Individual Dental Insurance « Health Insurance Advisory

Individual Dental Insurance

Author: Administrator | Mar 19 2011 | h-s-a, Individual Dental Insurance, temp-health-ins

According to the American Dental Hygienists’ Association, oral health is a critical component of total health. Recent research has linked periodontal disease to heart and lung disease, diabetes, low-birth weight babies, and a number of other systemic diseases.

Dental caries (decay) is the most common chronic disease nationally affecting 53% of 6-8 years olds and 84% of 17 year olds. Fortunately, caries is preventable through the use of fluoride and dental sealants and is less than half the cost of one silver filing.

Serious oral health problems also occur among adults too. Each year about 30,000 Americans are diagnosed with oral and pharyngeal (throat) cancers, and more than 8,000 people die of these diseases. In addition, almost 30% of elderly adults no longer have their natural teeth due to tooth decay and gum disease.

As the cost of dental care increased over the years, dental insurance has gained in popularity.  Many employers offer some form of group dental insurance today.  However, it is estimated that only 62% of employers actually offer full coverage dental insurance.

If you are paying too much or do not have full coverage dental insurance, an individual dental insurance plan will help promote your overall health and wellness, and protect your pocketbook.

Studies show those without full coverage dental insurance are less likely to see a dentist than those with dental insurance. The uninsured tend to visit a dentist only when they have a problem and forgo important preventive care (cleanings, exams and x-rays) which tend to result in health issues and expensive dental treatment down the road.

Cost of restorative treatment is more expensive than preventive services

The Coalition for Oral Health, representing a wide spectrum of oral health associations, reported that one-dollar spent for prevention saves from eight to fifty dollars in restorative care (see chart below):

Average Cost of Common Dental Procedures Min. Cost Max. Cost
Exam & Cleaning $86 $110
Complete X-Ray Series $123 $171
Filling $119 $181
Root Canal $1,315 $2,351
Crown $1,144 $1,443

The importance of preventative dental care

Good oral hygiene can prevent disease. The early detection and treatment of oral disease is critical to saving lives. During oral health examinations, dental hygienists can detect signs of many diseases and conditions like HIV, oral cancer, eating disorders, substance abuse, osteoporosis, and diabetes. In addition, dental hygienists can work with patients to develop oral health care treatment plans that manage oral infection so it does not exacerbate serious diseases.

Many states have undertaken various strategies to address the access-to-oral-health problem by providing incentives to dental providers to serve people enrolled in Medicaid or the State Children’s Health Insurance Program (SCHIP).

Full coverage dental insurance- covered services

Most individual dental insurance plans usually pay some or all of the cost of the following dental services and supplies:

1. Preventive: cleaning, exams, sealants and fluoride treatment

2. Diagnostic: bitewing x-rays and full mouth x-rays

3. Basic: fillings, simple extractions and repairs

4. Major: oral surgery, periodontics (treatment of diseases affecting the gums and supporting structures), prosthodontics (replacement of missing teeth and related mouth or jaw structures by bridges, crowns, dentures or other artificial devices) and endodontics (treatment of diseases of the dental pulp, tooth root, and surrounding tissues, including root canals)

5. Orthodontia: correcting irregularities of the teeth by the use of braces or other devices (orthodontia is an optional benefit under most individual dental insurance plans and services are covered for juveniles only).

What are the most common reasons for purchasing full coverage dental insurance?

An individual dental insurance plan can benefit you in many ways, including:

1. Financial protection – without some form of dental insurance to help cover the expense of dental care, the cost of paying for expensive dental procedures, such as restoration, surgery, endodontic and periodontal services, is simply not affordable.

2. Maintenance of a healthy mouth and overall wellness – studies show that regular dental check-ups and cleanings help maintain overall health. That is why most dental insurance pays 100% for routine exams and cleanings every six months.

3. Prevention for children – from fluoride treatment to sealants and braces, children can benefit significantly from regular professional dental care. Dental insurance can help make the cost of preventive care more affordable, even orthodontia.

Types of Full Coverage Inexpensive Dental Insurance

There are several types of individual and student dental insurance plans, including:

  • Dental Preferred Provider Plans
  • Dental Maintenance Organization (DMO) Plans
  • Scheduled Reimbursement Dental Plans
  • Discount Dental Plans

Indemnity Dental Insurance

These are “traditional” dental insurance plans where the dental insurance plan covers a percentage of your dental expenses. Since there are no network providers, dental services can be obtained from any dentist.

After you satisfy the deductible, the dental insurance plan generally pays for covered services up to an annual maximum, usually between $1,000 and $2,000. Indemnity dental insurance will pay based on the Reasonable and Customary (R&C) expense. That means if your dental provider charges more than the R&C expense, as determined by the dental insurance company, you will be responsible to pay the difference. Additionally, individual dental insurance may have waiting period(s) for certain services.

Dental Preferred Provider Plans (PPO)

Although, generally less expensive than indemnity dental insurance, PPO (Preferred Provider Organization) dental plans work very much the same way. They also offer the option to obtain dental care from a network provider. Since the dental insurance company has negotiated discounts with participating providers, you pay less for dental services. While individuals can also seek treatment from dentists outside of the PPO, they will have higher out-of-pocket costs.

Just like indemnity dental insurance, benefit payments made by the dental insurance plan can be paid to you or directly to your dentist, if you assign them. Reasonable and Customary, however, does not apply when dental services are received from a network provider. That means your dentist cannot bill you for the difference between the negotiated rate and his/her retail charge for the services rendered.

DMO Dental Insurance

These dental plans, also called DMO’s, operate the same as health maintenance organizations. As a result, they maintain a much smaller network of dental providers because DMO’s pay a set fee each month to the participating dentist you select.  DMO plans reward participating dentists who keep patients in good health and keep plan costs low. The premium for a DMO dental plan is generally the lowest of any type of dental insurance plan. Your out-of-pocket expense for dental services is also less too. However, the trade off is less flexibility because there are much fewer dental providers to choose from than traditional PPO dental plans and care must be rendered by the dentist you select.

Scheduled Reimbursement Dental Plans

A scheduled reimbursement dental plan pays a fixed dollar amount based on the fee schedule that appears in the dental insurance policy. This fee schedule lists a wide range of dental services and shows exactly how much the dental insurance plan will pay you for each service. Most scheduled dental plans include a deductible and calendar year maximum. Some have waiting periods for certain procedures. You are responsible for paying your dentist the difference between what the dental insurance policy pays and the amount of your dentist’s actual charges.

Dental Discount Plans

Discount dental plans are not insurance. They simply provide discounts for a wide range of dental services when care is obtained from a participating dentist.  Health discount plans represent a great value and alternative if you do not have or cannot afford individual dental insurance.

At healthinsuranceadvisory.org, we offer a FREE health discount plan. This program provides significant discounts on prescription drugs, dental expenses and vision services at major chains and local providers across the country. No enrollment, membership or monthly fees. Use it immediately. There are no usage restrictions and you are not required to provide personal information to get one!

Start saving today. You will realize discounts up to 65% on prescription drugs, 25% to 40% over usual charges for dental services and 10% to 50% off eyewear, contact lenses and exams. Download and print your FREE health discount card now!

Our online dental insurance quotes allow you to quickly and easily find an affordable individual dental insurance plan.  You can even enroll online too!

Since dental insurance rates are regulated, the dental insurance premium you pay is the same as buying direct from the health insurer.  At healthinsuranceadvisory.org, you have total peace of mind knowing that you are paying the best possible price.

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