Unlike other types of insurance, dental plans are not a safety net against an unlikely event in the way that emergency medical services or homeowner’s insurance is. Hopefully, if you have dental insurance, you take advantage of it frequently and don’t keep it just in case of emergencies. By opting for group dental insurance, you can lower the cost of your premiums while still enjoying the benefits of regular dental cleaning and checkups. Here are the three main types of group dental plans:
Preferred Provider (PPO) – A dental PPO works the same way that it does for medical insurance. Basically, you choose from a group of dentists that are part of a network of providers. As long as you get your dental care through a member of that network, you enjoy the maximum benefit and coverage provided by the insurance. With a PPO, you can also opt to go to a dentist that is not in the network, but you typically have to pay a higher portion of the cost.
Visit the Mouth Healthy website from the American Dental Association to learn more about dental care and how to keep your teeth healthy at any age.
Dental HMO – An HMO, or health maintenance organization, is similar to a PPO in that it involves a network of dental providers. With an HMO, however, you usually need to see a dentist in the network in order to receive any dental coverage. HMOs can sometimes be a good way offset the costs of more expensive procedures since in-network services are generally most cost-effective.
Indemnity Plans – Indemnity plans, sometimes called fee-for-service plans, are a good option if you want to stay with a particular dentist who is not part of a network. Indemnity plans will sometimes use a reimbursement process by which the patient pays the total cost out of pocket and later gets a percentage paid back to them by the dental insurance. Indemnity plans are often more expensive.
Premium & Coverage – The cost of a group dental plan, also referred to as the premium, is usually an important factor for most people when choosing coverage. For the most part, these premiums will correlate with the level of care that’s covered by the insurance plan–like anything else, you get what you pay for when it comes to dental insurance. Though there are limits on dental coverage (see below), there are several basic treatments that should be included as a covered benefit in a group dental plan. These include things like cleanings, tooth fillings, X-rays and root canals. The extent to which they are covered may vary from plan to plan, but most dental insurance plans should meet these criteria.
Coverage Limits – For the most part, insurance carriers that offer group dental plans will have individual coverage limits that cap out annually, usually between $1,000 and $2,000. This is an important consideration, especially if you anticipate needing major oral surgery because you’ll have to cover the expenses that exceed the yearly plan limit.
For more information about oral care and dental insurance, visit the resources page of the California Dental Association.
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