Having dental insurance is important to your overall health. Not only does it ensure that you get regular checkups, but that you also to have coverage for bigger dental problems or emergencies. In Oregon, you have a few different options to choose from when considering dental insurance. Each type of plan has its advantages and disadvantages, so it depends on your individual and family needs to determine which type of plan is right for you.
Oregon has 4 different options for dental insurance:
- Indemnity Plans
- Discount Plans
Indemnity plans are what many people consider to be traditional dental plans. They are based on a fee for a service payment method. The insurance provider agrees to cover a certain amount or percentage for the cost of your dental procedures. They base the amount they are going to pay on the usual, customary, and reasonable fee or UCR schedules. Each plan has its own fee schedule. The UCR is determined by the average cost that certain procedures from dentists that participate in their plans charge. These averages are then used by insurance companies to set what they believe to be a fair price for the services and treatments provided. This then determines the amount that they are willing to cover for each procedure. One of the biggest benefits that Indemnity plans have is that they can be used at most dentist offices. With most indemnity plans, you pay for services at your dentist office upfront and then submit your bill to your insurance for reimbursement. With an indemnity plan, you will pay more out of pocket, but you have a wider choice of dentists to choose from. Most providers place a limit on what they will pay for each procedure, so be sure you know what that limit is before you get the procedure done, or you may not get all of the money you paid reimbursed back to you. Be sure to check with your provider before every procedure to find out their fee schedule, as it can change, so you are aware of what they will pay before you pay your dentist for your procedures.
If you choose a discount plan, they do not make reimbursements, which is the opposite of indemnity plans. When you purchase a discount plan, you receive a discount card that allows you to receive dental care at a discounted rate. There usually aren’t many limits to the amount of care that you can receive with one of these plans. Since these plans do not offer reimbursement, you will be responsible for the entire amount of the discounted bill at the time of your dental service. You pay the plan for a discount and then pay your dentist the discounted fee that the plan affords to you. These types of plans can be paid monthly or yearly and are often a fraction of the price of dental insurance. For those without dental insurance or the means to purchase dental insurance, these discount plans can give you up to sixty percent off your needed dental work. They can also work well for those with dental emergencies because the plans can take effect in as little as two days.
PPOs are a network of dentists within an insurance plan. Dentists within a PPO plan agree to offer their services and procedures at agreed upon rates in order to receive patients from those insurance plans. As long as you stay in-network, your out of pocket costs will be low and predictable. If you receive care from dentists outside the network, the fees and cost to you are significantly more than those dentists within the network. Some PPOs may require waiting periods before certain procedures, so always be sure to check with your plan before scheduling.
DHMO plans are managed care plans where instead of covering a certain amount for procedures, members often just pay a copay at the time of your visit. These plans also work within a network of dentists but are often more strict about using only in-network dentists. Often, these plans will not cover procedures not listed in their summary of benefits. You must choose a primary dentist and they have a limited scope of coverage, but tend to be one of the cheapest insurance options.