Dental Plan Coverage

Some typical features of these plans: High deductibles before coverage begins (well-designed plans don’t apply the deductible to preventive services) Probationary periods on certain procedures that last up to a year Annual dollar limit on benefits Chose your own dentist Your average monthly cost: $15 and up Companies selling these plans are regulated by state insurance departments.

Question: I am self employed, and do not have dental insurance currently. I am wondering if a buying a family dental plan is really worth it or not. I have two teeth that are starting to bother me and would like to see a dentist. My wife and son are okay, but I would like for them to go in for a dental check up. The few dental discount plans I have reviewed do not seem like they are really saving you money when a crown still can cost up to $300–$400 that does not seem like a big saving to me. I have looked at a few dental insurance plans as well, but with the waiting periods and cost of those plans being much higher, they too do not seem like I would be saving anything by buying them. So what should I be looking for to help me with my dental cost?

Answer: On average the cost of crowns can run $500-$800 without insurance so I would say that the discount plans are saving you between $100-$300 dollars on a crown based on your post. When you take into account that our dental discount plans run between $7.95-$9.95 a month for an individual that savings seems pretty good. I suggest calling a few dentist for crown rates without insurance so you can compare if the savings are truly there for you. Depending on what state you are in we may so have dental HMO insurance plans. Our HMO insurance plans do not have waiting periods for their dental services to be covered and will normally have lower cost for their covered services then the dental plans do. So you may want to compare these plans as well. With regards to our Dental PPO and Indemnity plans, I would agree that they may not be the best way for you to go due to the waiting periods. In this case for crowns waiting period can be up to a year or more.

According to a MetLife Study that was released many parents are not following recommended guidelines for brushing, flossing, and other dental health care habits for optimal pediatric oral health.   Nearly a quarter of the parents surveyed, 23%, have been told by a dentist or hygienist that their child was at risk for tooth decay, and 47% of the parents surveyed have not spoken to their pediatrician about their child’s teeth and may not be making the connection between their child’s oral health and their overall health care.

In a prior post we talked about how not all younger children can go to a general or family dentist and when buying a dental insurance plan you want to make sure it provides coverages for Pediatric dentist. PPO plans may be the best choice for this. As they have a broader range of in network providers and in most cases provide benefits for out side network providers. This is helpful when having to go to a Pediatric dentist.

However, PPO plans are not a plan type you buy for short term use as they normally come with waiting periods. Therefore you want to buy a PPO plan in order to be prepared for your babies future dental care needs. Read plan terms and conditions carefully before buying any dental insurance so you will be able to pick the best plan for you and your family.

Did you know that by eating a well balanced is good for your oral health care? By eating a well balanced diet and avoiding in-between meal snacks help to maintain your dental health as well as your overall wellness.

Question: My 13 year old needs to have braces. I been told this by our family dentist. Right now I been paying cash for our family dental care needs since all we normally have going on is our twice a year check ups and cleaning’s. If I get dental insurance will it help to cover braces?

Answer: We do provide many plan options for orthodontic services. I would suggest reviewing either our HMO dental insurance plans and or our dental discount plan for saving on braces. We do have some PPO plans that provide limited benefits for orthodontic services but they would have a year waiting period before benefits would be effective for braces.

Dental Plan Coverage – Effective or Start Date

When shopping for individual, family or group dental insurance quotes, always review the dental plan coverage description thoroughly for any variations in coverage levels.  Coverage is not in effect until an application is signed, transmitted, payment received and approved by the underwriting company unless otherwise specifically stated.  Finding the right value in dental insurance or dental plans is an important step in purchasing dental coverage for you and your family.

It is important to understand what is a yearly dollar maximum limitation and to compare yearly maximum coverage on a regular basis before selecting any dental insurance plan. The dollar amount that a plan will pay you during one full year is very important factor to consider while choosing the dental insurance plan. For most PPO’s and Indemnity dental insurance plans they will have yearly maximum limitation, normally ranging from $500-$2000.  The yearly dollar maximums, renew on an automatic basis every year. You should be aware of that amount that is not used within a given year will not roll over into the next.

Example: Suppose you had $2000 yearly maximum for 2016 but you only spent $1500 of it. You may think that since you still had $500 at the end of the 2016 then for 2017 you are going to have $2000 + $500. Unfortunately that is not the case. Your funds are not cumulative. For 2017 you still will have the same $2000 as a yearly maximum for full year.

However the maximum is also per person so whether you have one person on the plan our four people on the plan each person has the 2000 maximum limitation per year.  When shopping dental insurance with a maximum limitation, you want to think not only of your current dental needs but future needs so you can get the right maximum limitation that best fit those needs.   Also make sure you work with your dentist when dealing with maximum limitation so that services could be scheduled out in a way that best saves you whenever possible.

Example: Going back to the same 2000 limitation, say in a given year your dentist says you need $3500 in dental services. See if it possible to have part of what needed towards the end of the year and the rest done in the being of the next. Doing so you will then receive benefits for the whole $3500 without going over your maximum in a given year.

When buying a dental insurance plan, many insurance plans do provide some limited benefits/coverage for orthodontics services. However it is important to read the plans terms and conditions with regards to orthodontics coverages. Some may only cover orthodontics services for children under the age of 19 where as others have restrictive maximum limitations per year and life time pay out.

Like tip 1 tip 2 is also something you should be doing at home as part of your daily oral health care habit, which is flossing. By flossing you are removing food particles that get caught in your teeth that brushing may not remove. Spend the extra few minutes a day by flossing your teeth for better overall oral health care.

