Dental insurance is usually not part of health insurance coverage. Instead, it is usually an optional plan that can be purchased separately and does not always work exactly the way medical coverage is.
Dental insurance is a policy that helps cover the cost of services administered in a dental office for a monthly premium similar to the way you pay for health insurance. “But it’s not insurance in the traditional sense,” said Alex Karenbrock, a sales associate at Apollo Insurance Group in Lees Summit, Missouri. “This is a plan for discounts with limited benefits. This means that if you go to a dentist who is online, he is contractually obliged to give you a reduced insurance fee, not the office fee, which is usually 20% to 40% higher, she says. Your dental insurance coverage helps to pay part or all of the fee – how much is paid depends on your specific plan and the benefits offered.
Although dental insurance does not always cover your entire bill, many people find it helpful when it comes to saving on preventative care and dental procedures that may be needed. Dental work can become very expensive very quickly, and insurance can often help alleviate this financial burden.
Different types of dental insurance
There are eight major types of dental insurance, according to the American Dental Association (ADA). If you are looking for coverage, knowing the differences is key.
Preferred Supplier Organizations (PPOs) the plans are like health insurance, as they offer a network of dentists who are covered by the insurance company to perform dental work for a fee. These plans usually offer stronger coverage for more expensive procedures such as implants, braces and surgery, according to Yenile Pinto, DDS. owner of Deering Dental in Miami. “PPOs also tend to have better doctors in their networks, and you usually have the opportunity to take advantage of them online,” she explains. “The disadvantage of PPOs is that most plans benefit from $ 1,000 to $ 2,000, after which you are responsible for paying the full amount, even though you pay the reduced insurance rate, which can save you up to 40%,” says Dr. Pinto.
Dental Health Organizations (DHMO) the plans give dentists a certain amount of money each month for each patient assigned to them. They are then required to provide certain services free of charge or at a reduced cost to these patients. “DHMO plans usually have unlimited benefits, but there is a surcharge for all procedures and they usually have more limitations and lack coverage for higher-end procedures,” says Dr. Pinto. “In addition, because dentists’ reimbursements are relatively low, many choose not to participate in DHMO, which can limit your access to better and more experienced providers.
Compensation plans are the closest in structure to the traditional health insurance plan. The insurance company pays claims based on the procedures performed and usually allows patients to choose their own doctors. “This policy pays the dentist a percentage of the bill on your behalf in accordance with the plan’s guidelines,” Karenbrock explains.
Direct Recovery (DR) The plans are exactly what they sound like: “These types of plans require you to pay the bill in advance and then file a claim with the insurance company to get a refund check in the mail later,” Karenbrock said.
Service point (POS) plans are arrangements under which patients who have a dental care plan can receive treatment from an out-of-network provider. The patient usually recovers, but the benefits are significantly reduced compared to what they would be if the patient saw a provider who is online.
Plans for discounts or recommendations are not technically insurance plans: “There are alternative types of plans, called discounted dental plans, which give you a discount only on dental services – such as a coupon at the grocery store,” Karenbrock explains. “But you are still responsible for the full cost of the reduced bill.”
Exclusive Supplier Organizations (EPOs) the plans only allow patients to use the dentists involved to reimburse them. Due to this limitation, these plans significantly limit access to dentist choice and care.
Table or schedule of compensation plans require consumers to pay a certain amount for each procedure. Patients have to pay the difference between the fee and the carrier’s payment.