Planning To Buy Dental Insurance? Here’re The Factors To Be Considered

posted in: Dental Insurance | 0


Some invasive dental procedures can prove to be expensive, and insurance coverage can surely help in maintaining a great smile in such a situation. However, there are multiple policies available in the market, and choosing the wrong one can prove to be a massive waste of money.

What is Dental Insurance?

Such cover often proves to be a lifeline for patients as it helps in managing dental care expenses.

Is there any dental insurance that covers 100 percent of costs for necessary procedures? Can you have dental insurance without health insurance?

Yes, dental insurance can be purchased separately. Most companies cover 100 percent of the costs incurred for preventive care procedures like cleanings, routine examinations, and x-rays. Sadly, according to the National Association of Dental Plans data, around 74 million Americans do not have dental insurance.

How Does Dental Insurance Work?

Policies cover significant, basic, and preventive dental care expenditure for patients. Before signing for a dental insurance policy, there are factors that the buyer needs to focus on for ensuring the cover meets his or her needs.

First and the most crucial point, it is not something that the patient can purchase and then file a claim after a few months. Most of the policies come with a waiting period of anywhere between six months to two years. The policyholder cannot file claims for any major or minor dental work done during this timeframe. The waiting period may differ from one policy to the other.

Insurance deductible, the co-pay amount, and yearly maximum are probably the most crucial factors that dental insurance buyers must consider. The insurance deductible is the amount that the individual must pay from the bill for the concerned treatment before filing a claim. The co-pay (out of pocket) is the amount (or percentage) that the insured person needs to pay out of the bill.

The annual coverage is restricted to a certain amount referred to as a yearly maximum. It can be any amount between $750 and $2000. Policies that have a higher yearly maximum amount often charge a high monthly premium.

After crossing the yearly maximum claim amount, the patient does not remain eligible for claiming any dental care bill for the concerned policy term.

How Do You Get Dental Insurance?

You can opt for a dental cover from your employer’s insurance company (group insurance) or buy an individual plan. The monthly premium depends on the plan, your location, previous claims history, and the insurance company that you select.

Most of the policies come with a monthly premium of around $50 (per member) per month. On the other hand, the employer’s insurance is cheaper and can cost roughly between $19 and $32. Both come with a minimum contract of 12 months.

It is essential to focus on how the insurer categorizes various dental procedures. For some companies, root canals can be a necessary (basic) procedure, while it is tagged as a major procedure by several others.

Most importantly, do not forget to check the flexibility to see any oral specialists and dentists that are a part of the insurer’s network. For example, PPO and indemnity plan allows you to see the dentist of your choice while HMO and DMO insurance assigns you a specific doctor or office to receive any dental services under their plan. Also, review the company’s policies for pre-existing conditions and rules for using an out-of-network dentist.

The policy can also be selected from dental offices that you prefer for treatment. Several dentists offer discount in-office programs to their patients.

What are Dental Insurance Benefits?

Not just the complicated procedures but even the costs for necessary procedures like cleaning, filling sealants, x-rays, and quarterly checkups are covered. It acts as a financial safety net to protect people from unplanned dental care treatment bills.

Almost all the policies (with a basic monthly premium) offer to take care of 50% to 80% of the costs incurred for root canals, fillings, extractions, and procedures performed for treating gum diseases. Depending on the type of policy, co-insurance, and co-pay amount, the patient needs to pay the remainder of the bill.

The insured may incur higher out-of-pocket expenses or co-payment while opting for dentures, inlays, bridges, crowns, implants (for a cracked, weak tooth), and other invasive procedures.

Types of Dental Insurance

The PPO-Preferred Provider Organizations type, Indemnity (Traditional type), and the DHMO-Dental Health Maintenance Organizations type are some of the most popular options.

PPO and traditional types are most preferred as they have an extensive network of dentists. Under the conventional (indemnity) plan, the patient can choose their dentist and get the costs for treatment covered.

DHMO options are considered restrictive because the patient is entitled to benefits only if the treatment is completed at the in-network clinic selected by the firm.

Personal Dental Insurance

The term is self-explanatory. These are individual/personal plans that offer cover for a single person.

Family Dental Insurance

If you opt for a family plan, you can get a cover for your spouse and kids as a part of the same group. Family plans can help you save a considerable amount on premium costs, deductibles, along with other expenses. Each member’s coverage can be customized as per their dental care needs.

Cosmetics Dental Insurance

Insurers consider processes like teeth whitening, placement of porcelain, correcting tooth alignment, bonding, dental implants, and some other procedures as elective, unless medically necessary. They do not offer coverage for these procedures if they are performed to improve the patient’s aesthetics. Firms also offer discount plans for implants if the procedure is performed at one of the in-network dental offices.

Emergency Dental Insurance

Dental insurance plans may have a waiting period of around six months to a year when it comes to starting the coverage after the insured person is enrolled. The period is to avoid patients from signing up for a dental insurance policy right before opting for an expensive procedure.

There are a few PPO and group plans that do have zero days to six months of the waiting period. Procedures covered under them may differ according to the insurance company and state regulations.

However, severe toothache, dental crown pain, broken tooth, and injuries caused to the mouth or teeth as a result of an accident can be considered dental emergencies. Every insurance company has its own set of rules when it comes to covering dental emergencies. Even some health insurance companies compensate for the Emergency Room (ER) expenditure incurred due to dental emergencies.

If you are looking for one of the best and most trusted dental care experts in Roswell city, you should consider making an appointment with TruCare Dentistry.