Considering the extremely high cost of dental treatment, purchasing the Dental Insurance may save you a considerable amount of money and bring you confidence that you’ll have a proper dental work even if you are currently financially dry.
There are numerous types of Dental Insurance and in order to get the most beneficial and matching your needs one you need to know exactly what each dental plan brings to you.
The typical Dental insurance policy covers basic dental treatment, including preventative works. Though, your policy may cover the less number of procedures than you expect it does.
For instance, if you have tooth’s holes which need to be filled with filler, your policy covers only an amalgam filling. If you want the filler of the same color as your teeth, it is considered a non-basic procedure and you will have to pay for it from your pocket.
It’s very similar to the health insurance principles. Read more here if you are interested https://www.choice.com.au/money/insurance/health.
Here are the main types of dental plans:
1. Direct reimbursement
This type of Dental Insurance is preferred by many due to its simplicity and the full freedom the policyholder has when it comes to choosing a dental doctor. A certain agreed percentage out of total dental works cost is stated in the policy as subject of reimbursement. It does not matter what types of works and procedures the policyholder undergoes, they will be reimbursed the same exact percentage of treatment’s cost.
Of course, the premiums are in the direct correlation with the predetermined percentage of reimbursement.
The Direct reimbursement plan has a “maximum dollar limit” agreed by the individual and insurance company, so in case you’ve reached that limit, your following expenses are your business solely.
Dental plans under the Direct Reimbursement policy type are flexible and simple and may vary greatly:
- For example, here is the plan for the maximum yearly dollar limit of 1500 dollar
- 100% coverage of the $100 dental works cost at the first time
- 80% coverage of the $250 dental works cost for the next time
- 50% coverage of $2,400 cost for the next time
- Or, the plan can be as simple as that:
- You get fixed 80% coverage of 1875$ dental works cost.
With fixed amount of limit and the simple dental plan that you have chosen, you have full control over your budget and somehow it becomes an incentive for more wise and reasonable choice of treatments.
Dental Insurance is often bought with the health insurance and life insurance as a full package. Read about all benefits of life insurance here https://www.nylaarp.com/Learning-Center/Coverage-Options/Types-Life-Insurance-Term-And-Permanent.
2. UCR plan
UCR dental plan stands for “Usual, Customary, and Reasonable”. This type of dental insurance allows the individual choose any dentist they want and insurance company covers the certain percentage of the dental doctor’s fee or the administrator’s fee limit. Depending on what amount is more beneficial for the insurer (means the lesser amount), it will be covered according to the policy.
The fee limits are agreed between the policyholder and the third party which is the payer.
UCR fees are calculated based on the average fees for certain types of dental works the doctors in your area charge. If let’s say, the average fee for the dental procedure you need is calculated to be 900$, it’s your maximum limit for this procedure. That means, your reimbursement will be the 50% of 900$, which is 450$ (or if you’ll find a doctor with the lesser fee, you’ll have a 50% of that amount, whether it’s 800$ or 700$).
Here is the tricky moment with UCR. In case your doctor’s fee for that particular type of treatment is higher than 900$ (let’s say 1300$), you still will be reimbursed with 450$ and the rest amount you will have to pay from the own pocket.
3. Table of schedule of allowance (TOA)
This dental plan is more restrictive than others yet also simple and clear. You will be offered a list of dentist – partners of the insurance company and you may choose any of them.
The insurer provides you a list of dental services. Your policy lets you use the certain fixed amount of money for the particular type of service. All rest you cover yourself, whatever the fee your doctor charges.
For instance, if your coverage for root canal procedure is 500$ – you will get only 500$ not depending on whether the full fee is 1000$ or 600$, so it’s in your direct interests to find the doctor with the lowest fees. Again, the doctor must be listed in the policy.
Here is an example of detailed dental plans which may help you understand it better
4. Capitation programs
This type of dental insurance does not allow you to make your own choice of a dentist, but instead you will be given a doctor-contractor of the insurance company.
The insurer simply pays a certain fixed amount of money to the dentist (like a monthly deposit) for all future works and procedures you and your family may need.
What is great with this type of insurance is that the policyholder receives any treatments for free.
Still, there are some procedures where the copayment (with the individual) may be required.
If the policyholder exceeds the “deposit” paid by the insurer, they have to cover expenses from the own pocket.
The premiums you pay for Capitation Programs are in direct correlation with the amount the Insurer pays to the dentist.
Summarizing all above, the key aspects you should pay attention to when purchasing the Dental Insurance are:
- Whether you are free to choose the doctor or you are limited in your choice by the list of dentists given by the Insurer.
- Whether your policy covers the works only or the coverage also extends to the diagnostics, analysis, emergency cases.
- What percentage of the dental care will be paid by you and what part will be covered by the Insurer.
- What are the money limits of your dental plan and whether it is possible to vary limits without the need to purchase another policy.
- Who exactly pays the coverage and when the policy kicks in.
- Whether you are free to get an appointment with the dentist when you need it or you are limited by the schedule.