Dental insurance encourages regular check ups that prevent costly dental work later.
Dental insurance comes in several different flavors and toppings.
All of individual or small group dental insurance plans will cover the following at typically no extra cost to you and no waiting period.
- Twice yearly cleanings.
- Twice yearly exams.
- Dental X-rays once a year.
Deductibles
Most plans will have $25 or $50 deductible that you will have to pay initially.
Waiting periods
The PPO (Preferred Provider Organizations) will have a waiting period of between 3 – 6 months for basic services and 12 months for major services. What constitutes a “Basic” versus “Major” service can vary between plans. In general, your basic services are fillings and major services are root canals, crowns, extraction, etc.
PPO versus HMO
PPO plans allow you to go to virtually any dentist you want. Each plan will have a network of dentists to choose from. If you go outside the network, not all services maybe covered. The dental insurance plan may pay the dentist or you, but you will be responsible for any dollar amount over the “Usual and Customary Rate” the company reimburses their network dentists in the area.
If you have a favorite dentist, check to make sure he or she accepts the dental insurance you are considering.
HMO’s (Health Maintenance Organization) have a network of dentists that you must see. You actually have to select the dentist at the time of enrollment. HMO plans have typically lower monthly premiums than PPO plans. But you will have an office copay (usually $5) with an HMO dentist and never with a PPO. HMO plans will cover more basic services at no charge to the patient like fillings and flouride treatments.
Dental Service Copay
Beyond what the various plans may cover under “no charge” (cleanings, exam, X-ray, fillings) there will be a co-payment or fee schedule for specific items. Some plans will use a percentage (plan pays 80% of the negotiated rate) other plans will have a set rate per procedure. For instance, under the Blue Shield Dental PPO plan an anterior root canal will cost you $156. The same service under the Anthem Blue Cross HMO plan will be $289.
Annual Maximums
PPO plans have a maximum dollar amount they will pay on your behalf for dental services through the year. This maximum can range from $500 – $2000. It will include the amounts they pay on your behalf for the cleanings, exams, X-rays, and their portion of the cost sharing for other basic and major services. For example, the plan may have a negotiated a rate of $80 for a filling. If your copay is $20, the $60 the plan pays accumulates towards your annual maximum. HMO’s have no yearly maximum, but the copays for major services can be higher.
Individual versus Group
Group dental insurance plans can have a slightly higher monthly premiums than an individual plan. However, group plans typically cover more services, can have lower copays, and offer a wider selection of dentists to choose from. There are both PPO and HMO group plans.
Do I need dental insurance if I never go to the dentist?
If you visit your dentist regularly, have no history of dental problems and are comfortable with what your yearly dental expenses are, there may little incentive or need to purchase dental insurance. If, however, you don’t see a dentist regularly, even if you don’t have dental problems, having dental insurance will encourage you and your family members to get regular cleanings and check ups. The cost of prevention, in this case regular cleanings and exams, will necessarily reduce your dental expenses in the future.