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3 Tips on Selecting Your Dental Benefits

Shopping for dental insurance doesn't have to be burdensome.

September 18, 2017 - By HealthCare.com Staff - read

Dental benefits can help you and your family save money on dental care services each year. Keep these three tips in mind to select dental insurance that’s just right for your needs.

1. What Dental Benefits Does Each Plan Offer?

As with health insurance, the dental insurance plan which works for one individual may not suit another.

Consider your oral health needs in a typical year. Maybe you routinely seek preventive dental care, rarely need cavities filled, and floss like it’s your job. Or perhaps you visit the dentist frequently for one reason or another. How often will you be using your dental benefits?

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In addition to plan premiums, review plan coinsurance rates for preventive care (annual cleanings and exams), basic care (simple extractions and fillings), and major care (crowns, root canals, oral surgery). When you’re looking at your dental benefits options, you’ll also want to note whether a plan has a deductible and if your coverage is capped at a maximum amount.

2. Know the Difference: Dental Discount Plans vs. Dental Insurance Plans

When comparing your options for dental benefits, note which type of dental plans you are considering. Some of your coverage options may be dental insurance plans, while others may be dental discount plans. Although both dental insurance plans and dental discount plans help consumers pay for dental care, these two plan designs operate differently.

  • Dental discount plans are low-cost memberships which provide consumers with access to dental benefits and discounted dental services from participating providers. Discounts may range from 10 to 50 percent off the cost of cleanings, fillings, X-rays, and other services. Dental discount plans don’t have a claims process and purchasing one is like purchasing a membership to Costco, or using a coupon. Policyholders present their dental discount membership card to their dentist during an appointment and a discount is applied to their bill.
  • Dental insurance plans work much like health insurance plans do, employing a cost-sharing arrangement to help consumers pay for their dental benefits. Coverage varies from plan to plan, though it’s not uncommon for preventive care–which usually includes two routine exams and professional cleanings per year–to be covered at 100 percent.

3. Examine Dental Provider Networks

Different plans structure dental benefits differently. Here are the most common plan structures:

  • Health maintenance organization (HMO) plans require consumers to receive dental care from an in-network provider and typically have the lowest monthly premiums and out-of-pocket costs. However, HMOs offer little flexibility with regard to provider choice. If you go to a dentist who doesn’t belong to your plan’s provider network, the cost of your dental is unlikely to be covered by insurance.
  • Preferred provider organization (PPO) plans allow for more flexibility when it comes to using your dental benefits. PPO plans offer more choice with selecting providers, with some plans providing partial coverage to people who seek care out-of-network. Monthly premiums for PPO plans tend to cost more than those of HMO plans.
  • Indemnity dental plans (also known as fee-for-service plans) tend to offer the most provider flexibility. Network restrictions do not apply under these plans, so consumers can receive care from whatever dentist they choose. Dental indemnity plans, however, do require consumers to pay for dental benefits out-of-pocket; consumers must submit a claim to their dental insurance provider in order to receive reimbursement.

Before settling on a dental plan, assess the network structures of each option and find out if your preferred dentist participates in any plan networks. If you do not have a preferred dentist, check the plan’s provider directory to see which dentists do participate, and whether they are conveniently located to your work or home. Occasionally, plan directories are out of date, so it’s always a good idea to call the insurance company and/or your dentist to confirm your provider is in-network. That way, you can be sure that your insurance will be accepted (and that you’ll be able to utilize your dental benefits).

Taking the Next Steps

You can evaluate your dental coverage and see if it’s the best option for your needs.

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