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Dental Plans


Dental plans have become a hot topic! With issues such as health care reform and the rising cost of dental care, dental insurance plans are becoming even more of a necessity. A recent survey shows that 63 percent of Americans believe dental plans should be included in the health care reform effort, and with good reason: Oral health has been proven to significantly affect your overall health. Studies have directly linked dental conditions to health problems such as heart disease, stroke, diabetes and premature labor, and cavities among children have reached epidemic proportions. With painful dental problems affecting the quality of life of millions of Americans every year, the importance of dental care can no longer be ignored.

The fact is everyone needs a dental plan just as much as they need a medical insurance plan. But according to The Washington Post, it’s estimated that 82 million Americans have no dental plan coverage. Uninsured dental patients risk paying thousands of dollars out of their own pockets when dental problems pop up. Dental plans cover many preventive and restorative dental treatments to help save you money and improve your health.Putting Your Dental Plan in Place

If you don’t have a dental insurance plan, it’s not too late to get one. There are several ways to obtain a dental insurance plan for you and your family. We’ve provided some basic information to help you understand your dental plan options.

Group Dental Plans — Many companies who offer medical insurance also offer their employees dental insurance plans. Either the company or the employee pays a premium to the dental plan insurance company to receive their benefits. With a group dental plan, you are limited to the type of plan offered through your company. Your employer can tell you what kind of dental plans are available.

Individual Dental Plans — If your company does not offer health insurance or you are self-employed, some dental plans can be purchased privately. You may choose to research your options and apply for the dental plan on your own or go through a dental insurance broker. Your individual dental plan provider will then review your application and inform you whether you qualify to become a member.

Direct Reimbursement Plans — Although different from traditional dental plans, direct reimbursement dental plans are gaining popularity in the corporate culture. Through a reimbursement dental plan, you pay the dentist directly and your company reimburses you all or a percentage of the fee.

Discount Dental Plans — Dental discounts plans are not dental insurance plans. Members pay a fee and save a percentage on dental treatment from participating providers. Your coverage depends on how many dentists are on the dental plan and what types of discounts are available. If you’re interested in a discount dental plan, be sure to read the fine print and understand all of your benefits before signing on the dotted line.

State-Funded Dental Plans — Government-funded dental plans were designed to assist low-income families who cannot afford their own dental insurance plans. These plans are organized and run on a state level, hence the term “state aid.” The availability of these dental plans varies state to state for adults, but is mandatory for children. For information on your state dental plan programs, contact your local social or family services departments.How Dental Plans Work

What dental insurance plans cover differs from insurance carrier to insurance carrier. Most dental insurance plans cover basic preventive dental care, meaning your dental checkups, cleanings and X-rays. Dental plans may also partially or fully cover many of your basic and necessary restorative dentistry treatments, such as a tooth filling or dental crown. It’s important to note that dental plan coverage varies according to the type of plan you have and the type of treatment you need.

Many insurance companies have several types of dental plans for you to choose from. Some examples of dental insurance plans include the following:

Dental Health Maintenance Organization (often referred to as DHMO, DMO or HMO) — With a DHMO, you must choose among an approved network of dentists in order to receive your benefits. In some cases, the dental insurance company will assign a dentist to you. DHMO dentists are paid per patient rather than per dental treatment, receiving a monthly fee for the number of patients assigned to the office.

Exclusive Provider Organization (EPO) — Like a DHMO dental plan, you must stay in-network to receive your benefits. But unlike an HMO, the EPO pays dentists for each service rather than pay them on a fee-per-patient scale. It’s important to note that if you choose to go to a non-network provider for either of these dental plans, your provider will not cover any of your treatments.

Preferred Provider Organization (PPO) — With a PPO dental plan, coverage varies depending on whether you choose to go to an in-network or out-of-network doctor. Dentists who practice within the network agree to charge a reduced fee for certain dental procedures, lowering your out-of-pocket expenses. Out-of-network dentists may charge a higher rate, which is passed on to you, the consumer.

Indemnity — Indemnity dental plans allow you the freedom to go to any dentist but often at a greater expense. While you pay the deductible, indemnity dental plans usually cover only a percentage of the dental treatment fee, leaving you to pay the difference.

No matter what type of dental insurance plan you have, most dentists require payment due at the time of service, whether that is your co-payment, fees for services not considered “reasonable and customary” or a payment in full that is reimbursed by your dental insurance plan. You should discuss your dentist’s payment policies prior to your appointment to avoid any unexpected bills. For further details on how your dental plan works, talk to your dental insurance plan company.

It’s important to have a long-term plan when it comes to your dental health care. Dentistry can be expensive, especially if you need major work. To help avoid costly dental treatments, be sure to eat a balanced diet, practice good oral hygiene and utilize your dental plan by visiting your dentist twice a year. Remember, most dental plans cover preventive care, so investing in a dental plan may actually save you money in the long run.