Apart from being uncomfortable and downright frightening for many people, getting dental work can be pricey. Even the most basic procedures can drill a hole through your wallet. As a result, many people put it off until they’re facing a significant health issue.
Having comprehensive insurance can make a world of difference, not forcing you to live with a mouthful of cavities.
However, if you’re to choose a policy, it can get overwhelming to understand what each insurance covers, what you need, and how much you’ll have to pay. Let’s simplify the search procedure by breaking it down into five steps.
Step 1: Understand Dental Insurance Types
In general, dental insurance means that you pay for a service that covers some dental work expenses. These policies can cover routine X-rays and cleanings and more complicated procedures, such as getting implants.
Most policies follow a 100-80-50 structure when determining your coverage. Depending on your plan, this approach would mean covering:
- 100% for preventative care
- 80% of the necessary procedures
- 50% for surgeries and implants
So, there’s still a large share of the expenses for you to pay by yourself. Choosing the right plan can help, though. Let’s discuss the most common ones.
Indemnity Dental Plans
Also known as ‘fee-for-service’ plans, these are quite expensive and not that popular among the general population. The insurance company caps the amount they’ll pay for procedures, and if your dentist charges higher, the rest of the bill is on you.
There’s an advantage to indemnity, though. These insurance policies don’t limit you to a network, letting you visit any professional you prefer.
Preferred Provider Organization
PPOs are among the most widely-used plans. Dentists join the PPO network, negotiating a fee structure with insurers offering it.
Once you get this coverage, your visits to in-network professionals become much cheaper than to out-of-network providers. These represent an excellent mix of affordability and flexibility, as the PPOs tend to be comprehensive, including numerous professionals.
Health Maintenance Organization
HMOs are the cheapest but also the most limiting of the three central options. They are usually specific to certain areas and professionals working within them.
You’ll get most procedures for free with this premium, but dentists might charge fees for specific, highly-complex treatments.
Step 2: Think Group vs. Individual
If you’re looking to save money but don’t want to limit yourself to an HMO, you could consider a group coverage program. Your employer likely offers one, and there are also Affordable Care Act policies to explore.
Going for a group option tends to be cheaper and come with extensive benefits.
However, they tend to be relatively rigid in their structure, making the premiums too expensive or too restrictive for different people. For instance, why should you pay so much for twice-a-year checkups? On the other hand, somebody might need many dentist visits not included in the policy.
If you can’t find a group plan that meets your needs, consider the individual alternative. It’s a bit trickier to find, but you can tailor the insurance to your requirements once you do.
In this case, it’s a good idea to do a bit of window shopping online and compare quotes. Visit different insurance company websites and see what they have in store. You could also check on HealthMarkets for a quicker, more seamless hunt.
Step 3: Consider Your Needs
It’s incredibly challenging to find a plan covering all dental services that doesn’t cost a fortune. For example, almost no policy includes implants. So, you’ll have to think about why you tend to see a dentist and choose a plan accordingly.
There’s a catch to consider here. Some clauses in your insurance agreement might prevent you from getting the most expensive treatment option available. This issue often arises when dentists want to try innovative procedures that are yet to enter insurance plans.
Another limitation you might face is the number of treatments. Your plan might, for example, allow only one ‘recall visit’ – everything that falls under regular checkups – a year. However, you might need more frequent recalls.
The point is – read the fine print and take your time to consider your needs before you sign any dotted lines. You could even visit your current dentist and make a list of individual procedures you expect to face in the years to come.
Step 4: Consider Your Budget
If saving money is on top of your priority list, the alternative with the lowest monthly premium and annual out-of-pocket maximum might tempt you.
However, before you rush into it, go through the list from the previous step. Such solutions could be even more pricey in the long run if you regularly require more treatment.
Try to see insurance as an investment. You’re saving money and your health by paying more at the moment. Of course, don’t choose the coverage that’ll break the bank, but spending a little extra isn’t always the worst idea.
Step 5: Choose a Large Network
The previous two steps can be helpful for people with specific funds and medical needs. However, what happens if you can’t tell what kind of treatment you’ll require in the future or don’t have strict budgetary restraints?
In this case, it might be the best idea to go for the middle-of-the-road option, the PPO plan. Making this decision narrows down your option pool quite a bit. You can make the ultimate selection even easier by looking at large networks.
Choosing an extensive option has two primary advantages. One, the professional you’re already seeing might be a part of the PPO network. Two, you have more options at your disposal, which ensures you don’t get stuck with a dentist you dislike.
Once you enter a comprehensive PPO, do your best to visit an in-network provider as often as possible to make the most out of your plan.
The Bottom Line
Overall, choosing dental insurance can be a massive, overwhelming task, but it’s 100 times worth the trouble put into it.
Plus, as long as you’re following the fundamental principles – considering what you need and what you can pay, checking who you can visit and how often, and reading the fine print – you’re very likely to end up with a plan that truly suits your lifestyle.