Dental Insurance Programs: What to Consider When Choosing One

VWB Blog 2 years ago 20

According to the National Association of Dental Plans (NADP), 80% of people in the US have dental benefits, which is an increase compared to just 66% in 2016. This is good news because it shows more people nowadays are concerned about their dental health.

Of the people with dental benefits, most are provided by their employers. According to the NADP however, the increase in dental insurance enrollments can be attributed to the expansion of state-regulated Medicaid services, although for children only. Unfortunately, the federally regulated Medicare doesn’t cover dental care.

As a patient, it’s important that you know this information about dental insurance programs, so you can plan out proper care for your dental health. Most dental procedures are costly. Having an insurance plan can save you money, and you have a better chance of getting the dental care you need.

Here are some information and tips that can help you better understand dental insurance programs, what options you have, and what to consider when choosing one.

Dental Insurance Plan Models

According to the American Student Dental Association (ASDA), dental insurance plan models are either government or commercial-based. Government models include Medicaid, Children’s Health Insurance Program (CHIP), and Tricare.

Medicaid and CHIP are further divided into two models: fee-for-service and managed care. These models are available for children until they’re 20-years-old. For adults, the coverage varies per state. On the other hand, Tricare is for the U.S. military and their families.

Commercial models are either discount dental plans, dental indemnity insurance, dental health maintenance organization (DHMO) insurance, or dental preferred provider organization (DPPO) insurance.

Discount dental plans aren’t an insurance program. They are simply plans. They are an agreement between patients and dentists, who agree to give discounts for their services.

Dental indemnity insurance is traditional insurance with no provider networks. This makes dental indemnity insurance more expensive than DPPO and DHMO.

On the contrary, DHMO insurance uses a network of providers and allows patients to choose a primary provider. They encourage patients to stay in the network, so patients can get their plans’ full benefits. This type of insurance is sometimes called a capitated payment model because payment for dentists
depend on the number of patients on a network.

The most popular insurance model is the DPPO. Just like with DHMO, this insurance has a network of providers, and patients get to choose from one of them. DPPOs provide more cover for patients within in-network preventative care. Restorative work, however, has co-payments.

Considerations When Choosing a Dental Insurance Plan and Provider

It’s easy if your employer offers you dental coverage. It could be more costly if you get your own dental insurance. If you do choose to get your own insurance, your dentist could recommend the best based on your dental health needs and history. You’ll still get the chance to compare plans and choose the right one. Here’s what you have to find out while you’re searching.

Of course, your first agenda is to know the costs. What is the annual total cost? Does this include deductibles, co-pays, and premiums? Does it have a limit on out-of-pocket expenses? What is the annual maximum?

Then, you have to know what’s included in the coverage. Does it include emergency, preventive, and diagnostic services? If emergency services are included, can you still get it even if emergency care is required somewhere else or when you’re not at home to receive it? What routine treatment and major dental care procedures are covered? Does it cover for braces or extraction of wisdom teeth? Will there be limitations to a provider’s care if you have a pre-existing medical condition?

You should also find out if your dentist or dental care specialist you need is in a provider network. Can you see your dentist as needed? Should you schedule an appointment first? Can you even choose your own dentist? Who controls the procedures that you should get: the dental plan, you, or your dentist?

It’s best to ask your insurance provider any question you may have about your insurance. Your dentist can only give you basic information. Dentists, anyway, can’t predict the level of coverage you’ll need for particular procedures. Remember that each plan varies in coverage.

Consider Your Needs

For most people, having a dental insurance plan means they have good coverage for basic dental health needs such as dental X-rays, cleanings, and checkups. Children, however, will need more coverage for restorative procedures and overall dental health.  Consider this when choosing insurance for you and your kids.

Meta title: Guide to Choosing the Right Dental Insurance Plan
meta desc: People often pass up the chance to read the fine print in their dental insurance plans. They learn too late when some benefits they needed weren’t included. Learn how to choose the right dental insurance plan, so you have the dental benefits that you need.

Written By