Indemnity
Insurance Dental Plans quotes - Understand the type of dental plan you buy. Consumer
information:
This type of dental plan pays the dental office (dentist) on a traditional fee-for-service basis. A monthly premium is paid by the client and/or the employer to an insurance company, which then reimburses the dental office (dentist) for the services rendered. An insurance company usually pays between 50% - 80% of the dental office (dentist) fees for a covered procedures; the remaining 20% - 50% is paid by the client.
These plans often have a pre-determined or set deductible amount which varies from plan to plan. Indemnity plans also can limit the amount of services covered within a given year and pay the dentist based on a variety of fee schedules. Some typical features of these plans:
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High deductibles before coverage begins (well-designed plans don't apply the deductible to preventive services)
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Probationary periods on certain procedures that last up to a year
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Annual dollar limit on benefits
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Chose your own dentist
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Your average monthly cost: $25 to $50
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Companies selling these plans are regulated by state insurance departments.
Dental HMOs
These insurance plans, also known as "capitation plans," operate like their medical HMO cousins. This type of dental plan provides a comprehensive dental care to enrolled patients through designated provider office (dentist). A Dental Health Maintenance Organization (DHMO) is a common example of a capitation plan. The dentist is paid on a per capita (per person) basis rather than for actual treatment provided.
Participating dentists receive a fixes monthly fee based on the number of patients assigned to the office. In addition to premiums, client co-payments may be required for each visit. Some typical features of these plans:
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Monthly premiums (some require you to prepay a year's worth)
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Co-payments for office visits
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Free preventive or routine care
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You must select from an approved network of dentists
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May have an initial enrollment fee
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Annual dollar cap
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Your average monthly cost: $5 to $15
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Companies selling these plans are regulated by state insurance departments.
Preferred Provider Organizations
Another true insurance plan, a Preferred provider organizations ( PPO) falls somewhere between an indemnity plan and a dental HMO. This plan allows a particular group of patients to receive dental care from a defined panel of dentists. The participating dentist agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser.
If the patient chooses to see a dentist who is not designated as a "preferred provider," that patient may be required to pay a greater share of the fee-for-service. A group of dentists agrees to provide services at a deeply discounted rate, giving you substantial savings — as long as you stay in their network. Unlike the more restrictive DHMO, though, you can go out of network and still receive some benefits. Some typical features of these plans:
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Monthly premiums
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Annual dollar cap
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You must stay within the approved network of dentists or pay higher deductibles and co-payments
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Your average monthly cost: $20-25
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Companies selling these plans are regulated by state insurance departments.
Dental Discount
This type of dental plan is not insurance. The managing organizations have negotiated with local dental offices to establish a set price for a particular dental procedure and offer deep discounts (some up to 70%) off the regular ADA pricing code.
This plan has several advantages over traditional dental insurance plans, namely, there are no exclusions for pre-existing conditions. This allows a patient to receive immediate coverage for work without meeting any waiting period requirements.
Direct Reimbursement Plans
A dental care plan now coming into vogue is the direct reimbursement plan. This is a self-funded benefit plan — not insurance — in which an employer pays for dental care with its own funds, rather than paying premiums to an insurance company or third-party administrator.
You, the patient, pay the full
amount directly to the dentist, then get a receipt detailing services rendered
and the cost, which you show to your employer. The employer reimburses you for
part or all of the dental costs, depending on your specific benefits.
Your company might reimburse 100 percent of your first $100 of dental expenses
and then 80 percent of the next $500, and 50 percent of the next $2,000, with a
total annual maximum benefit of $1,500. Or it might reimburse only 50 percent of
your first $1,000, resulting in a $500 yearly cap.
Traditional dental insurance is often perceived as the best way to pay for dental expenses. And while dental insurance is an excellent option when sponsored by your employer, it may not be very cost effective when you are paying for it.
Most individual dental insurance plans require you to satisfy waiting periods and deductibles before having major and sometimes even minor restorative work done. Discount dental plans help make maintaining good oral health a lot more affordable. And, with no waiting periods or complicated coverage procedures, dental discount plans are about as simple as you can get.
How do discount dental plans
work? As we become aware about our oral health, there has been a demand for
affordable dental care. Discount dental plans are the newest option for those
without coverage. These dental discount plans are much cheaper than traditional
dental insurance, and also offer almost equal coverage for all dental work, even
cosmetic procedures not covered by standard indemnity dental plans.
The catch is that dental discount plans are not really insurance at all. They
work more like club memberships, where the cost of membership (your "premium")
earns a steep discount on any club service (dental work) you buy. The discount
normally applies to all dental office services performed by an approved "plan"
dentist, but no procedure is covered completely.
What are the ins and outs of discount dental plans? When it comes to dental discount plans, the good news is afford ability, breadth of services, and immediate coverage. The bad news is greater financial risk and responsibility on your part.
Although the monthly cost of most discount dental plans is very low compared to the price of a traditional dental insurance or indemnity insurance policy, there's more allover financial risk with a dental discount plan. No care is totally covered, so an expensive procedure will mean a big out-of-pocket expense, even with the dental plan. And even when undergoing a low-cost service (like cleaning), you'll still be expected to pick up a part of the cost.
However, on the plus side, discount dental plans are effective immediately - so are many procedures you need now will be covered as soon as you buy the dental discount plan. Traditional indemnity and/or insurance dental plans usually impose a waiting period of between 6 and 18 months for any major procedure. The last "pro" is that all good dental discount plans should come with a money-back guarantee.
Some typical features of a direct reimbursement plan:
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Neither you nor your employer pay monthly premiums
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Freedom to choose any dentist
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Typical employer cost: depends on the number of employees and benefit caps
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Benefits usually capped at $500 to $2,000 annually.