Dental health is necessary for general body health. Taking care of your teeth is not only important for your facial appearance; it also prevents conditions that could affect your body. These include gingivitis and periodontal diseases. One of the most important steps in ensuring that you receive dental care is by having a dental insurance cover. The main types of dental insurance plans are Indemnity, Health Maintenance Organization, and Preferred Provider Organization. Let us look at each plan in sufficient detail.
Also called traditional insurance, this is a policy that allows the policy holder freedom to choose any dentist they want for their treatment. The policy holder is required to pay the dentist for their services and then seek reimbursement from the insurer through a claims process. These covers cover between 50%-80% of the total dental cost, with the balance being settled by the policy holder.
There are two ways of determining cost through indemnity plans: UCR and Table of Allowances.
The Usual, Customary, and Reasonable or UCR, is a formula used by insurance carriers to calculate the cost of a procedure. The insurance company will determine the price of certain procedures from different dental services and come up with the average prices for these procedures. The insurance carrier will then base their benefits on a percentage of these average prices.
For example, if your provider finds the average expense for a filling is $120 and they are willing to pay 80% of this cost, if you are treated by a dentist who is charging $140, your insurer will only pay $96 (80% of $120), leaving you responsible for paying the rest-$44.
The Table of Allowances refers to a list of the procedures covered by your policy and the fixed amount your carrier is willing to pay for each. If you get a procedure that is not covered, you get to pay for it.
The main disadvantage of indemnity plans is that they are the most expensive policies. You are required to pay upfront for the cost of treatment and wait to be reimbursed. Furthermore, reimbursement can take a while due to the long claims process. The premiums and deductibles are also very high compared to other dental insurance policies.
Health Maintenance Organization
This is a form of managed care policy that is adopted to make health care more affordable. With this policy your carrier only pays a select network of dentists. The insurance carrier negotiates with these dentists on matters related to services and costs. The dentists are paid a set monthly fee depending on the number of people assigned to the practice and not on the type of services provided. On the other hand, you are required to pay a monthly premium. In some cases, you may be called upon to settle dentist co-payments.
The main benefit of this plan is that you can visit the dentist several times but they will only get a fixed payment at the end of the month regardless of the services they offer to you. The downside of this plan is that when you seek treatment from a provider outside the recommended network of dentists, you are not illegible for reimbursement.
Preferred Provider Organization
PPO is more costly when compared to HMO and Indemnity plans. While you are given a list of dentists to consider for your treatment, you are allowed to seek services from dentists who are not in the list. However, your insurance provider will pay a low amount for services provided by dentists who are outside their list.
The premiums for PPOs are very high and you are also required to pay a deductible. It is after you pay the deductible that the policy caters for a share of your treatment. PPOs have a maximum limit that they are willing to pay for your treatment each year. After reaching the maximum limit, consumers are responsible for paying for the full cost of dental treatments.
When looking for a dental insurance plan, you want a policy that is both affordable and sufficient for your dental care. If you go for dental procedures regularly, a HMO would be ideal because the provider is given a fixed limit. If you do not frequent dental clinics and your dental health is intact, consider indemnity or a PPO plan. Whatever you do, the ultimate goal of having dental insurance should be to maintain oral health at an affordable and convenient clinic.