Typically, dental insurance is not part of health insurance coverage. instead, it’s usually an optional plan that can be purchased separately and doesn’t always work exactly like medical coverage does.
Dental insurance is a policy that helps cover the cost of services administered in a dental office for a monthly premium similar to the way you pay for health insurance. “but it’s not insurance in the traditional sense,” explains alex karrenbrock, sales associate at apollo insurance group in lees summit, missouri. “It is a discount plan with a limited benefit. that is, if you go to a dentist who is in the network, he is contractually obligated to give you the discounted insurance rate and not the office fee, which is typically 20% to 40% higher,” he says. the. your dental insurance coverage helps pay some or all of the fee; the amount paid depends on your specific plan and the benefits offered.
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Although dental insurance doesn’t always cover the entire bill, many people find it helpful when it comes to saving on preventive care and dental procedures that may be necessary. Dental work can become very expensive very quickly, and insurance can often help ease that financial burden.
different types of dental insurance
There are eight basic types of dental insurance, according to the American Dental Association (ADA). if you’re looking for coverage, knowing the differences is key.
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preferred provider organization (ppo) plans are like health insurance in that they offer a network of dentists who are covered by the insurance company to perform dental work for a fee fixed. These plans generally offer stronger coverage for more expensive procedures like implants, braces and surgery, according to Yenile Pinto, D.D.S. owner of deering dental in miami. “PPOS also tend to have better doctors in their networks, and you usually have the option to use your benefits outside of network as well,” she explains. “the downside of a ppo is that most plans have a benefit of $1,000 to $2,000, after which you are responsible for paying the full amount, even though you pay the discounted insurance rate, which can save you up to 40 %,” says Dr. I paint.
Dental health maintenance organization (DHMO) plans give dentists a certain amount of money each month for each patient assigned to them. they are then required to provide certain services at no cost or at a reduced cost to those patients. “dhmo plans generally have unlimited benefits, but there is a copay for all procedures, and they tend to have more restrictions and lack coverage for higher-tier procedures,” says dr. pinto. “Also, because dentists are reimbursed relatively low, many opt out of dhmos, which can limit their access to better, more experienced providers.”
indemnity plans are the most similar in structure to a traditional health insurance plan. the insurance company pays claims based on procedures performed and typically allows patients to choose their own doctors. “This policy pays the dentist a percentage of the bill on her behalf according to plan guidelines,” Karrenbrock explains.
direct reimbursement (DR) plans are exactly what they sound like: “these types of plans require you to pay the bill up front and then file a claim with the insurance company to receive a check refund in the mail later,” Karrenbrock says.
point-of-service (POS) plans are arrangements where patients who have a managed care dental plan can receive treatment from an out-of-network provider. the patient is generally reimbursed, but the benefits are significantly reduced compared to what they would be if the patient saw an in-network provider.
Discount or referral plans are not technically insurance plans: “There are alternative types of plans called discount dental plans that only give you a discount on dental services, like a coupon on the grocery store,” Karrenbrock explains, “but you are still responsible for the full cost of the discounted bill.”
exclusive provider organization (epo) plans only allow patients to use participating dentists for reimbursement. Because of that restriction, these plans significantly limit access to dental options and care.
table plans or allocation tables require users to pay a fixed amount for each procedure. patients must pay the difference between the fare and the carrier’s payment.