In the best of circumstances, the purpose of dental insurance is not so you can get expensive work done on your teeth. The best way to use dental insurance is as a preventative measure, to help you avoid getting tooth decay or gum problems in the first place. You should be using your dental insurance to get checkups at least twice a year, your teeth cleaned at least once a year, and an x-ray of your mouth taken at least once a year to check for problem areas.
Dental insurance can range anywhere from a simple plan to help you get discounts on checkups and other basic dental services, to full coverage. The plan you select will depend on your personal finances and dental needs, but there are a few things you should know about dental insurance plans before you begin your search for one.
First, there are two main types of dental insurance coverage: Open Panel, and Closed Panel dental insurance. Open panel means that you can choose your dentist, and no matter who you choose, your coverage will be the same. Closed panel dental insurance means that the company requires you to see one of a certain group of dentists they have selected. Closed panel insurance is usually less expensive, because the insurance company is able to contract with several dentists. As a result, the dentists will usually work for less money than they would otherwise. But, you should find out how many and which dentists are covered under a closed panel dental insurance plan, and where they are located. Will you be covered when you are on summer vacation? Will the plan allow you to visit your family dentist whom you already know and trust?
There is also a type of coverage in between closed and open panel, known as Preferred Provider Organization. With this kind of dental insurance, the insurance company will cover a higher percent of your expenses if you see one of their “preferred” dentists. They will still cover some of your fees if you opt to visit a different dentist, just not as much. Regular closed panel dental insurance may also be called Exclusive Provider Organization.
You have several options for benefits plans. Indemnity plans are the most common, mainly because they are the simplest and most straightforward. The dentist gets paid by the insurance company based on the amount of service he provides, and you pay the insurance company your monthly premiums plus about 20-50 percent of the cost of the services you have received. With an indemnity dental insurance plan, you may have a deductible, or a predetermined amount you have to pay before the dental insurance company pays anything, and these plans are usually closed panel.
Under a direct reimbursement plan, the patient pays the dentist directly, and is then reimbursed a set percentage of his expenses. This type of dental insurance is most often provided by employers for their employees, and is usually open panel.
A capitations plan is a closed panel plan where the dentist gets paid by the dental insurance company based not on the fees for his services, but instead on how many patients he has seen. If you sign up for a capitations dental insurance plan, you will be required to pay a monthly premium, and probably a co-pay, or a fixed percentage of the dental services you receive, as well.
Now that you will be able to understand what the dental insurance agent really means when he's discussing different kinds of plans, you're ready to make an informed decision on which dental insurance plan best meets your personal needs.
By Riannon Cutler