Dental insurance seems simple to understand, but it can actually be quite confusing for individuals who have never purchased a plan before. In this article, we go over what you need to know when shopping for dental insurance, so you can find the best plan and coverage for you and your family.
What Services Are Included in a Dental Insurance Plan?
In a dental insurance plan, you will typically see services like basic or major restorative procedures, including fillings, root canals, implants, and dentures. Insurance plans will also cover diagnostic and preventative care, such as cleanings, x-rays, check-ups, and fluoride treatments. However, how much coverage you have for each service will depend on the plan and carrier you choose to work with.
What Kinds of Dental Plans Are There?
The three most common dental plans you could choose from are PPO, HMO, or indemnity plans.
PPO—or preferred provider organization—is the most common plan of the bunch. It entails a fee structure that a dentist negotiates after joining a PPO network. This means you will need to find a dentist within your PPO network to benefit from their insurance fees.
HMO—or health maintenance organization—entails a monthly or annual premium the patient pays for services. However, you will need to be within an HMO network or work with a provider offering this type of insurance plan to use it.
Indemnity plans are lesser-used insurances and are often referred to as fee-for-service plans. Instead of choosing a dentist through a network, you can choose anyone, pay for the entire service cost, then file a claim with indemnity insurance for reimbursement.
Indemnity plans can be expensive if the carrier does not approve of your claim, but you can choose any provider within your area. PPO plans are also slightly more expensive, but you have more flexibility with wider networks. HMO plans are the most affordable, but you must be within an HMO network to use the insurance.
Group Coverage or Individual Policies?
Generally, you would gain insurance through your employer called group insurance. If not through an employer, individuals have the option to choose a group policy through AARP or public programs. However, if the dentist does not accept public program insurance, then you must find a provider that does.
Individual plans are on the pricey side because you’re purchasing a plan directly through the insurance carrier instead of through an employer. Individual policies will have limited benefits, and you will most likely need to wait for approval before major procedures like dentures or implants.
There is a lot you need to know when shopping for dental insurance to ensure you and your family are getting the best possible coverage. Ensure you understand the deductible, cap amount, and pay formula to better understand what you will be paying for when using the insurance at a dentist in LA. Remember, once you have an insurance plan, find a provider within your area and network to take advantage of the prices your insurance is giving you.