Dental Insurance is extremely helpful and can save you from many astonishing and unpredictable situations. The most crucial question is how to choose a dental insurance plan that will contain every important factor.

1. How to Choose Dental Insurance?

Nobody knows whenever a toothache might strike and then you need to go under dental care. If you’ve ever experienced a toothache then you must know what it is like to consult a dentist. People often wonder why it is necessary to take dental insurance.

It’s just a minor thing. Well, actually no, it’s not a minor thing. Risks are unpredictable and they can happen at any time and anywhere. Dental Insurance is the best way to face an unwanted and unexpected issue that might arise anytime.

Dental insurance is a must-take measure. It will also help you during your regular check-ups and can save you money. Choosing dental insurance requires numerous considerations. Given below is detailed information about dental insurance and the considerations you must take.

2. What is Dental Insurance?

There are many health insurances that people purchase to buy them security in an unexpected case. Dental Insurance is a type of health insurance. It can be said that it’s a subset of health insurance that is particularly about oral health and hygiene.

Dental insurance is specifically designed to pay a certain amount of treatment charges. In this, the insurance company pays a certain percentage of the total amount that is mentioned in the dental insurance plan.

Dental insurance plans are available for an individual, family, or a group of certain members. It is purchased by a subscriber will give him/her several specified benefits to maintain oral health.

3. Types of Dental Plans

As per the sources of the American Dental Association, eight main types of Dental Plans must be checked whenever you are taking dental insurance. Understanding each type carefully will help you find suitable dental insurance for yourself.

3.1. Preferred Provider Organizations (PPO)

A PPO is a general indemnity insurance plan that comprises a network of dentists. These dentists fall under a contract with the insurance company and are obliged to deliver specific services under an already set-up fee.

Also, they must follow the norms as per the insurance company. The contracted dentists demand the allowance fee that is mentioned in the contract by the company. Meanwhile, the non-contracted dentists can go for higher or lower fees according to themselves.

A PPO plan is enforced to help the patients to know a network of dentists. These dentists can only demand a certain range of fees according to the contract. It refers to the fact that you’ll need to spend the least from your pockets when getting treated with the in-network dentists.

However, you need to pay a designated amount, which is known as coinsurance. The remaining amount will be paid by the company.

3.2. Dental Health Maintenance Organizations (DHMO)

DHMO is also known as the Capitation Plan. Under this plan, the dentists who are contracted with the insurance company are already pre-paid. They are pre-paid with a specific amount every month for each patient that has been assigned to that dentist.

 Further, dentists are obliged to give certain predefined services that are mentioned in the contract. These services are given at no cost or reduced costs. However, the plan does not include any individual service provided by the dentist.

So, the company does not compensate or refund for the individual services. Also, if a patient is not taking the treatment from the designated dentist, then the company will pay no amount. The dentist must be the contracted dentist, who is mentioned in the plan to receive benefits.

3.3. Discount Plans / Referral Plans

Technically, the discount or referral plans are not insurance plans. In this type of plan, the company sells the plan, and contracts with many dentists. Here, the contracted dentists give discounts on their dental fees as per the norms in the plan.

Patients need to pay the all required costs for the treatment based on a certain discount. Initially, these plans were made to sell to individuals. But, it has been observed that employers were buying them more for the employees at their companies.

Discount plans have a lower premium cost than the Preferred Provider Organizations (PPO). Also, it allows a certain managed fee for the services provided in the treatment.  

3.4. Direct Reimbursement (DR)

It is a kind of plan that allows you to get a discount. This discount is based on the money you’ve spent instead of the treatment you’ve got. Further, it’s a type of self-funded plan that permits people to go to their desired dentist.

Here, a patient deposits the entire cost of treatment directly to the dentist. Then, the patient has to submit a valid receipt of the paid amount or the proof of treatment to the company. Further, the company will pay a certain percentage of the entire amount to the patient.

However, there are no claim forms for insurance in some plans. Also, no process needs to be done by the insurance company or the dental office.  

3.5. Indemnity Plans

Sometimes, the Indemnity plans are also known as the traditional insurance plans. Here, the company pays a certain percentage of the charges. These charges are the amount that has been paid for a treatment taken by a patient.

Usually, the indemnity plans permit the patients to select their own desired dentist. But, it could be combined with a PPO. Most of the indemnity plans have a supreme package for each procedure performed.

This package is known as UCR or Usual, Customary, and Reasonable fees. 

3.6. Point of Service Plans

Point-of-service commonly referred to as POS, is a kind of oral healthcare plan. It provides various benefits depending on the preference of the dentist a patient. This highly depends on whether a patient is getting treated by an in-network or out-of-network dentist.

These types of plans usually offer low-cost insurance. Also, it has a very limited set of healthcare providers as compared to other plans. Further, the benefits vary in the amount of compensation.

If a person approaches an in-network dentist, the reimbursement will be higher than approaching an out-network dentist.

3.7. Schedules or Table of Allowances Plans

This is a type of indemnity plan, in which the insurance company pays a previously fixed amount for each procedure. It doesn’t matter what are the actual charges for a procedure, you’ll be only compensated with a certain charge.

Here, the patient has to be responsible by himself for paying the actual charges. However, this plan can also be paired with PPO. It will limit the network of dentists with maximum allowance.  

