Because dental disease is so common, being protected by dental insurance and using it wisely are essential. Dental coverage, or a dental benefits plan, reimburses you for certain dental expenses according to written agreement. Unlike many medical diseases, which can be unpredictable and catastrophic, most dental diseases are preventable. Because of this, dental benefits plans are usually structured to encourage patients to obtain the regular, routine care that is vital to prevention and diagnosis. This emphasis on prevention is reinforced by most plans, which require the patient pay a greater portion of the costs for treatment of dental disease than for preventive procedures. Dental premiums usually vary, from about $10 a month for a single person to $71 for a family. 

Making Choices

Plans may allow you the freedom to choose your own dentist, or may, in exchange for lower rates, limit your choice. Although the opportunity to choose your own dentist is only one factor in the decision to choose a plan, it is a good idea to note the difference between the two alternatives:

·         Open Panel/Freedom of Choice. Allows covered patients to receive care from any dentist and allows any dentist to participate. Dentists may accept or refuse to treat patients enrolled in the plan. Coverage with this feature allows you to receive full benefits for treatment provided by any dentist of your choice.

·         Closed Panel. Allows covered patients to receive care only from dentists who have signed a contract of participation with the third party. The third party contracts with a certain percentage of dentists within a particular geographic area, who in turn offer lower rates to the patient.

 Controlling Costs

To control dental treatment costs, most plans will limit the amount of care you can receive in a given year through a variety of methods. They may place a dollar "cap" or limit the amount of benefits you can receive, or may restrict the number or type of services that are covered. The exclusion of certain services or treatments is also a method of reducing costs. Be sure to investigate exactly what services your plan covers and excludes. Many plans provide patients and purchasers with special administrative services. It is important to find out if your plan provides these services to help you with managing the costs of your dental care.  

Major Plan Types

 Indemnity Plans - I
Indemnity plans are traditional fee-for-service based plans. Normally, you pay a monthly premium to the insurance company, which covers a portion of your dental expenses. Before the insurer will begin paying for care, you are usually required to pay a high pre-determined deductible, however, you can choose your own dentist. Preventative service costs are usually covered by the plan, which typically pays 100% of the preventative costs, 80% for common restorative services and 50% for major treatments, such as crowns and orthodontics. The remaining costs are paid by the patient through a variety of fee schedules. Most indemnity plans limit the annual dollar amount on benefits and may apply probationary periods on procedures that could last up to a year. The average monthly cost of an indemnity plan is between $19 and $25.
 

Dental HMOs
Also known as capitation plans, dental HMOs (DHMOs), are normally characterized by monthly premiums, free preventative or routine care, small co-payments for office visits, and selection from an approved network of dentists. The dentist is paid on a per capita (per head) basis rather than for the treatment provided. Contracting dentists -- those within the approved network -- receive a fixed monthly fee per patient regardless of whether treatment is performed. If needed, you may be referred to a specialist who also contracts with the plan, but you must pay in full if you use a dentist outside of the network. Other characteristics of these plans are possible initial enrollment fees and annual dollar caps. Due in part to the per capita basis of treatment, DHMOs are rarely made available to individuals. These plans cost on average from $6 to $15 monthly.

Preferred Provider Organizations (PPOs)
Preferred Provider Organizations (PPOs) are somewhere between an indemnity plan and a dental HMO. Within this plan, a defined panel of dentists provide services at a discounted rate as long as you stay in their network. If you go outside the approved network of dentists, you will pay higher deductibles and co-payments, though you may receive some benefits. Typically, PPOs have monthly premiums and may have an annual dollar cap. Due to the nature and set-up of this plan, these are also not normally available to individuals. The average monthly cost is $20.

Dental HMOs
Also known as capitation plans, dental HMOs (DHMOs), are normally characterized by monthly premiums, free preventative or routine care, small co-payments for office visits, and selection from an approved network of dentists. The dentist is paid on a per capita (per head) basis rather than for the treatment provided. Contracting dentists -- those within the approved network -- receive a fixed monthly fee per patient regardless of whether treatment is performed. If needed, you may be referred to a specialist who also contracts with the plan, but you must pay in full if you use a dentist outside of the network. Other characteristics of these plans are possible initial enrollment fees and annual dollar caps. Due in part to the per capita basis of treatment, DHMOs are rarely made available to individuals. These plans cost on average from $6 to $15 monthly.

Discount Dental Referral Plans
Discount dental plans, or referral plans, are the most widely available to individuals. Participants of these plans must use a participating dentist, who has agreed to offer services at a discounted rate. Typically, you pay an initial enrollment fee as well as a monthly fee to the discount company through which your discount is secured. Although discount plans work very well for many individuals seeking coverage, they are not regulated by insurance departments. Consumers are cautioned to research the history and legitimacy of these plans before providing to them their highly personal and secure information. The average monthly cost is $5 to $10.

Direct reimbursement Plans
A direct reimbursement plan is a self-funded benefit plan. It is not considered an insurance plan. In most instances, an employer or company sponsor pays for dental care with its own funds, rather than paying premiums to an insurance company or third-party administrator. The patient pays the full amount to the dentist, gets a receipt for the employer, who reimburses them for part or all of the dental costs, depending upon the patients specific benefits. Typically, neither you nor your employer pays monthly premiums. Cost depends on the number of employees, and participants have the freedom to choose any dentist they wish. Benefits are usually capped at $500 to $1,500 annually and the company may place a limit on how much an employee can spend on dental care within a given year. Often, though, there is no limit on services provided. Under this plan, the patient is reimbursed a percent of the dollar amount spent on dental care, regardless of the treatment category.