Dental insurance may be offered as part of an employer-provided health plan or purchased as a separate policy. The cost of a dental plan is based on a premium, which the plan member pays monthly.
Most dental plans have a stated deductible and annual coverage maximum. Most also require copayments or a flat fee per procedure. 강남역임플란트
Premiums
The monthly cost of a dental insurance plan depends on the premium, deductible, and copayments. To find the right coverage, consumers should compare several plans before selecting one. Dental HMOs (Dental Health Maintenance Organizations) typically have the lowest premiums, but they also limit choice and tend to have higher deductibles than other insured dental benefits products. Unlike copays, which are expressed as a percentage of the service’s cost, DHMO deductibles are stated as specific dollar amounts.
In addition to comparing the prices of various dental insurance plans, consumers should examine their annual maximums and whether any unused funds roll over the following year. Some policies may also offer a discounted rate for specialized procedures like crowns and root canals, depending on the type of plan.
Deductibles
Dental insurance plans typically include a deductible, which is the amount that you will pay each year before your coverage starts. This deductible is usually a low number, such as $50 for an individual or $150 for a family each year.
After you reach your deductible, your plan will begin to pay for basic services at a certain percentage (typically 80%), while you pay the remaining 20% as coinsurance. The specifics of these percentages will vary from one plan to another.
Many plans also have annual maximums, which are the highest amount that your insurance will pay in a year for covered care. This cap is often very low, so if you need extensive dental work, it may be wise to consider a plan with a higher maximum.
Copayments
Copayments are a flat dollar amount per visit that the patient pays before the insurance company starts to pay. These are usually consistent within a specific dental plan, but can vary by service type. They can be a great tool for budgeting, but it is important to understand the overall cost of your procedure before choosing a plan with a copayment.
A coinsurance plan pays a percentage of the dentist’s fee after the deductible is met. These percentages can vary by service category and are typically listed on your plan summary. These plans tend to be more expensive than a copay plan, but they provide more flexibility in choice of provider. They are also often paired with a DPPO, which limits contracted dentists to the negotiated “usual and customary” fees.
In-network or out-of-network dentists
There are some dentists that do not accept dental insurance and will only provide services at a cash rate. They will usually give you a discounted fee that is often less than what the insurance company would reimburse. These dentists are called non-in network.
Many in-network dentists have contracts with the insurance companies that dictate what they will charge for certain services. This helps the insurance company keep costs down and provides their customers with affordable care.
Some dentists choose not to be in-network because they don’t want to conform to the stipulations of insurance companies. They prefer to be independent and provide a one-of-a-kind experience for their patients. This allows them to use the best materials and techniques, ensure the cosmetic outcome they desire, and spend more time with their clients.
Dual coverage
When you have a dental insurance plan from one company and another, it is often called dual coverage. This does not mean that your monetary coverage gets doubled but that the two plans work together to coordinate your treatment. Each plan has specific rules that determine how the benefits should be split. This process is called coordination of benefits (COB).
COB provisions can vary from plan to plan and depend on state laws and regulations. Generally, the dental plan that is owned by you or your employer is considered primary and the stand-alone dental plan you have is secondary.
However, this does not always work out this way. The plans can still have different annual maximums, waiting periods, and other factors. It is important to understand how your dual insurance works so that you can maximize your coverage and save money on dental costs.