numerous independent finance plans and reputable finance companies offer a wealth of options to meet the budget and credit limit requirements for most insured and uninsured dental service applicants. There are treatment plans that your dentist’s office may offer in order to help you to pay your bill in a way that does not put too much financial strain on your family. Monthly payments, low interest rates and other special programs for low-income and uninsured individuals are frequently available to ensure that all those who are in need of dental work are able to receive treatment.