What You Need to Know When Choosing Dental Insurance
There are many facts to consider when trying to choose a cheap or affordable dental insurance plan. The task can often be daunting trying to find dental insurance for yourself or your family, as some employers do not offer dental insurance to their employees, leaving it entirely up to you.
Having dental insurance that is not only affordable, but also covers a broad range of common dental treatments, can be an effective way to offset mounting dental costs which often deters people from going to the dentist.
In/Out of Network Providers-
When choosing affordable dental insurance, it’s important to understand what is covered and what is not covered and at what percentages, and how it might relate to your personal dental needs. Some insurance plans only pay for Preventive care (routine cleanings, doctor’s exam, fluoride, sealants, and some dental x-rays). Other dental insurance plans pay for Preventive, Basic Restorative (fillings, root canals and simple extractions); and Major (crowns, bridges, dentures, partials, surgical extractions, dental implants, orthodontics). Some dental insurance companies only pay for Preventive and Basic, with no coverage for Major dental treatment.
UCR (Usual Customary and Reasonable)
Understanding what is meant by “Usual, Customary and Reasonable” is a topic many people find confusing. What does “Usual, Customary and Reasonable” mean? This means that the insurance company has a pre-set price that they will allow for every dental treatment procedure covered on the plan. It has nothing to do with the fees the doctor charges for any given procedure, but only what the insurance company chooses to cover. For example: Let’s say that your dentist charges $85.00 for a dental cleaning, but your insurance company will only allow $65.00 for dental cleanings because that is the UCR fee that they have set.
If your insurance plan requires you to see an In-Network dental provider, you should not be charged the difference of $20.00, because the dentist has contracted with the insurance company to write off the difference. If your insurance plan allows you to see the dentist of your choice, or an Out-of-Network provider, you will likely be charged the difference between the two fees, meaning you will receive a bill for the $20.00. You simply must decide how much of a price tag, if any, you will place on quality dental care vs. cheap or Affordable Dental Care.
Annual Maximums and Waiting Periods-
The annual maximum is the amount of money the dental insurance company will pay within one full year, renewing automatically as the anniversary date approaches. Some dental insurance companies have a pre-set maximum of $1,000 while another insurance company may have a pre-set maximum of $1,500.
A waiting period is the period of time an insurance company requires you to wait before having certain procedures such as crowns, dentures, partials, etc. Let’s say that your dentist tells you that you need a crown but your insurance policy has a 12-month waiting period for any Major work, your insurance company will not pay for the crown until the 12-month waiting period expires.
Questions to consider when choosing dental insurance:
1. Will I be able to choose my own dentist? This is an important question to ask since some insurance plans restrict your choices to those currently contracted with the insurance company, often referred to as an In-Network Dentist. If you choose an insurance plan that requires you to stay In-Network, ask for a list of participating dentists in your area so you can decide if they have a dentist you would consider seeing.
If you already have a dentist you wish to continue seeing, ask what dental insurance plans he/she participates in as a contracted provider, otherwise you will need to choose dental insurance that allows you to see an Out-of-Network Dentist.
2. What will or will not be covered? It is important to not only determine what dental procedures will or will not be covered, but also by how much. Some insurance companies cover Preventive dental care at 100% UCR (see UCR above), while still others cover the same procedures at lesser percentage amounts. Basic Restorative is often covered at 80% UCR minus any annual deductible, but this is also variable. Major dental coverage is typically covered at 50% UCR, but some insurance plans cover it at a higher percentage rate.
3. What will my out-of-pocket premiums be? Dental insurance premiums sponsored by an employer are usually the best deal, with personal out-of-pocket expense being much less than if a family pays for dental treatment without any dental insurance. If shopping for dental insurance independently, it’s important to consider the quality of dental care you wish vs. rushing to the cheapest or most affordable insurance.
Dentalplans.com - Choose from over 100,000 participating dentists!
How To Find A Trustworthy Dentist
This is a very informative article. Good job explaining insurance terms that everyone needs to know.
Thank you Helene, I appreciate the kind words and inclusion of this post in your blog carnival.