Dental Insurance
and Dental Plan Information:
Dental Discount
This type of
dental plan is
not insurance. The managing organizations
have negotiated with local dental
offices to establish a set price for a particular dental procedure
and offer deep
discounts (some from 20-60%) off the regular ADA pricing code. This plan has
several advantages over traditional dental insurance plans. This
allows a patient to receive immediate service for work without any
waiting requirements and no limits on use.
Finding the right
value in dental insurance vs dental plans is an important step in
purchasing dental coverage for you and your family. Both types of
dental plans have advantages and disadvantages and one size does
not fit everyone. Keeping this in mind is an important rule when
you shop for the dental plan that best fits your needs. We sell
both individual and family dental insurance and dental discount
plans throughout all 50 states. Here are some brief examples that
may help you decide.
Indemnity Dental Insurance Plans
This type of
dental plan pays the dental office (dentist) on a traditional
fee-for-service basis. A monthly premium is paid by the client
and/or the employer to an insurance company, which then reimburses
the dental office (dentist) for the services rendered. An
insurance company usually pays between 50% - 80% of the dental
office (dentist) fees for a covered procedures; the remaining
20% - 50% is paid by the client. These
plans often have a pre-determined or set deductible amount which
varies from plan to plan. Indemnity plans also can limit the
amount of services covered within a given year and pay the dentist
based on a variety of fee schedules. Some typical features of
these plans:
-
High
deductibles before coverage begins (well-designed plans don't
apply the deductible to preventive services)
-
Probationary
periods on certain procedures that last up to a year
-
Annual dollar
limit on benefits
-
Chose your own
dentist
-
Your average
monthly cost: $15 to $25
-
Companies
selling these plans are regulated by state insurance
departments.
Dental HMOs
These insurance
plans, also known as "capitation plans," operate like their
medical HMO cousins. This
type of dental plan provides a comprehensive dental care to
enrolled patients through
designated provider office (dentist). A Dental Health Maintenance
Organization (DHMO) is
a common example of a capitation plan. The dentist is paid on a
per capita (per person) basis rather than for actual treatment
provided. Participating dentists receive a fixes monthly fee based
on the number of patients assigned to the office. In addition to
premiums, client co-payments may be required for each visit. Some
typical features of these plans:
-
Monthly
premiums (some require you to prepay a year's worth)
-
Co-payments for
office visits
-
Free preventive
or routine care
-
You must select
from an approved network of dentists
-
May have an
initial enrollment fee
-
Annual dollar
cap
-
Your average
monthly cost: $5 to $15
-
Companies
selling these plans are regulated by state insurance
departments.
Preferred Provider Organizations
Another true
insurance plan, a Preferred provider organizations ( PPO) falls
somewhere between an indemnity plan and a dental HMO. This plan
allows a particular group of patients to receive dental care from
a defined panel of dentists. The participating dentist agrees to
charge less than usual fees to this specific patient base,
providing savings for the plan purchaser. If the patient chooses
to see a dentist who is not designated as a "preferred provider,"
that patient may be required to pay a greater share of the
fee-for-service. A group of dentists agrees to provide services
at a deeply discounted rate, giving you substantial savings — as
long as you stay in their network. Unlike the more restrictive
DHMO, though, you can go out of network and still receive some
benefits. Some typical features of these plans:
-
Monthly
premiums
-
Annual dollar
cap
-
You must stay
within the approved network of dentists or pay higher
deductibles and co-payments
-
Your average
monthly cost: $20-25
-
Companies
selling these plans are regulated by state insurance
departments.
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