You may be surprised to learn that some dental insurance policies pay only part of the bill for certain procedures. For example, a $200 deductible on a policy does not cover a $179 procedure, even if you are covered for that procedure. You may also be required to pay a co-pay, which is a set dollar amount, and a co-insurance, which is a percentage of the total bill that you must pay yourself.
In many cases, the premium for dental insurance is deducted from employee pay or paid directly to the insurer. The plan may also have a waiting period, usually six months, before it will start paying out. Additionally, you may need to see dentists in the network of the plan. Some plans offer discounts for services that are not covered by other plans. If you have more than one type of dental insurance, it is important to know what the specifics are before you sign up for a policy.
Almost 82 percent of dental policies today are preferred provider organizations, or PPOs. This means that the insurance company has created a network of dentists and other providers, resulting in lower out-of-pocket costs. However, it doesn’t mean you can’t visit a dentist who isn’t part of the network – you just have to pay a higher out-of-pocket fee. While a PPO covers all preventative care, you can still choose to see a dentist who is not in the network. In this case, your out-of-pocket expenses will be significantly higher, but you can get the best care possible and make the most out of your benefits plan.
The type of dental insurance you choose will depend on your needs. Most plans have a co-payment policy, which is a fixed amount that you’ll have to pay toward the cost of dental treatment. These are generally set per visit and are often based on your monthly income. If you have a high-deductible plan, you might need to choose a higher-deductible plan. Otherwise, your primary plan should be able to provide the same level of care.
A dental PPO will typically have a network of dentists, and will reimburse non-participating dentists according to the Reimbursement Schedule. If you choose a dental plan with an HMO, you’ll likely have a higher out-of-pocket cost. But if you don’t need your insurance to cover dental care, you should consider an out-of-network plan. A dental PPO will have a larger list of dentists and a lower out-of-network fee.
Some of the best dental plans will have a waiting period before you can use your benefits. A dental PPO will have a network of dentists. Then, you can choose a plan that includes your preferred dentist. Those who have a dental HMO will have a set co-pay, and the out-of-network dentist will not be able to provide your coverage. Moreover, dental PPOs may have a lower deductible.