What questions should I be asking when purchasing individual dental insurance.
• What do cleanings cost?
• How frequently can I get them?
• Are there waiting periods?
• What is the deductible? When does the deductible start? Does it cover orthodontists?
• How many dentists are in the system?
• Are there exclusions or waiting periods?
• What fee schedule does the insurance carrier use?
• Is pre-authorization required?
• Is periodontics covered and at what level?
• What are the deductibles, and are they different for in and out of network?
Following is information about the different dental plans to consider for you and your family:
DHMO: DENTAL HEALTH MAINTENANCE ORGANIZATION
Typically, the least expensive of dental plans . All dental services are provided by professional dentists who agree to provide specific treatments and services to patients at no charge (some services may require a co-payment.)
DHMO plans reward participating dentists who keep patients in good health, thereby keeping plan costs low. Dentists are paid directly by the insurance company for each individual, regardless of how much or how often covered services are used.
INDEMNITY
Usually allows the patient to go to the dentist of their choice. These plans generally pay a portion of the dentist’s fee or a set dollar amount (usually, whichever is less). Payments may be made to the insured member or, by assignment, directly to the dentist. If there is a difference between the amount paid and the dentist’s full charge and the amount paid, the individual usually pays the difference.
PPO – PREFERRED PROVIDER ORGANIZATION
Generally less expensive than Indemnity dental plans. Individuals select their dentist from a network or listing of dental providers who have agreed by contract to reduce their fees. Individuals can also seek treatment from dentists outside of the PPO (non-participating dentists) but may be responsible for higher deductibles and/or co-payments.
SCHEDULED
A scheduled plan or scheduled reimbursement plan reimburses you for a specific amount based on a fee schedule with any balance due being your responsibility. Scheduled plans do include a calendar year maximum, a deductible and have waiting periods on certain procedures. A Scheduled plan shows every covered procedure and the amount you will be reimbursed for each procedure. For example, if the insurance reimburses $47 for a cleaning, and your dentist charges you $50 for a cleaning, you would be responsible for the difference of $3.
DISCOUNT CARD
Discount cards are offered as a way to lower the cost of dental care. These cards are especially attractive for people who do not have insurance coverage for these services or who have inadequate coverage. Discount cards allow for unlimited use of services by using a dental network and are based on a discounted fee schedule. The cost of your membership card is small compared to the potential savings for you and your family.
Following are some of the providers we recommend:
Dominion Dental
Delta Dental
Dentaquest
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