Dental Insurance

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What is covered by Dental Insurance?

 In this video, I will explain how to benefit from dental insurance and I will try to address such questions as: How does the dental insurance work? What is the best dental plan? What is the difference between dental PPO and HMO plan? What is a waiting period? How much does dental insurance Cost? Am I required by law to have dental insurance?  Individual vs Group Dental- which one is better? What is covered by the dental insurance? What’s the difference between in-network and out-of-network? 

Learn More - here is a sample comparison of various dental insurance plans

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Dental Insurance - what is covered and what is not?

Here is what you should consider when shopping for a dental plan:

 Dental Insurance can be very hard to understand, but that doesn’t necessarily mean that it is worthless. In order to get the most benefits from dental insurance, you will need to understand how it works. As always, Information is key. In this article, I will explain how to benefit from dental insurance and I will try to address such questions as: How does the dental insurance work? What is the best dental plan? What is the difference between dental PPO and HMO plan? What is a waiting period? How much does dental insurance Cost? Am I required by law to have dental insurance? Individual vs Group Dental- which one is better? What is covered by the dental insurance? What’s the difference between in-network and out-of-network care?

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Always compare your options before you buy a Dental Insurance Plan. Know your benefits! Also, please watch the video above and learn how individual dental insurance works. 

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F.A.Q about dental insurance

Here is what you should consider when shopping for a dental plan:

How does dental insurance work?  
 If you’ve had health insurance, you’re going to be familiar with how a dental plan works. If you are still confused, I’ll explain how it works.
 

  • You pay a premium, a certain amount      monthly, to buy the dental insurance plan. 

Your insurance wont’ pay for everything, so there are a few things you may want to know like deductibles, coinsurance and copays.  
 

  • Your deductible is what you have to pay      out-of-pocket for services covered by your plan before the      insurance company pays.
  • Your plan may include copays, a fixed      cost you pay for a certain service, like an X-ray.
  • Coinsurance refers      to the percentage you pay of covered expenses after you meet your      deductible. So if your coinsurance for a filling is 20%, and the cost for      that service in-network in $100, you would pay $20 of that. The insurance      company would pay for the rest of your covered expenses up to your annual      maximum.


How much does dental insurance Cost?  
 The answer is – it depends.  
 The HMO plans tend to be less expensive and PPO plans a bit more pricey. Before buying dental insurance, first ask yourself what are your needs? Do the math. Often your annual premium is less than the cost of two visits to your dentist per year for regular check-ups. You can call your dentist and ask for the price of a visit if you pay yourself, without insurance. It’s likely that dental insurance is cheaper than paying for two visits out of your pocket. Plus, you get the added benefits of having dental coverage that will save you money in case unexpected dental issues come up. See above, the sample comparison of various dental plans available in California. By the way, comparing the dental benefits side by side is a great way of determining what type of plan would benefit you the most! There are some discount plans for as low as $9/month. PPO plans range from $35 to $80/month. The comparison is for information only and is based on California zip code.  Teeth whitening is included in most plans. Select from various Delta Dental PPO and HMO plans, Anthem, Cigna, Metlife etc. 

Am I required by law to have dental insurance?

The answer is No. The Affordable Care Act (ACA), doesn’t legally require adults to have dental insurance. However, having dental coverage is an important part of staying healthy and having access to preventative dental services. It is up to you whether you decide to buy dental insurance or choose to pay the full cost of dental care out of your pocket.  

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Dental Insurance F.A.Q.

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What is covered by the dental insurance?


HERE IS THE TYPICAL BREAKDOWN OF DENTAL BENEFIT CATEGORIES.


· Major– is Usually covered at 50%- Which means the insured (patient) pays the other 50%- Most of the time crowns, bridges, dentures, partials, inlays, onlays, etc are considered major.

· Basic– Usually covered at 80%- Which means the insured (patient) pays the other 20%- Most of the time fillings, extractions, periodontal services, root canals, core build up, quadrant scaling, scaling and root planing, etc are considered basic.

· Preventative– Usually covered at 100%- Which means the insured (patient) pays nothing additional- Most of the time routine cleanings, x-rays, exams, dental sealants etc are considered preventative. There are usually timing limitations to the cleanings and sealants, these are different on almost every policy.

Waiting Period? Group Insurance Vs. Individual Insurance?


In addition, I would like to outline one very important aspect of dental insurance. Most individual and family dental plans have a waiting period for basic and major services. Group plans or employee benefits plans usually don’t have a waiting periods due to various reasons. Due to the risk of adverse selection, the insurance companies impose a certain dental plans. 

For example, some contracts will not let you get any basic services in the first 6 months of the policy and you might have to wait as much as 12 months in order to get your major procedures covered. There are some exceptions,  here is a comparison chart that outlines various options. 


Now that you understand the basics of how dental coverage works let’s talk about the types of dental insurance plans, which is another area that can be totally confusing and can change each time you renew your health insurance if your dental insurance is part of that plan. It can change yearly, and this can determine how much out of pocket you pay.

So, let’s explore various types of dental insurance and try to determine what is the best plan

There are three basic types of dental insurance plans: Dental HMOs, Dental PPOs and Dental Indemnity plans. To find the best one for you, you should consider what your most important deciding factors are (for example, cost, keeping your dentist, flexibility) and look at dental plans that suit your needs.