Where to Buy Affordable Dental Plans

You can obtain quotes for more affordable dental insurance plans from companies online and through your local insurance agent or broker. Please keep in mind that there are many web sites who give the appearance of selling dental insurance but instead only offer a dental discount plan which is not insurance.

Your dentist may also have affordable dental plan options available to patients.  Ask the receptionist if they partner with a dental plan company and see if one might be right for you.

When reviewing dental HMO’s plans, one important part of having the plan work the best for you is having a dentist within the plan network you will want to go to. HMO’s dental insurance plan do not provide any benefits/coverages for dental offices that are not a provider of the plan. There for choosing a plan provider is very important.

I suggest when choosing an in-network provider of an HMO insurance plan make sure to call the dental office up prior to buying the plan. Verify that they are still accepting the plan and new members. Confirm anything that may be important to you in picking a plan provider. Such as business hours, how far booked up they may be, location, years in practice, that they are doing the type of dental care services you may feel you need and anything else that would be important to you.

Dental Insurance – Cosmetics

Cosmetic dentistry may help you to get your best smile at any age.  One of the most popular cosmetic dental procedures to a perfect smile is bonding.  Cosmetic dental bonding is a fairly painless procedure usually performed in one dental visit by applying an enamel like material to your teeth which is then shaped, hardened with a special light and polished.

For a more dramatic smile, porcelain veneers can make a drastic difference. With veneers, you can control the color, position, shape, and size of your new teeth which can correct crooked, worn, or chipped teeth. This procedure can cost between $1,200 – $3,500 per tooth.

Cosmetic dentistry insurance coverage is not afforded by most dental insurance companies. If you are with a group dental insurance company through your employer, you may want to inquire if cosmetic dentistry insurance coverage is provided under your dental plan.

Cosmetic dental coverage is normally provided by discount dental plans. Discount dental plans usually cover 15 to 20 percent of the cosmetic dental care cost.

Tip one on improving your dental health is something you should be doing twice a day for at least two minutes and that is brushing your teeth. Brushing your teeth should be part of of your daily oral health care habit. Make sure to change your tooth burhs every 3-4 months and use a toothpaste that has fluoride.

When buying a PPO plan using the plan network of providers is normally going to provide you greater value. Although most PPO plans do provide benefits for outside net work dentist (dentist not a provider of the plan) they will in some cases reduce the coverages provided under the plan for non provider use. Such as maybe the plan pays 100 percent for preventive care with plan providers but only pays 80 percent when you choose a dentist not in the plan network of providers. Even if the PPO plan you are reviewing dose not reduce their benefits for out of network dental providers, you still run a risk of having a greater chance of UCR(Usual, Customary and Reasonable) fees. Since inside network providers have mostly agree to reduce their cost to stay within the plan UCR rates and non provider have made no such concession.

Business Dental Plans

As a business owner, you are facing many difficult dental insurance plan decisions. One of the decisions is buying a business dental plan. Business dental insurance plans have become essential to businesses due to the increasing benefit needs of the employees, especially when they visit the dentist.

Group business dental insurance coverage is more affordable since all the participants of the plan are under one policy normally paid by the employer. Offering dental insurance to employees can aid in the employer recruitment and retention.

Studies indicate that supplemental employee benefits such as dental insurance can help retain high quality employees. The cost for business dental insurance will very, depending on the number of employees, the plan specifications, employee contributions, and the cost limitations you specify with your dental insurance agent.

Question: I looking for both Dental and Vision insurance in one plan or at least two very affordable plans. I live in California.

Answer: For both dental and vision in one plan we have PPO’s plans though StandardLife dental that provides vision benefits as well. We also have lower cost HMO plans though California dental and PrimareCare although they do not include vision we also have a vision web site www.bestvisionplans.com that has a low cost vision insurance options though VSP Another option for both dental and vision would be reviewing our dental discount plans though Careington and Aetna both also come with discounted savings for vision and Rx

Benefits of Dental Insurance

Dental insurance benefits vary depending on the type of dental insurance plan.  When reviewing the benefits of dental insurance especially when selecting a dental insurance plan, keep in mind there are various policy coverage options, dental plan deductibles, co-payments, limitations, restrictions and exclusions.

It is extremely important that you read the list of benefits provided by the dental insurance provider and be sure you are getting a dental insurance plan if that is what you wanted to purchase.

A reminder discount dental plans are not dental insurance plans. A discount plan partners with specific dentists to provide customers with a savings on visits to the dentist office much the same as dental insurance. The downside to discount dental plans is that they are not regulated and you have limited recourse if you experience dental problems.

HMO’s dental insurance plans suggests dentist that is working with them. This means that you cannot go to your dentist (unless they are a plan provider of that plan)  and you will have to pick the one from their list, you have to choose dentist that has contract with your dental plan company, in order for your plan benefits to be valid.

Most PPO’s plans allow individuals to stay with their current dentists. Dentists that have contract with dental insurance companies are considered as In-Network Dentists, otherwise they are called Out of Network Dentists. Note: Sometimes out of network dentist will have reduce benefits/coverage’s.

Regardless of how good your dental insurance plan may be, it only really benefits you if you use it. Do not wait to use your dental insurance until you have dental pain and or other issues. Most dental insurance plan provide free to low cost preventive dental care services. They do this in order to help prevent you from having larger dental care needs in the future. Yet many people still but off their route office visit and check ups. This dose not only increase your risk of having to have larger dental care services in the future but do to delay dental care it can cost your more money in the long run.