Dental Insurance

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The Secret to Buying Dental Insurance

Whether you are a recent grad or a longtime member of the workforce, it’s possible you may take a job in which dental insurance benefits are not part of the package, find yourself in between jobs and without an employer-sponsored dental plan, or become self-employed and responsible for your own dental insurance coverage. Should this happen, it is wise to secure your own.

However, not all dental plans are created equal. Not all dental “plans” are even considered dental insurance. When you begin shopping, there are several things to keep in mind. Use this list to help guide you.

1. Know your needs

Consider your oral health needs and financial situation before you start searching. Are you historically cavity-free and looking to maintain regular preventive exams and cleanings? Do you anticipate needing major procedures? What percentage of your overall health care budget can you contribute to dental insurance premiums and out-of-pocket expenses?

For instance, individuals in good health who only foresee needing regular exams and cleanings may benefit most from a plan that covers preventive and diagnostic care at 100 percent. Such a plan would have a lower monthly premium. Someone who regularly needs major services may want to consider more robust coverage, but he or she will pay a higher monthly premium as a result.

2. Know how coverage compares

When looking at the dental insurance plans offered by various carriers, be sure to compare at the various coverage levels and designs each carrier offers. You may even start there. Narrow it down by selecting which benefits meet your financial and oral health needs. Then, make a comparison of similar plans across carriers.

How much will your monthly premium be? What will you pay for care beyond that? Add it all up. When looking at benefits, identify waiting periods, coinsurance percentages and copay amounts, calendar-year and out-of-pocket maximums.

Also take into consideration what plans your dentist accepts or, if you don’t have a preferred dentist, what plans providers conveniently located near you accept. Do the plans you are considering require you to see oral health professionals in their networks?

3. Know the difference between PPO and indemnity

Dental plans that use a preferred provider organization—aka, PPO—allow consumers to use in-network service providers at a negotiated discount rate. While those enrolled in the plan are often free to seek care out of network, it is often more expensive and you will be responsible for paying any additional charges.

A dental indemnity plan does not require you to visit network providers and pays a specified amount toward services; any amount beyond that is your responsibility. The flexibility of an indemnity plan is typically ideal for those who live in rural areas and other places where few providers participate in PPO networks.

4. Know that dental discount plans are not dental insurance

Dental discount plans provide members with access to discounted rates for dental services. Members pay providers up front and in full for visits and then submit a request for reimbursement from the discount plan. Some dental discount plans are included at no cost in other insurance products; others are standalone discount dental plans for which you pay a one-time enrollment fee. There is no calendar-year maximum with a discount plan.

Dental insurance, on the other hand, covers a portion of your billed services up front according to the plan benefits you select. You pay a monthly premium in addition to applicable deductibles, coinsurance and copays. Dental insurance plans typically cover two preventive care visits a year; even a basic plan will contribute toward procedures such as fillings to help lessen the financial impact. Dental insurance plans include a calendar-year maximum, which means that once you have reached this cap you must pay any additional charges.

5. Know it’s easy to apply, but it’s also important to be selective

There is no underwriting for dental coverage and no pre-existing condition limitation so as long as your premium is accepted you will be approved for coverage for the requested effective date.

Weigh your decision carefully before applying and paying your premium. Almost all individual dental plans have a 12-month waiting period or longer on major services, which means you want to choose a plan that fits your budgetary dental care requirements from the start. Don’t put yourself in a position in which you find the plan you select is inadequate or too expensive and you must start a new plan with new waiting periods at a time when need coverage beyond preventive and diagnostic care.

If you have any additional questions about purchasing a plan, consult a broker or agent to assist you for no extra cost. You may also directly contact the carrier for the plan you are interested in via chat, phone and email.

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