There are many different options for your dental needs. Many health insurance plans now have an optional dental benefit that can be added. Also offer many of the most popular stand alone dental plans. Depending on your needs and budget, there are four types of dental insurance plans available to individuals in California, and a fith type in dental discount card plans.
There is good news and bad news about dental coverage. The good news about dental coverage in California is that it is issued on a guaranteed acceptance basis. Meaning, even if you have dental conditions, or need procedures, you cannot be denied or declined coverage! However, the bad news is ALL plans limit the maximum annual payable benefit. Usually plans cap out at around an annual maximum benefit of $1000 dollars. Also they limit how often they will pay, and how much they will pay for many of the more common or expensive dental procedures. Also, many of the plans that offer a good benefit, specifically dental PPO plans, have 6-12 month waiting periods on major services including fillings, root canals, and orthodontics. Although the Dental HMO plans do not have waiting periods, they limit the dentists you can visit. Provider selection is the biggest drawback to DHMO dental plans.
Because most dental problems are generally preventable, and non-catastrophic, most plans emphasize preventative procedures. Virtually every dental plan covers semi-annual cleanings, and regular x-rays. You can pick your own dentist with indemnity and PPO dental plans. With HMO plans and discount cards you are limited to using the participating dentists that accept those plans. The number of dentists participating in any particular dental HMO plan varies drastically by city, county, and region. It is strongly suggested that you research the dentists in your area that will accept your dental HMO plan before you apply for coverage.
Many individuals complain about the waiting periods, or limited dentist selection, but the reason those limitations were put into place was due to abuse of dental benefits. Too many people took out coverage one month, got a root canal or other expensive procedure the next month, and then canceled the plan! Therefore there are have evolved many restrictions, including waiting periods, dentist selection, pre-approval of procedures, and others.
- DHMO Plans
- DPPO Plans
- Indemnity Plans
- Direct Reimbursement Plans
- Discount Cards (not insurance)
Dental Insurance
Considered an attractive benefit by most employees, dental insurance operates in much the same way as health insurance. In fact, it can often be purchased in addition to basic medical care, or it can be purchased as a separate policy from a separate provider. Dental coverage, or a dental benefits plan, reimburses the policyholder for certain dental expenses according to written agreement. Because most dental diseases are preventable (unlike many medical diseases, which can be unpredictable and catastrophic), most dental benefits plans are structured to encourage patients to obtain the regular, routine care that is vital to prevention and diagnosis. This emphasis on prevention is reinforced by most plans, which require the patient pay a greater portion of the costs for treatment of dental disease than for preventive procedures. Dental premiums usually vary from about $10 a month for a single person to $71 for a family.
Making Choices
Some plans allow you to choose your own dentist. Others, in exchange for lower rates, limit your choice. Although the opportunity to choose a dentist is only one factor in the decision to choose a plan, it is a good idea to note the difference between the two alternatives: Open Panel/Freedom of Choice. Allows covered patients to receive care from any dentist and allows any dentist to participate. Dentists may accept or refuse to treat patients enrolled in the plan. Coverage with this feature allows you to receive full benefits for treatment provided by any dentist of your choice. Closed Panel. Allows covered patients to receive care only from dentists who have signed a contract of participation with the third party. The third party contracts with a certain percentage of dentists within a particular geographic area, who in turn offer lower rates to the patient.
Coverage To control dental treatment costs, most plans will limit the amount of care a patient can receive in a given year through a variety of methods. They may place a dollar ” cap” or limit the amount of benefits, or may restrict the number or type of services that are covered. The exclusion of certain services or treatments is also a method of reducing costs. Be sure to investigate exactly what services the plan covers and excludes, including special administrative services available to both purchasers and participants.
Dental Health Maintenance Organizations (DHMOs)
These plans offer low cost or free preventative procedures and routine office visits, low co-pays, and selection of a single dentist from a list of approved in network dentists providers. These plans often have caps on maximum annual benefits payable. These plans cost on average from $6 to $15 dollars a monthly.
Also known as capitation plans, dental HMOs (DHMOs), are normally characterized by monthly premiums, free preventative or routine care, small co-payments for office visits, and selection from an approved network of dentists. The dentist is paid on a per capita (per head) basis rather than for the treatment provided. Contracting dentists — those within the approved network — receive a fixed monthly fee per patient regardless of whether treatment is performed. Patients may be referred to a specialist who also contracts with the plan, but they must pay in full if they use a dentist outside of the network. Other characteristics of these plans are possible initial enrollment fees and annual dollar caps. These plans cost on average from $6 to $15 monthly.
Get a DHMO Dental Quote now.
Dental Preferred Provider Organizations (DPPOs)
These plans cost on average between $16 and $39 dollars a month. You can go to any dentist in the network. Keep in mind that the networked dentists in your geographic region may vary greatly between plans. It is always a good idea to contact the dentist you are planning to go to, and ask them which PPO dental plans they accept. Also, while you have the dental assistant on the phone, you should go one step further, and ask what plans they prefer!
