What is Dental Insurance?
Dental insurance pays a portion of costs associated with preventive, minor, and some major dental care.
When you should consider Dental Insurance?
Dental plans include coverage for preventive care like routine exams, cleanings, and X-rays. Some plans require a copay for preventive services while others cover those services 100% with no copay. It depends on the plan you choose, but preventive services are usually covered. Many dental plans also include coverage for basic services like fillings and extractions, and major services like root canals, crowns and more.
You pay a monthly amount—this is your premium.
You pay for a certain amount out-of-pocket for services covered by your plan before your insurance starts paying—this is your deductible.
After you meet your deductible, you are responsible for a percentage of covered expenses—this is your coinsurance. Most dental plans feature either a 20% or 30% coinsurance.
Under some dental plans, you might pay a fixed cost for certain services, like X-rays—this is called a copay.
Types of Dental Insurance
There are two major types of Dental insurance—HMO and PPO Plans.
Dental HMO insurance plans, also known as dental health maintenance organizations or DHMOs, are usually much cheaper than PPO dental insurance plans and dental indemnity insurance plans. HMO dental insurance plans have networks of dentists under contract with the dental insurance company that offer dental services to insured members at pre-determined rates. HMO dental insurance plans are usually used by businesses to insure their employees, but can be used by individuals and families as well. Individuals who do not receive dental insurance through their employers often turn to HMO dental insurance plans as an option.
One of the main advantages of HMO dental insurance plans is that they usually have lower premiums than the other dental insurance options. Regrettably, HMO dental insurance plans have been known to impose strict restrictions on insured members. For example, the dental HMO will not provide a reimbursement if the insured sees a dentist that is not in their network. People insured with HMO dental insurance plans must select a primary dentist from a pre-approved list. All referrals to dental specialists must be provided by the primary dentist. One of the key differences between dental HMO insurance and dental PPO insurance is that DPPOs usually allow dentists to spend more time with insured patients. Dentists in dental HMO insurance plans are expected to see a certain number of patients, so some dentists have been known to rush through dental appointments. Additionally, participants in HMO dental insurance plans often complain about tiresome referral and claims procedures. Despite some of the restrictions and limitations associated with this type of dental insurance, HMO dental insurance plans are a feasible option for many people due to their low cost in relation to other dental insurance plans.
Dental PPO insurance plans, also known as dental preferred provider organizations or DPPOs, are a popular dental insurance option due to their flexibility in allowing insured members to choose dentists and dental specialists. Typically, PPO dental insurance plans are said to offer better service and have less limitations than HMO dental insurance plans, but the premiums are usually more costly. Businesses often use PPO dental insurance plans to provide their employees with a valuable dental benefit. PPO dental insurance plans are used by individuals and families as well.
Dental preferred provider organizations are managed care organizations with a network of dentists under contract with a dental insurance carrier. This network of dentists provides dental PPO insurance plan members with special rates on dental care. The rates are usually lower if the insured member selects a primary dentist and/or dental specialists from the dental PPO network, but the insured individual still has the freedom to choose a dental care provider outside of the established network.
Despite this flexibility, PPO dental insurance plans have some limitations as well. In addition to the higher premiums usually associated with dental PPOs in relation to other dental insurance plans, they also have tedious claim forms to fill out and insured members usually have to wait to receive reimbursements. Participants insured with a dental PPO insurance plan are responsible for paying their deductible before receiving any reimbursement. In addition, since most dental PPO insurance plans only cover a portion on the dentist’s fee, insured individuals also have to make a co-payment to the dentist. Many people join PPO dental insurance plans because this type of insurance plan gives them more freedom when choosing a dentist and/or dental specialists.
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