Choosing the right dental insurance plan is an important decision. It will determine how much you spend on dental care throughout the year. There are numerous insurance plans available, but not every family will have the same needs. Because of this, the right insurance plan for your family may not be the same as the best one for your neighbors.
The following tips will help you find the right dental insurance for you and your family.
Understand the Types of Plans
Before you start looking for dental insurance, make sure you understand the various types of plans that are available. This is important as you may prefer a particular structure over another.
HMOs tend to be the most affordable dental insurance plans. These plans limit you to their network. As long as you stay in your network, dental care is covered. If you see a dentist out of network, you will be responsible for the full cost.
Your employer-offered dental insurance is likely a PPO. These tend to have slightly higher premiums than HMOs, but they make up for it with a larger network. Not only do they typically have larger networks, but they also typically give you some coverage if you see a dentist who is out of network. While you won’t have to pay the full cost to see an out-of-network dentist as you would with an HMO, you will still have to pay some of the cost.
Dental Indemnity Plans
Choosing this type of plan will give you a higher premium and a higher co-pay than you are likely to get with a PPO or an HMO. However, you get the freedom to see any dentist you want. There is no in-network or out-of-network.
Dental Discount Plans
These are an alternative to traditional dental insurance. You can think of it as more of a membership that gets you discounts than an insurance plan. You will pay a small fee every month, and, in return, you will get discounts on your dental care.
Pay Attention to Coverage Amounts and Limits
While the coverage amounts and limits will vary by insurance plan, their structure also tends to vary based on the type of insurance plan you have.
For example, many PPOs follow 100/80/50 coverage. This means that you get 100 percent coverage for preventative care. Basic restorative care gets 80 percent coverage, and major restorative care gets 50 percent coverage. You will also likely have a deductible for restorative services but not preventative services. That being said, the deductible is typically small, around $50 for individuals or $150 for families. There is also a variation of this called 10/70/50, which is identical but only covers 70 percent of basic restorative care.
Instead of paying out a percentage of the cost of treatment, HMOs tend to specify co-payments that you are responsible for with each service. For example, you may have to pay $10 for every dental exam. Or you may have to pay $20 for every filling.
Always pay attention to the annual limit for your insurance plan if there is one. This is especially important for those who have poor oral health or are prone to dental issues. PPOs frequently but do not always have coverage limits. By contrast, HMOs typically don’t have annual coverage limits.
If there is a coverage limit, expect it to be around $1,000 to $2,000 per year per member of the plan.
Classes of Dental Insurance Coverage
One of the most important considerations for your dental insurance is what services and treatments you want to be covered. The good news is that insurance companies make it easy to compare this by dividing coverage into classes.
Keep in mind that while most insurance plans will follow these four classes, not all do.
The classes are as follows:
- Class I: Preventative and diagnostic care (checkups, cleanings, and X-rays).
- Class II: Basic restorative treatment (root canals and fillings).
- Class III: Major restorative treatment (bridges and crowns).
- Class IV: Braces (orthodontia).
If you want coverage for Class IV, pay close attention to the details. Not all insurance plans will even offer this coverage. If they do, expect it to have a lifetime maximum that is separate from your other insurance. There may also be age-related restrictions on coverage for braces. If those age restrictions exist, they will typically limit the coverage to those in their teens or younger, although there are variations.
Check If Your Dentist Is In-Network
Assuming you opt for either a PPO or HMO, which is the most likely scenario, make sure that your preferred dentist is in-network before choosing a plan. This is especially important in the case of HMOs, as you will either have to pay for the full cost of all dental services or switch dentists. Even if you choose a PPO, it is worth checking as you would be responsible for some of the costs associated with out-of-network dentists.
You can check with your dentist or with your potential insurance plan. Dr. Dhiraj Sharma, for example, accepts most major PPO and HMO dental insurance.
Consider Dental Insurance from Work First
When you start looking for dental insurance, it’s smart to start by looking at your dental coverage from work if you have it. This will typically lead to better costs for you due to employers getting “group rates.” Think of it as the equivalent of saving money by buying in bulk.
In some cases, your employer may even subsidize part of your dental insurance. You may also get the added convenience of being able to pay for insurance via automatic payroll deductions.
Think About Your Family’s Dental Needs
Perhaps the most important thing to keep in mind as you weigh the pros and cons of various dental insurance plans is what your family needs. Are your children likely to need braces soon? If so, opt for a plan with orthodontics coverage. Does anyone in your family have a history of a lot of cavities or need for crowns or root canals? If so, you likely want to spend a bit more for coverage.
When thinking about your family’s dental needs, consider the services you expect to need as well as your budget. You will likely want to work out possible scenarios of what your dental care for a year may look like and compare costs across various insurance companies. If you have more questions about finding the right dental insurance or finding a reliable dentist in Lincoln Park, contact us today.