You never know when a toothache might strike – and if you’ve ever experienced one, you know how important it is to have access to dental care when you need it. Dental benefits are the best way to be prepared for any unexpected problems that might arise. They can save you money in those situations, and, better yet, they will help you prevent more serious problems by allowing you to schedule regular cleanings and check-ups at a much lower cost.
When it comes to selecting a dental benefits plan, there are several factors to consider to find a plan that best suits your needs. The details can be confusing: premiums, deductibles, and levels of coverage will vary across plans, so it’s a good idea to thoroughly review your options. Otherwise, you may end up with insufficient coverage in the event of an emergency – or, alternatively, coverage that is more expensive than you budgeted for.
Whether selecting dental insurance through your employer or on your own, the following steps provide general guidance on how to select the right dental plan.
Before selecting dental benefits, it’s important to do some homework regarding your family’s and your own dental history, current oral health status, and your budget.
If you are a single adult under the age of 30 with very good dental health and no history of oral disease, then your dental benefits needs may be very different than, for instance, a household of four with two young children. The family of four may have one parent with a history of gum disease, a child who is likely to need orthodontic work, and another child with a history of multiple cavities.
To thoroughly understand your requirements, make a generalized list of you or your family’s dental and oral health needs - both historic, current, and predicted - as well as what you’ve paid in the past for dental care visits. This will serve as a good benchmark for evaluating policies and anticipating overall costs.
There are several different types of dental plans. Each will work differently in terms of out-of-pocket costs, benefits, deductibles, and so on. Generally, dental plans are divided into the following categories:
Preferred Provider Organizations (PPO): Dental PPO plans are contracted so that members have access to a network of dentists who accept reduced fees for covered services. This means that members are subject to the lowest out-of-pocket costs when receiving treatment from an in-network dentist. The out-of-pocket cost that members do pay is a designated percentage of the reduced fee, called coinsurance. The plan then pays the remainder. Most Delta Dental of Tennessee plans fall under this category.
Dental Health Maintenance Organization (DHMO): A DHMO provides lower cost coverage with a focus on preventive care. Members must use in-network dentists in order to obtain coverage (except in cases that a point of service provision allows them to opt out of the network at a reduced rate of coverage). The dentist network size of an DHMO plan is smaller than that of PPO, but the premium is also usually lower.
Discount Plans: A discount plan allows members to choose from a panel of participating dentists who charge discounted fees for their services. Members pay these fees directly to the dentist at the time of treatment; no paperwork is necessary. Discount plans typically have a lower premium than PPO and Managed Fee for Service Plans, but they also have no limit on the charges that a dentist can make for service.
Managed Fee-for-Service Plans: Fee-for-Service Plans, also known as Indemnity or Traditional Plans, will generally offer the largest network of dental providers to choose from. Similar to a PPO plan, members pay a certain percentage for each service provided by an in-network dentist (this portion is called coinsurance) and the plan will pay the remainder. The percentage will vary based on the service received.
You may not have access to all types of dental plans listed above – the plans you can choose from will depend on what’s available in your area
Make sure you look through the specific plans available to you to determine the best fit.
Once you have a solid understanding of the types of dental plans available in your area or offered by your employer, you can begin to conduct deeper research into the details – such as covered procedures, waiting periods, and annual limits.
Creating a list of pros and cons can help guide you through the decision-making process. Consider the following questions when evaluating your options:
What is the annual maximum limit, if any? This refers to the total amount the plan will pay for the benefit period. Is there a waiting period? This refers to the amount of time you must wait after purchasing coverage to be able to access your benefits.
What are the differences between in-network and out-of-network dental visits in terms of coverage? In other words, are you able to receive coverage, whether full or partial, when visiting an out-of-network dentist?
If you are hoping to schedule a cosmetic procedure (such as teeth whitening), be aware that most dental plans will not cover these types of procedures. If this is important to you, contact the dental company before making a final decision if this is a priority.
Each type of dental plan will have a different sized network (meaning the contracted dentists who are enrolled with the plan) to choose from. If you live in an area where there are relatively few dentists nearby, then network size may be a critical factor.
In addition, you may want to find out whether your current dentist is covered by the plans you’re researching. Be aware that you will likely have to pay more out of pocket to continue seeing your existing dentist if he or she is out-of-network.
Different dental plans will work differently in terms out-of-pocket cost. PPO is the most attractive plan because it balances between cost and access to care.
To determine which dental plan makes the most sense for your budget, spend some time calculating your estimated yearly dental costs based on historical patterns.
When crunching the numbers, make sure to consider:
Premiums (monthly vs. annual)
Co-payments
Deductible (if applicable)
Annual maximum
This will help you understand your options from a financial perspective and make the choice that best aligns with your family’s budget.
Choosing the right dental plan can be intimidating, but it’s not difficult – so long as you’ve done your homework. Don’t rush into the decision: Instead, take time to evaluate your dental needs, budget, and anticipated level of care. While it’s impossible to perfectly predict every dental injury or illness that may arise, arming yourself with the facts will help you avoid unwanted surprises when it comes to reimbursement and out-of-pocket expenses.
Searching for the right plan? Take a look at our individual and family dental insurance plans.