Dental insurance is an option for those who want to protect themselves against high dental care costs. These plans generally include a premium, a deductible, 韓国インプラント and annual maximums.
The best dental insurance providers offer low premiums, affordable out-of-pocket expenses, and large provider networks. They also have a strong focus on preventive care.
Direct Reimbursement Programs
Some employers offer their employees a type of dental coverage that is self-funded rather than traditional insurance. Often known as direct reimbursement, these plans allow employees to choose any dentist and typically do not have the network limitations of PPO or DHMO dental plans. In addition, DR plans do not have deductibles or preauthorizations and do not restrict coverage for procedures such as periodontics, endodontics and oral surgery.
These plans usually limit the amount they will pay per procedure based on a predetermined fee level called the “usual, customary and reasonable” fee (UCR). These fees are subject to wide fluctuations and do not reflect the actual charges of area dentists.
Employees under a DR plan generally pay the dentist at the time of treatment and then submit the receipt to the employer for reimbursement. Some DR plans also have time limits on certain services, such as a series of X-rays or a maximum number of fillings on a single tooth, so the employer may need to get prior approval from the DR plan administrator for some treatments.
An indemnity plan pays a percentage of the reasonable and customary charges for a particular procedure. This type of plan does not have a preferred provider network and does not require referrals from primary care physicians for specialist visits or preapprovals prior to procedures. There is usually a deductible that must be met before the insurance company will pay for coverage. This type of plan may also include a coinsurance rate. It is important to understand the deductible, coinsurance, and UCR amounts before selecting an indemnity plan.
Dental HMOs (HMO) offer low-cost coverage that often comes with no deductible. They typically offer a network of dentists that participate with the plan and have agreed to charge less than their usual fees.
Patients are incentivized to stay with the network because the insurance company will pay for services only if they receive care from a participating provider. Unlike PPO plans, these plans usually have yearly maximums and do not provide reimbursement for care received out-of-network.
If you or your family never have any major dental work done, then a basic or entry-tier DHMO may be right for you. However, if you have kids and want a plan that covers orthodontics and other more extensive procedures, then look into a higher-tier DPPO. You can explore options for a stand-alone dental plan at eHealth or talk with a licensed independent insurance agent who can help you find the best option to fit your needs and budget.
Dental Preferred Provider Organization (PPO) plans allow participants to see any dentist they choose. However, the plan may only pay a portion of the discounted fee charged by participating providers. This type of dental insurance is usually more cost effective than an indemnity or DHMO plan.
Most plans have an annual maximum benefit. The participant is responsible for paying any expenses beyond that amount, after the deductible has been met. Preventive care, such as checkups and cleanings are covered 100% by most PPO plans. However, a limited provider network can be a drawback to some plans.
As the dental insurance market continues to evolve, it is important for dental practices to consider their options carefully. Choosing the right insurance options can improve patient retention, and drive more visits to the practice, resulting in greater profitability for the business. Ultimately, it is best for practices to embrace health integration and partner with health plans.
Many plans offer a choice of network providers. Generally, networks are made up of providers who agree to prearranged service fees for patients. This keeps costs low and increases convenience. Some networks require patients to name a primary care physician (PCP).
Most dental insurance plans have a deductible and coinsurance. Some also have a benefit cap. Most plans encourage adults to visit the dentist twice per year.
If you like your dentist and are considering an EPO plan, check with them to see if they’re in-network. While they may not be in-network with every EPO, many have broad nationwide networks.
Similar to HMOs and PPOs, POS plans are more flexible. They allow people to go out-of-network if their primary care physician makes a referral, and they typically cover in-network services at a lower rate of cost than if people visit out-of-network professionals (“Types of Dental Plans” 2018). They may also charge minimal co-payments for in-network visits and may not require people to select a PCP or get a referral before visiting a specialist.
However, if beneficiaries do choose to see out-of-network providers, they may still be responsible for the plan’s annual deductible and “co-payments or coinsurance, and/or the usual and customary fees” that a provider charges (Schaake). Also, they may not receive full coverage unless their primary care physician has made a referral. The POS plan model has evolved over time, and the details vary between different insurance companies.