If you thought health insurance was confusing, try comparing individual and family dental plans. The insurance industry has taken a simple concept and turned it over to their marketing departments which created too many plans without proper explanation. However, most dental plans are surprisingly similar and with a little bit of filtering it is easy to spot the right plan for your family. Individual and family dental plans have year round enrollment unlike the open enrollment periods for health insurance.
Searching Dental For Everyone website
In an effort to sort dental plans for my clients I added the Dental For Everyone quoting engine to my website. While there are lots of good plans and free quotes on dental and vision insurance, the variety of carriers and different plans just freeze consumers with option overload. Because I believe in consumer choice and competition, I don’t want to offer just one dental or vision carrier and call it the king of the hill. This is my attempt to give consumers some tips and filters for selecting dental and vision insurance.
Filtering out dental plans
Frankly, I don’t care which carrier you select for either your dental or vision insurance. All I want is that you find an insurance plan that fits your family’s needs at a reasonable premium and isn’t a major pain in the rear end for either you or me to work with. Here are some of the filters to help narrow down the various options of dental and vision insurance.
Filter 1 – Avoid Discount Plans
The first is filter is to avoid buying a discount dental or vision plan. They are a profit center for the seller and a money siphon for the buyer. You are purchasing a promise that the dentist will honor any discounts he or she may wish to pass along on inflated dental service prices. Dentists participate in these discount plans as a form of advertising and not to provide affordable services to patients.
Filter 2 – What plans does your dentist accept?
Do you have a dentist you know, love and trust? Ask your dentist what dental plans are accepted at the practice. It could be they don’t accept any of the individual and family plans. They might only accept group dental insurance. That can work as long as they accept DPPO or Dental Preferred Provider Organizations. DPPO plans include coverage for out-of-network dentists.
The situation that will save you the most money and stretch the dental insurance premiums to the maximum is if your dentist is an in-network provider for the plan. That means the dentist will accept the full reimbursement for the dental services and won’t send you a bill for any balance not paid. For example, if the dental plan pays a usual and customary amount of $50 for dental cleaning, but your out-of-network dentist charges $65, you may be billed a balance of $15 from your dentist for the difference.
Filter 3 – PPO or HMO
The Dental Preferred Provider Organizations (DPPO) are characterized by –
- Large network of dentists
- Coverage for out-of-network dental providers
- Includes a maximum dollar amount benefit per year
- Waiting period of up to twelve months for some dental services
Dental Health Maintenance Organizations (DHMO) are generally defined by –
- Small network of dentists
- You must specify a dentist with the plan before you make an appointment
- No coverage for out-of-network dental services
- Monthly premium can be over 50% less than a DPPO
- Virtually all services have a set copayment amount so there is no surprise costs
- No maximum amount or cap on what the dental will pay on your behalf for the year
Indemnity plans: this type of dental insurance doesn’t have a network of dentists. Instead they reimburse the member a set amount for a specific service. These plans can be good for people who travel extensively and never know when or where they will need a dentist.
Filter 5 – Orthodontia
Several of the dental plans include coverage for children’s and adult orthodontia. If neither you nor your children need braces, you should avoid those plans. Dental plans that cover orthodontia can have premiums that are 25% higher than plans that don’t cover orthodontia. If you don’t need braces, there is no reason to pay for the coverage.
Filter 6 – Maximum Benefit
Next to whether a plan is a PPO or HMO, and includes orthodontia, the next largest factor influencing the monthly premiums for PPO plans is the maximum annual benefit paid by the plan on behalf of a member. For PPOs, each plan will specify the maximum amount the plan will pay out in claims on behalf of member during the year. Once the plan has spent the maximum amount, the member must cover all the costs of the dental services. Dental HMOs don’t have a maximum cap on the annual amounts, but the copayments can be higher than a PPO plan.
Coverage benefit differences
Most dental insurance plans are very competitively priced. In other words, given the same coverage and benefits, the exact plan from two different carriers will have very similar monthly premiums. While some plans may appear overpriced in a side by side comparison, there are usually some little subtleties that account for the difference. Such benefit design and coverage items include.
- How the plan calculate the member’s coinsurance percentage. Some plans will have a progressively decreasing member share of cost to reward people for persistency or continuing their insurance plan over several years.
- Some carriers have multiple networks of dentist. Plans that include the larger networks cost more.
- Plans may offer coverage for dentures and implants.
- Orthodontia may be limited to children only. Many plans that include orthodontia coverage will have separate deductibles and maximum annual benefits.
- Some plans charge higher copayments and deductibles for members over 65 years old.
- Some plan will adjust the premium rates based on age while others have one rate for all adults.
The presentation of the different dental plans on the Dental for Everyone website, based on your zip code, can be a little overwhelming. There will be plans from –
- Delta Dental
- Madison Dental
- Renaissance Dental
- Security Life
- Standard Life
I’ve put together a condense summary of benefits of each plan on my Dental Insurance page. Also included on the insurance page will be summaries for Assurant, Blue Shield of California, and Cigna. The summary of each of the plans may help filter out some plans.
With most of the dental insurance plans you can add VSP vision insurance. The rates will vary, but the vision insurance will be approximately $11 per month when added to a dental plan with discounts for multiple family members. Purchasing vision insurance without dental insurance is approximately $15 per month.
By filtering out dental plans based on the type of plan, whether your dentist accepts certain plans, and the type of coverage you want will help you get the best return for your premium. Because all California individual and family health insurance plans, along with most small group plans, now include pediatric dental benefits, you may not need to children under 19 years of age on the family plan.