Dental insurance works differently than most health insurances, and it can get rather confusing. However, it is important to understand how your dental benefits work and what impact they can have in getting the dental care you need. Read below for important clarifications on dental insurance.
- Acquiring insurance
. There are generally four types of dental plans: DHMO, PPO, discount dental plans, and indemnity dental insurance plans.
- A DHMO is comprised of a network of dentists who pay a fee to carry your specific plan. Your copayments and fees are usually pretty low. If you go to a dentist outside of this network, the insurance won’t provide any coverage.
- A PPO plan, or preferred provider organization, also includes a network of dentists. These dental providers have agreed to provide dental care to patients with this insurance for a lower price. If you choose to see a dentist outside of the PPO network, this type of plan will still provide some coverage, however, your out-of-pocket cost may be a little more.
- Discount dental plans are not technically insurance. They provide individuals discount dental prices based on a fee schedule. In our experience, it is often difficult to find dentists who accept these plans due to the degree of discounts required on the fee schedule.
- Lastly, an indemnity dental insurance plan is a more traditional form of dental insurance. With this type of coverage, your benefits are not affected by a provider network.
- Coverage . This will depend on your specific plan, but most dental insurances cover 100% of preventive care and hygiene. For example, if you come in for a cleaning, it will likely cost you very little, or nothing at all. On the other hand, larger cases will require a deductible. For example, filling a cavity could cost $100, even with a robust insurance plan.
- Deductible . A deductible is a minimum fee that the insurance company requires you to pay out of pocket each year. Once your deductible is met, your insurance kicks in. Most insurance companies require a flat fee paid each year.
- Copayment . A copayment is a fee that you pay to the dental office for more advanced procedures. For example, a crown or bridge will require a copayment. This is a way for you and your insurance company to share the cost of the procedure.
All of this aside, dental benefit plans require an investment on your end, regardless of your treatment plan. An increasingly popular alternative is fee-for-service. Instead of investing in dental benefits you may not utilize, you can save that money and simply pay for just the treatment you need. Many times, especially with routine dental care like cleanings and X-rays, this is a more cost-effective option.
At Petersen Family Dentistry, we also offer an in-house Oral Health Plan, which many patients without insurance find attractive. This plan is not insurance, but helps patients receive all of their preventive care and exams throughout the year at a reduced cost, and provides opportunities for discounts for any additional treatment that is needed. Please speak with us if you would like more information.
As a courtesy, we always do our best to help patients understand their insurance benefits prior to completing treatment. However, because of the multitude of different plans that exist, and the challenges of communicating with insurance providers, it is not always possible for us to have complete information. Therefore, we strongly encourage our patients to be their own advocate and ensure they understand the details of their own plan.
Be sure to do your research so that you can uncover whether fee-for-service is your best option, or if there is a dental plan that fits your needs
