If you’ve ever had any dental work done, you were probably disappointed or even angered by the way your insurance covered (or didn’t cover) your procedure.
While some dental insurance plans cover 100% of certain types of services (cleanings, for examples) other categories of treatments might only be covered at 50% (like a crown or a root canal.) This begs the question, “is there really such a thing as full coverage dental insurance that covers 100% of everything that you need, regardless of what it is?”
After all, those more expensive dental procedures often get delayed due to their cost, which winds up resulting in more out of pocket expenses later.
Understanding the Difference in Dental Savings and Insurance Plans
The amount of coverage that you receive under your dental insurance will depend on the type of plan you’re enrolled in. Not all policies are created equal, so it’s best that you do just a little bit of homework.
Here are the basics, you need to know the different types of insurance or dental savings plans that are out there, when you’re looking for full coverage, look for these:
Dental Insurance PPO & HMOs
PPO and HMO plans are “managed care networks” that your dentist can choose to participate in. As part of the network, their patients receive extra savings through their insurance carrier. HMO plans require that you only see a dentist who is part of the network, otherwise you will not receive any coverage. PPO plans allow you to select dentists outside of the network if you wish, but receive a lower reimbursement in those instances. Some people prefer these plans, assuming their favorite dentist is already in-network and they don’t need a lot of work done.
Dental Indemnity Plans
This type of plan is a “Fee for Service” approach to care. You can select any dentist in any location, without having to stay within a specific network.
However, you will personally pay your dentist at the time of your service, for the entire procedure, and then file your own insurance claim (some dentists will do this for you.) Eventually, you are directly reimbursed by your dental insurance company. That being said, an indemnity plan will only pay for amounts that fit their private “Usual, Customary, and Reasonable” (UCR) fee scale…not what your dentist actually charges. For example, your dentist may charge you $180 for a filling, but the UCR fee only allows up to $160. When you have 80% coverage on fillings, that means 80% of the UCR fee and not 80% of what your dentist actually charges you, which can wind up costing you more.
Dental Savings Plans
Maybe you’ve recently gotten a new health insurance plan through the ACA, but dental coverage wasn’t included. Enrolling in a Dental Savings Plan eliminates the waiting periods and maximum allowable amounts of traditional dental insurance.
You can pick your own dental savings plan and if you go to a dentist that accepts the plan, you can save between 10-60% on your dental treatment. Dentists love dental savings plans, because there are no claims to file, and no waiting for reimbursements.
Even if you find that you have a sudden change in what your dental needs are, you can arrange to get a dental savings plan without having to delay your treatment. Because the options are flexible, you can usually call and have your plan added or changed at any time.
What’s the Best Bang for Your Buck?
Since the late 70s, most dental insurance “maximum allowable” amounts (that is, the amount of money your insurance policy will cover in dental treatment per year) has remained stagnant. Unlike medical insurance, it hasn’t adjusted with the cost of inflation. The purpose of this is to promote preventive care like early exams and cleanings, so that everyone is paying less for their dental treatment because their teeth and gums are already healthy.
But when you aren’t that great at flossing your teeth every day, you might need a plan with benefits that cover more than your standard dental insurance policy.
Even if you already carry a traditional dental plan, a dental savings plan can save you hundreds to thousands of dollars in the long run. This option is best for people who are anticipating having a lot of dental work (such as braces, dental implants, or several root canals) in the next year, as opposed to just needing a checkup.
Dental savings plans are the best bang for your buck when you need to purchase private dental insurance but want better coverage. Plus, you even have the option to add coverage for things like vision, telemedicine, and hearing.