In late 2011 and early 2012, senate investigations which were conducted revealed that millions of Americans lacked basic dental health insurance. Furthermore a report that showed that over 125 million Americans do not have this form of insurance at all. For those Americans who do have dental insurance, it is important for them to understand the type of plan they have. The majority of dental insurance plans, just like health insurance plans, are provided by an employer, therefore most Americans do not have a choice when it comes to the type of coverage they receive. You should keep in mind that most of these plans can cover the dental care of other family members. Here are some things to understand about the different dental insurance plans.
The Different Dental Insurance Plans And How They Differ?
An Indemnity Plan
An indemnity plan is quite straightforward when it comes to covering the costs of dental care. The plan is frequently called a “fee-for-service” or “traditional plan.” Under an indemnity plan, an insurance company pays upfront when treatment is provided to the dental patient. This sort of payment structure can be beneficial, as it covers each individual procedure and can easily be tracked. In addition, patients oftentimes can have a dentist of their choosing, and they do not need referrals for specialists. Moreover, this plan comes with a table of allowances that provide specific information on the costs of each dental procedure. It should be noted that this plan may set limits on the number of procedures you can have over the course of a year. One drawback to an indemnity plan is that you pay up front and have to wait to be reimbursed. On the other hand, the advantage to this plan is its flexibility in seeking care. That feature is an added plus for many people, especially those who might live in smaller communities and have limited options when it comes to choosing a dentist.
A DPPO (Dental Preferred Provider Organizations) operates much like a PPO. If you have a DPPO, you have a wide range of choices and do not have to have a primary dentist for general treatment. Since you do not have to pick a specific dentist for your care, you also do not have to receive referrals. However, if you choose to go outside of network, the costs will be higher than on other plans. In addition, a DPPO generally includes a deductible and co-pays for office visits. In some cases, if you go outside of network with a non-participating provider, you might end up having to pay 40% of the cost for treatment versus 20%. Despite these disadvantages, a DPPO offers a wide network of dentists, so many find this plan to be advantageous.
A DHMO (Dental Health Maintenance Organizations) for dental care is similar to HMOs for overall health insurance plans. Under such a plan, you and your dependent family members are provided with a list of dentists and other dental care personnel who are enrolled in the given DHMO. If you do not choose these dentists or listed specialists, you will wind up paying more for your dental care. Furthermore, your chosen dentist, just like having a primary care physician under a PPO, must provide you with referrals if you require treatment that is outside of their expertise. When it comes to covering the costs, DPPOs generally require patients to pay co-pay for office visits and they also have deductibles that must be met before the insurance company begins covering the costs of the care. While this may sound costly, if you stay within network, you can save money and keep expenses down. If you must go out of network, the dentist or specialist will send you a bill at which point you must submit it to your insurance company. They will review the care and determine how much they will cover for treatments received. A disadvantage to this plan is that the network of providers can be limited. So, if you live in a small community or rural area, it might be a challenge to find appropriate dental care.
It is important to understand the pros and cons of all of these dental health care plans. As mentioned above, all three have drawbacks and benefits. Furthermore, if you are self-employed, you’ll be able to determine which one fits best for you and your family’s dental needs. However, if you employer chooses the plan, it is critical to understand what gets paid by the insurance company, especially if you develop a serious dental problem. Having a clear understanding of how your dental plan works will enable you to get the appropriate care you need – whether it is for basic cleanings or more serious work – and allow you to save money.