3.8. Exclusive Provider Organizations (EPO)

An EPO is a type of insurance plan that limits the patient’s approach to a wide network of dentists. There are very limited contracted dentists. And if a subscriber wants to take the benefit of this insurance, then they must approach a contracted dentist.

It limits the choices of dentists along with maximum allowance costs.  

4. What Should A Dental Insurance Plan Cover?

Coverings will be different for each type of dental insurance plan. Given below are several regular coverings that a dental plan must include:

• Root Canal Treatment
• Tooth Fillings
• Tooth Extractions
• Oral check-ups
• X-Rays
• Dental injuries due to an accident
• Preventive Treatments

Many plans usually exclude the following terms:

• Teeth Implants
• Dentures
• Orthodontics
• Jaw Alignment
• Prosthesis

A subscriber must consider the coverings that might be essential for him/her in the future.

5. Considerations When Choosing a Dental Insurance Plan

When choosing a dental insurance plan, there are many factors that one should consider before finalizing the plan. A best plan is considered to be the one, which is within the subscriber’s budget and covers all the necessary factors.

Given below are the essential factors for a subscriber to consider:

5.1. Decode Your Needs

The first step to choosing dental insurance starts with your needs. A family has many members, even if it’s a nuclear family, there are always parents and kids. Necessities will be different depending on various cases.

For instance, it’s possible if a child has cavities and other dental problems. Sometimes, dental problems can also be genetic. If it is genetic, then it means one of the parents along with a child has dental problems.

So, in different cases, the scenario of needs will be different too. Whatever the case is, regular dental checkups are a must for everyone. However, a person with dental problems needs to have checkups regularly.

To find the best dental insurance plan, considering and decoding your needs is a crucial step. 

5.2. Understand Each Kind of Dental Plan Thoroughly

There are various dental insurance plans with their requirements and benefits. Each plan has a different cost, network of dentists, reimbursement amount, validity, and conditions. Understanding each plan thoroughly before buying insurance is necessary.

The best plan is the one that falls under your budget and has everything as per the subscriber’s necessities. A subscriber must know what’s best for his/her role. It includes deductibles, benefits, and out-of-pocket costs.

5.3. Check for the Plans Available in Your Locality

Everyone has access to a different type of plan that is mentioned above. The fact that it also depends on what’s available in your region. To find out about these factors, a subscriber should contact the insurance companies that are mostly used in your nearby region.

5.4. Determine What Your Plans Cover

After knowing each type of plan thoroughly and enquiring about what’s available in your locality, you need to consider the plans. Buying plans can be of two types, either the subscribers are purchasing it for themselves or the employer or company is offering you the dental insurance plan.

In both cases, you should know the details of each plan. It’s important to know what a plan is covering entirely. Also, consider whether it is beneficial for you or not. To analyze these facts, it’s better to consider all the pros and cons of the plans you are looking for.

Find out the annual maximum limit, if there is any. Further, consider the benefits when getting treated with in-network and out-network dentists.

5.5. Consider the Network Size

There is a different networking size of the contracted dentists for each dental plan. The network size can become a critical factor if there are few dentists in your local area. It’s crucial to know whether the dentist you are opting for is assigned to the insurance plan or not.

It will affect your treatment and regular check-up charges. It’s better to know beforehand that a patient will be responsible for paying the entire cost if he/she is looking for an out-of-network dentist. 

5.6. Appraise the Cost and Your Budget

Firstly, there will be a different quarter, half, and annual amount to pay for each insurance plan. Secondly, each dental plan will have a different cost for an out-of-network dentist. To deal with these types of issues, PPO is a well-considered plan.

It balances the network access and cost of care. A subscriber should calculate his/her income annually, and the dental insurance costs that he/she needs to pay in the future regularly. Make an estimated budget for everything and look through the previous dental plans to analyze costs.

Following are a few things that everyone must consider:

• Co-payments
• Annual Maximum Allowance
• Deductible (if applicable)
• Premiums of the plans (Monthly v/s Annual)

6. Why is Dental Insurance Necessary?

Dental hygiene and health are among the important factors that help maintain the entire fitness of the body. During the times of dental problems, a patient has to go through various regular check-ups and treatments.

Nobody knows how far the treatments will go. The more the procedures and treatments, the more will be the dental care costs that one needs to pay. Dental Insurance Plans help a subscriber in various aspects.

Given below are the different aspects that state why dental insurance is necessary:

• Maintaining oral health by getting regular check-ups at lower costs.
• The mind feels at ease because if anything happens accidentally, you don’t need to worry much about the treatment costs.
• The insurance company pays for the expensive dental care treatments or surgeries, which produces the bills of thousands of dollars.

7. Conclusion

Dental Insurance plans are necessary for everyone to have. These plans are designed for the comfort of subscribers and to manage their oral health without concern about the costs. Maintaining oral hygiene must be included in everyone’s routine.

The mouth is the home for one’s well-being. When the mouth stays healthy and clean, there will be fewer risks for your body. A certain amount will be paid by the insurance company for the dental treatments of a patient.

Although, there are many types of Dental Insurance, the three main types, include PPO, DHMO, and Indemnity Insurance. The companies distribute the procedures or treatments along with the services for a fixed cost in various types of insurance plans.

Last Updated on January 3, 2024 by Khushahal Malakar