Dental HMOs:

HMO stands for Health Maintenance Organization. If you participate in a Dental HMO, you generally have

· Lower premiums than either a Dental PPO or an Indemnity plan

· No annual maximum to the benefits the plan will pay

· A restricted network of dentists and dental providers

· No benefits for going to out-of-network dentists or providers

· A list of copays (standard costs) you will spend for office visits and specific dental services

Dental PPOs

PPO stands for Preferred Provider Organization. If you choose a Dental PPO, you can expect

· Higher premiums than a Dental HMO

· An annual maximum to your benefits (often $1,000, but it varies by plan)

· A network of dentists or providers that have agreed to offer discounted services and that you can choose to use to save money

· Some benefits paid to out-of-network dentists or providers you might choose to go to instead

· A list of the percent the insurance company will pay for different dental services. (For example, many Dental PPOs cover 100% of preventive services like exams and cleanings but may pay only 50% for major expenses like crowns or bridges.)

Dental Indemnity Plans

This is traditional fee-for-service insurance, offering the most freedom of choice. You can expect

· Higher premiums than either a Dental HMO or Dental PPO

· An annual maximum to your benefits

· A small deductible you have to meet

· No network of providers, meaning you get the same benefits with any dentist you choose (but also meaning there are no network-negotiated discounts on dental services)

· A list of the percent the insurance company will pay for different dental services, just like with Dental PPOs

What is the difference between in-network and out-of-network dental care?

In-network care means that you can only see the doctor or doctors that are in network or have a contract with your insurance company. Out of network means that you can go to other doctors, but you have to be extra careful and don’t assume that because you will end up paying more for out of network care. 

Here are a few things to keep in mind 


Cost and convenience. You can help make more affordable dental care for yourself by staying in-network. A dentist in-network has agreed to lower rates on services. 

Also, some dental insurance plans don’t pay any benefits to out-of-network dentists at all, or pay less. Check your plan before you buy.

Finally, if you stay in-network, you often won’t have to deal with submitting claims yourself. The dental office and your insurance provide will handle that. If you are out-of-network, you may have to submit your own claims and wait to be reimbursed. Again, before you buy a dental plan, I will highly advise that you search whether or not your doctor is in network or find another doctor that woks with your insurance company. 

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NAVIGATING THE DENTAL INSURANCE “MAZE”

1.

 Pay attention when you are buying the insurance. If you are at work and the employer is offering multiple plans, spend some time really researching which plan is best for your family. If you really only need dental cleaning, then may be a basic dental plan will be sufficient. If you are planning a major procedure like root canals, crowns, etc. then you may want to get a more expensive plan that pays more for these procedure and is less likely to exclude services.

2.

Call your insurance company and ask questions. Remember you are paying them, ask them questions try to understand your plan. 

3.

Read the booklet that your get from the insurance company. It is ultimately your responsibility to know how your plan works, so do your homework- read the summary of benefits for your plan. Believe me, this will save you tons of money!

4.

Work with an insurance agent. Agents will be able to compare various options and help you choose the one that is best for you. If you don’t have an agent, we will be glad to help you in California. 

5.

Get a treatment plan from your Dentist. This is a great way of estimating what dental work needs to be done, when and how much it will cost you. 

6.

 Do the math! Call your dentist office and ask “How much did we spend total aside from insurance last year?” If this amount is less then your insurance premium maybe you should just pay out of pocket or utilize an HSA (health savings account). It really doesn’t make sense to pay more for insurance then you get in benefits year after year. Again, Do the math; it will help you make the right decision.

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Dental Insurance 101

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Feel free to reach us if you have a question about dental insurance or would like to get comparison of various plans. 

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How to Get the Most out of Your Dental Insurance?

Pre-treatment estimates

Minimize your out-of pocket expense for dental care by asking your dentist for a pre-treatment estimate from Delta Dental before you agree to receive any prescribed, major treatment. This lets you know up front what the plan will pay, and the difference you will be responsible for. Your dentist may be able to present alternative treatment options that will lower your share of the bill, while still meeting your basic dental care needs. 


What is a pre-treatment estimate?

A pre-treatment estimate is a free service that some insurance companies provide to their enrollees. It can help you and your dentist make more informed decisions about your dental care.

A pre-treatment estimate is particularly useful for more costly procedures such as crowns, wisdom tooth extractions, bridges, dentures or periodontal surgery, or implants (by the way there are some insurance companies cover implants!!!). When your dentist submits a pre-treatment estimate, the insurance company will send an estimate of your share of the cost and how much the insurance will pay.


Why should I consider a pre-treatment estimate?

A pre-treatment estimate is a good idea if you are having extensive work done and want to know what your share of the cost will be. Also, you can find out:

  • · If the procedures are covered
  • · If you will exceed your maximum
  • · How best to plan your payment portion


How does it work?

Your dentist sends to the insurance company a proposed treatment plan, along with relevant x-rays. The insurance company then checks to be sure that the services are covered. Some dental work may be limited or excluded by your plan, and a pre-treatment estimate will help you understand which services are covered before you proceed with treatment.

The insurance company also calculates how any coinsurance and dollar maximum limits might affect your share of the cost. You and your dentist then receive an estimate of the amount the insurance company will pay for approved services and the amount of your payment portion.


How long does it take?

Pre-treatment estimates usually take about three weeks. To provide faster turnaround, a pre-treatment estimate does not take into account any deductibles, so please remember to figure in your deductible, if necessary.

Unless the need is urgent, it's worthwhile to find out how much of your treatment is covered, allowing you to plan in advance for your portion of the dentist’s bill.