Individual Dental Insurance Plans | How to buy « Health Insurance Advisory

Individual Dental Insurance Plans | How to buy

Author: Administrator | Feb 07 2012 | Family Medical Insurance Plans, Individual Dental Insurance

Oral health is integral to your overall wellness. Individual dental insurance plans are important because they can pay for the cost of routine dental exams and preventive care, such as cleanings and x-rays, and protect you financially against large out-of-pocket dental expenses, such as crowns and root canals. To find the best dental insurance plan for your or your family, be sure to follow these must know tips:

Tip #1 – know how dental health insurance works

Most individual dental insurance plans have a deductible and calendar year maximum. When you compare dental insurance, look closely at these features. For example, does the deductible start over every calendar year or   do you satisfy it only one time (lifetime deductible)? Are there a maximum number of deductibles per family? Does the deductible apply to all covered dental services or just certain covered expenses? Are you also required to pay a copayment for certain services?

The calendar year maximum represents the total dollar amount the dental insurance policy will pay out every twelve months.  If you are buying full coverage dental insurance, then you will want at least a $1,000 calendar year maximum.

For purposes of determining the percentage individual dental insurance plans pay toward covered expenses (coinsurance), dental expenses are classified into one of the following categories:

  1. Preventive (exams, x-rays, cleanings, fluoride treatment and sealants),
  2. Diagnostic,
  3. Basic (fillings and extractions), and
  4. Major (crowns and root canals).

Coinsurance generally ranges from 100% for preventive care services to 50% for major care. 

Tip #2 – be familiar with the different types of dental health insurance plans

There are several popular individual and family dental insurance plans available. They are:

  • Indemnity Dental Insurance – this dental plan allows you to use any dental provider. Since individual dental insurance plans pay based on the “allowable” or “reasonable and customary fee” for each covered service, you may owe the difference between the dentist’s billed charge and the “allowable” or “reasonable and customary fee.”
  • Preferred Provider Organization or PPO Dental Insurance – choose any dentist or use a network provider. However, your out-of-pocket cost is less when you use a network dentist. While the savings may come from the PPO Dental Insurance Plan paying a greater percentage of the bill (higher coinsurance), you will never be balance billed with PPO Dental Insurance (the dentist cannot require you to pay the difference between the PPO negotiated fee and his or her retail charge).
  • Dental Maintenance Organization or DMO Dental Insurance you must select a primary dentist who coordinates all of your dental needs. The panel of participating DMO dental providers is smaller than PPO Dental Insurance. DMO Dental Insurance generally covers in-network dental care only and you are often required to obtain a referral to see a dental specialist.

Tip #3 – look at the fine print

Individual dental insurance plans may have waiting periods before certain dental expenses are covered. These waiting periods commonly range from six to twelve months and are often applicable to Basic and Major dental services. Coverage for preventive and diagnostic care usually begins immediately. Cleanings are often limited to two visits per calendar year. Frequency limits may also exist on the different types of mouth x-rays.

Rather than use waiting periods, some individual dental insurance plans increase the coinsurance (percentage the plan pays) each year that you have the dental insurance policy. The coinsurance in the first few years of the policy, however, is usually less than a dental insurance plan that has waiting periods.

Since the cheapest dental insurance is not always the best, we will help you find the best dental insurance plan for you and your family. Call for an individual dental insurance plan quote at 800-403-8511.

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