It’s that time of year again: Millions of Americans will be choosing their healthcare and dental insurance plans for 2018. If you are doing the same, read on to learn a bit about dental insurance and how to choose a plan that will be right for you.
Preferred Providers and In-Network Dentists
If you have a dentist who you like, the first item to find out is which dental insurance plans they accept. While you can go to out-of-network dentists with some plans, you’ll save the most money if you choose a plan that your dentist participates with. If your dentist doesn’t participate in any of the plans that are available to you, then you’ll need to decide if you should see them out of network or if you should choose a new dentist. Keep in mind that while you can see any dentist you want (with a higher out-of-pocket expense if they’re not participating) with a POS or PPO insurance, a dental HMO, sometimes called a DMO, generally won’t pay for you to see an out-of-network dentist at all.
Deductibles and Maximums
Most dental PPO plans have a deductible and/or a maximum. A deductible is a fee that you need to pay the first time you see the dentist each calendar year. Sometimes the deductible is waived on preventative care (cleanings and checkups). A maximum allowance is the amount of money that the dental insurance will pay per calendar year.
It makes sense to think about how much work you’re likely to need. If you need a lot of treatment, then choosing a plan with a low maximum might not be in your best interest.
Coinsurance and Copays
If you have a dental PPO plan, you will have coinsurance for each procedure. This is a percentage of that plan’s UCR (usual, customary and reasonable fee) for the procedure. This is outside of any deductible that you need to pay. If you see a dentist out of your plan’s network, the UCR might be substantially lower than the fee your dentist charges. For example, if your dentist charges $200 for a filling and your plan’s UCR is only $120 and your coinsurance is 50%, then they will pay only 50% of the $120, or $60. You would then be responsible for the rest of the fee, or $140. (If your dentist is in-network, then they will accept the UCR, so you’d only need to pay the additional $60 left after the insurance paid $60.)
DMO insurance plans assign you a copay for each procedure. You have to see an in-network dentist if you want the procedure paid for. If the procedure copay is $40 for a filling, then that’s all you pay; it doesn’t matter what the dentist’s normal fee is, because the insurance will cover the rest of the contracted fee.
Dental insurance can be confusing, so be sure to talk to your HR representative or an insurance coordinator to learn more about what type of plan would best meet your needs