Most people know they need health insurance. And, with the health insurance marketplace, it’s a lot easier than it used to be. But, when it comes to dental plans, we all need a little help getting things organized. Here are some tips on how to shop around, what to ask, and how to pick the right plan.
Your Basic Options
The Preferred Provider Organization (PPO)
A PPO is a network of dentists who are bound, by contract, to offer dental services for an agreed-upon price. The insurance company organizes the group of dentists and helps facilitate pricing for the organization.
It then sells insurance policies which reflect the pricing scheme set by the organization.
The number and amount of services is predetermined, but there are usually several plans for you to choose from, so you can get the types of services and coverage you need.
When you initially sign up for a plan, you can choose options like your deductible, copay options, and other features and benefits. You will receive a statement of benefits from the insurer, which includes both in-network and out-of-network benefits.
In-network coverage pays for services provided by the dentists in the plan. Out-of-network coverage provides services outside the network of dentists in the plan. Normally, when you choose out-of-network services, you pay a higher out-of-pocket cost for those services.
In some cases, there reduce, or no, coverage when you go out of network.
As you might guess, this makes in-network coverage much cheaper than out-of-network coverage.
The Dental Health Maintenance Organization (DHMO)
A DHMO relies on a network of dentists too, but the plan works a bit differently from an PPO. Instead of relying on dentists to negotiate rates, the plan sets up a menu of prepaid services that you can take advantage of.
Dentists are paid whether you use the services or not. Obviously, this means it’s better for you to take advantage of the service than to sit there and pay premiums each month.
Insurance companies know that only a portion of the insured in the insurance pool will take advantage of services every month, which makes the plan profitable.
In some cases, you might not have to pay anything out of pocket for services, like basic maintenance, cleanings, etc.
What To Ask
There are a few questions to ask before signing up to a DHMO.
First, ask whether you can choose the dentist that you want. Some DHMOs won’t let you do this, or the list will be really limited. Others give you the freedom to keep the dentist you already have.
Are there any restrictions or limitations on coverage if you need to be treated by a specialist? Can you even get care by a specialist? Make sure that you know what kind of coverage you’ve got and that you’re not being limited in any way by it.
What are the total costs for the plan? You’ll want to ask about the total premiums, the deductible, if any, co-payments, and coinsurance. You can get a dental plan quote at Guardian Life to get started, and then compare it with other plans to see who offers the best rates and coverage.
Don’t just look for a low price. Look for good value.
What is the maximum that the plan will pay? Not all plans are unlimited, so ask. And, even when there is a high limit, is that per year, or the lifetime maximum. Keep in mind that, when you do hit those maximums, you will have to pay for dental expenses out of pocket.
Does the plan cover crowns, root canals, oral surgery, or other hardware and procedures? Most will, but many will not. What about treatment for gum disease? Gum disease is very common, and it’s likely that you already have early stages of it.
It there an out-of-pocket limit for deductibles and coinsurance? Most plans do have limits, but you’ll want to ask.
What about emergency treatment? Health insurance will sometimes cover emergency dental treatments, but not always. Make sure your dental insurance does.
Choosing The Best Plan
In general, if you want the ability to keep your dentist, and he or she is in the existing network of the insurance company’s PPO, then that will probably be your best option.
DHMOs are basically prepaid medical care, and they’re great when you think you’ll use a lot of dental services. One caveat with them: your premium may rise substantially over time, especially if other people in the DHMO use services frequently. That’s because the menu of services is priced attractively based on the idea that not everyone will use all covered services every month.
In some months, the dentists will collect more in fees than they are giving back in service. In other months, the opposite will be true. If the dentists start losing money, fees are bound to increase.
Harvey Mitchell is in the medical insurance industry. He wants to help people better understand the jargon often involved and has taken to sharing his knowledge through writing for health and personal finance blogs.
