Since healthy teeth and gums are critical to good health care, you would think that dental care would be a part of medical health insurance. Unfortunately, dental care falls under a different category. Individuals must purchase dental insurance in addition to medical insurance in order to have full and complete coverage. As if medical health insurance isn’t confusing enough, it can also be bewildering to try to choose the appropriate dental health plan.
When choosing dental coverage either from your employer or on your own, it is critical to understand the difference between dental insurance and dental benefits. Dental insurance refers to an insurance plan in which you pay premiums, and your dental insurance company will then pay for dental procedures as they arise. Meanwhile, the term dental benefits refers to procedures which may be covered in full or in part by your particular dental insurance plan. Most dental insurance plans cover preventive care, such as twice-yearly teeth cleanings and exams. Regular exams catch conditions such as gum disease and cavities before they cause health issues.
One form of dental insurance involves coverage through a dental PPO. When you choose a PPO for your dental care, you pay premiums which allow you to select a dental provider within the PPO network. Members are generally allowed to use providers outside of the network if they are willing to pay higher rates. This allows for greater flexibility when seeking dental treatment. Dental PPOs may offer greater flexibility when it comes to dental providers. However, one drawback to this option is that it tends to be more expensive than other types of insurance.
A DHMO plan is generally less expensive than a DPPO. While this option may cost less than the PPO, it does come with more restrictions. Members choose a primary care dentist for their preventive treatment and must obtain referrals from this dentist before seeing any specialists. This plan does not allow for obtaining dental care outside the network. The lower cost and the ability to receive dental care without paying out-of-pocket and submitting for reimbursement makes this type of insurance plan attractive to some individuals.
Some employers offer dental indemnity plans to their employees for their dental insurance. In this plan, members are able to visit dentists and specialists within their plan without first obtaining a referral. The member pays for dental care out-of-pocket, then submits their claims for reimbursement. While there is more flexibility in this plan than there is with an HMO, fees are often high. Additionally, filling out claim forms can be time-consuming. Furthermore, reimbursement may not always come quickly. Often, money set aside by employees in a health reimbursement account or health savings account can be used to pay for dental costs.
Discount or referral dental plans are not insurance plans. Instead, members pay out-of-pocket for dental care that is offered to them at discount rates. Members may choose any dentist within the network. Individuals can purchase discount dental plans, or employers may purchase them for their employees. When considering this type of plan, read the contract carefully to understand the procedures that are covered and the discounts you will receive.
If you are shopping for dental insurance, there are three main points you will want to consider. First, seek a plan with a low out-of-pocket maximum. The maximum is the highest amount you would be expected to pay if a dental emergency arose. Don’t choose a plan with a maximum than is higher than you would be able to pay. Secondly, look for full dental coverage. Full coverage provides for dental work in addition to checkups and cleanings. Lastly, look for premiums that make sense. While high premiums can be cost-prohibitive, ultra-low premiums may signal high deductibles or copays.
The term Dental preventive care refers to checkups, cleanings, and x-rays. These are the procedures that are used by dentists to catch problems early. At your twice-yearly checkup, your dentist will check for cavities, gum disease, worn tooth enamel, root decay, and bone disease. Your dentist will also check for signs of disease in your mouth and neck. Tooth cleanings help to clear away plaque that your toothbrush misses. Keeping your teeth and gums free of plaque prevents gum disease. Since there appears to be a link between gum disease and heart disease, taking care of your gums can help keep your heart healthy.
Sometimes preventive care points out issues that your dentist needs to address. Cavities may require fillings in order to prevent the tooth decay from spreading. An infected root canal may require root canal treatment. According to the American Association of Endodontists, a root canal procedure involves removing the infected pulp within the tooth. In other cases, your dentist may discover a cracked tooth or a cavity that is too large for a filling. If so, the dentist may recommend covering the tooth with a cap or crown to restore strength and prevent further damage.
Your dental insurance may or may not cover orthodontics and prosthodontics. According to Medline Plus, orthodontics refers to the use of braces or other devices in order to straighten the teeth, improve the bite, and properly align the jaws, lips, and teeth. Meanwhile, the American College of Prosthodontists defines prosthodontics as a dental specialty which focuses on correcting issues caused by missing tooth, face, or jaw structures. To determine if your dental plan covers these types of issues, check the fine print in your insurance contract.
When researching dental plans, you may notice that most follow a 100-80-50 coverage structure. This means they cover preventive care such as tooth cleanings at 100%. Basic procedures such as fillings or root canals may be covered at 80%, which means plan members pay 20% for these treatments. Major procedures, such as crowns or bridges, may require plan members to cover 50% or more of the costs. In any plan, certain treatments may not be covered at all. This may include items such as fluoride treatments, sealants, or braces.
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