Dental health is vital to your well being. The problem is that dental care doesn’t come cheap.
Fortunately, there are dental plans widely available that substantially reduce the cost of oral care. As with health insurance, these can significantly vary from one another.
The design of your policy has a significant effect on out-of-pocket expenses and coverage.
A thorough understanding of dental health insurance is vital in choosing the plan that best suits your family’s needs.
Most Common Dental Insurance Plan Designs
Although a variety of dental insurance is available, and individual features may vary, most commonly, these plans fall under one of four categories. These are:
- Direct reimbursement programs – You are reimbursed with a predetermined percentage of the total cost spent on dental care. This plan is not restricted by the category of treatment, allowing you the freedom to choose your dentist. It also creates an incentive to seek cost-effective options.
- UCR (usual, customary, and reasonable) programs – You have the freedom to use the dentist of your choice. These plans pay either the customary fee or a percentage of the cost, whichever is the lowest of the two. Customary fees are not necessarily the same as fees charged by the specialist.
- Table or schedule of allowance programs – These plans only cover predetermined dental procedures. This kind of insurance only pays a certain amount of the cost incurred. You as the patient are responsible for settling the difference
- Capitation programs – This form of insurance pays a fixed amount to contracted dentists per enrolled member. This payment is typically a retainer fee, occurring monthly. This then covers pre-arranged types of treatment with no charge to the patient.
Evaluate your needs to determine which type of program will best suit your situation.
Dental Insurance – What You Should Know
Dental insurance administrators often require a treatment proposal plan to be submitted. This will then be evaluated by them to determine the following:
- Your eligibility period
- Treatment options
- Copayment percentage or amount
- Which procedures are covered
- Benefits limitations
In instances where the treatment exceeds a certain amount, you’ll be required to obtain pre-authorization from your insurance provider.
In general, annual benefits limitations are predetermined to contain costs. This can be done by limiting the yearly dollar amount or the number of procedures. With regular preventative care, this works out to be adequate coverage.
By taking these limitations into account, you can minimize personal expenses and optimize scheme compensation by planning treatments with your doctor.
Dental insurance schemes often provide a peer review mechanism. This is aimed at resolving disputes between patients, dentists, and third parties to avoid lawsuits. It ensures results, individual case consideration, thorough records examination, and fairness. It typically ends in a satisfactory resolution for all parties concerned.
What to Consider While Selecting a Dental Plan
To ensure that you fulfill your oral care needs, you need to consider the following:
- Are you free to choose your dentist, or do you have to use one that forms part of your insurance’s network of doctors?
- Is your dentist required to perform the least expensive alternative treatment, or do you and they control treatment decisions?
- To what extent, if any, does the plan cover preventative, emergency, and diagnostic services?
- When it comes to routine treatment, what is covered, and how much is your copayment?
- Does the plan cover major dental care, and how much of the cost are you responsible for covering?
- Which procedures are not covered by the insurance?
- What are your annual limitations?
- Does the plan include dental specialists, and do you have the freedom to choose that person?
- Can you schedule dentist appointments when needed?
- Who is covered by the insurance?
- When does your dental coverage become active?
Your dental plan and its coverage are predetermined. Contact your insurance provider if you have any queries.
Reducing Dental Care Expenses by Maintaining Oral Hygiene
Through practicing proper oral hygiene, you minimize your risk of tooth decay and gum disease. This lowered risk results in less work for the dentist. Below are a couple of tips to help you maintain correct mouth hygiene:
- Brush your teeth two to three times per day
- Floss regularly
- Control your sugar intake
- Follow a healthy, well-balanced diet
- Hydrate regularly
- Use mouthwash
- Don’t use your teeth for anything other than eating (i.e., opening bottles, etc.)
- Change your toothbrush every two to three months
- Visit your dentist at least twice a year for a checkup
- Obtain reliable dental care
You only get one set of teeth, and they must last you a lifetime. It’s worth taking care of your teeth, and a reliable dental plan allows you to do this.