Preferred Provider Organizations (PPOs) are somewhere between an indemnity plan and a dental HMO. Within this plan, a defined panel of dentists provide services at a discounted rate as long as you stay in their network. If you go outside the approved network of dentists, you will pay higher deductibles and co-payments. Typically, PPOs have monthly premiums and may have an annual dollar cap. The average monthly cost is $20.
Get a free DPPO Dental Quote online.
Dental Indemnity Plans
Indemnity plans are traditional fee-for-service based plans. The average monthly cost of an indemnity plan is between $19 and $25. These plans are an excellent alternative to either PPO or HMO dental plans because you are not limited in your dentist options. You can literally go to any dentist, and still use your indemnity plan. This makes indemnity plans increasingly popular. Another popular option in recent years has been to combine an indemnity plan with a discount dental card. Although you have to use a dentist that accepts the discount card, you can stack the benefits from your indemnity plan and discount card. The biggest draw back in these type of plans is they limit the annual out of pocket maximum to usually around $1000 that they will pay out.
Indemnity plans are traditional fee-for-service based plans. Normally, the employee pays a monthly premium to the insurance company, which covers a portion of his or her dental expenses. A high pre-determined deductible is usually required before the insurer will begin paying for care, though you usually have the freedom to choose your own dentist. Preventative service costs are normally covered by the plan, which typically pays 100% of the preventative costs, 80% for common restorative services and 50% for major treatments, such as crowns and orthodontics. The remaining costs are paid by the patient through a variety of fee schedules. Most indemnity plans limit the annual dollar amount on benefits, however, and may apply probationary periods on procedures that could last up to a year. The average monthly cost of an indemnity plan is between $19 and $25.
Get a Dental Indemnity Plan Quote now.
Direct Dental Reimbursement Plans
A direct reimbursement plan is a self-funded benefit plan and is not considered an insurance plan. In most instances, an employer or company sponsor pays for dental care with its own funds, rather than paying premiums to an insurance company or third-party administrator. The patient pays the full amount to the dentist, gets a receipt for the employer, who reimburses them for part or all of the dental costs, depending upon the patients specific benefits. Typically, there are no monthly premiums. Cost depends on the number of employees, and participants have the freedom to choose any dentist they wish. Benefits are usually capped at $500 to $1,500 annually and the company may place a limit on how much an employee can spend on dental care within a given year. Often, though, there is no limit on services provided. Under this plan, the patient is reimbursed a percent of the dollar amount spent on dental care, regardless of the treatment category.
These plans are generally offered through an employer as part of a benefits package to include dental. Because of the common caps on all dental plans, many groups have the option of forming a dental savings account for their employees. A direct reimbursement plan is a self-funded benefit plan and is not considered an insurance plan. In most instances, an employer or company sponsor pays for dental care with its own funds, rather than paying premiums to an insurance company or third-party administrator. The patient pays the full amount to the dentist, gets a receipt for the employer, who reimburses them for part or all of the dental costs, depending upon the patients specific benefits. Typically, there are no monthly premiums. Cost depends on the number of employees, and participants have the freedom to choose any dentist they wish. Benefits are usually capped at $500 to $1,500 annually and the company may place a limit on how much an employee can spend on dental care within a given year. Often, though, there is no limit on services provided. Under this plan, the patient is reimbursed a percent of the dollar amount spent on dental care, regardless of the treatment category.
Get a Dental Reimbursement Plan Quote now.
Discount Dental Card (Not Insurance)
Discount dental plans, or referral plans, are the most widely available to individuals. Participants of these plans must use a participating dentist, who has agreed to offer services at a discounted rate. Typically, you pay an initial enrollment fee as well as a monthly fee to the discount company through which your discount is secured. Although discount plans work very well for many individuals seeking coverage, they are not regulated by insurance departments. Consumers are cautioned to research the history and legitimacy of these plans before providing to them their highly personal and secure information. The average monthly cost is $5 to $10.
To repeat, these cards are NOT dental insurance. In an effort to clarify, we will try not to refer to them as “plans” but rather “cards”. They typically cost about $10 a month. They are generally considered to be a more economical alternative to traditional dental insurance products. Many of our members take out a dental discount card in conjunction with an indemnity plan. That way, you are reimbursed on the indemnity plan, and get a discount from the discount card plan! The other advantage to this solution is that neither discount cards, nor indemnity plans generally have waiting periods for service. Now remember these cards pay nothing at the dentist office. They merely reduce the rate you pay the dentist based on her agreement to accept the card. This does not pay for any dental procedures you may have done.
HealthInsurancePlus.com has made a strategic decision NOT to review, offer or recommend discount card plans. Health insurance is a difficult concept to understand in the first place, and we have yet to find a discount card plan that actually meets our client’s needs. Consider this; a health insurance plan generally has a $5 million dollar maximum life time coverage limit. How much is the most your discount card plan will pay? Keep in mind that a discount plan may help for minor day to day expenses, but has little or no coverage for major or catastrophic events.
