The pros and cons of subscription-based dental coverage

Dentists and patients have options when it comes to billing and paying for dental services. Dental insurance is one of the most traditional forms, but subscription-based dental plans are another way people without insurance can receive dental care at a lower cost.

If you are wondering whether a subscription-based plan or traditional insurance coverage is right for you, this article will answer some questions to help you make the best choice for you and your family.

What is a subscription-based dental plan?

 A subscription-based dental plan, also known as dental discount or membership plan, is offered directly by a dental practice to patients who don't have insurance. You pay an annual or monthly fee to that specific office, and in return you receive certain services (most commonly two cleanings, exams, and X-rays per year) included in that fee, plus discounted rates on other treatments.

There are no insurance companies involved, no claims to file, and often no waiting periods. It's a direct financial arrangement between you and your dentist.

How dental insurance works

Traditional dental insurance works much like other forms of health coverage. You pay a monthly or annual premium to a benefits carrier, like Delta Dental of Tennessee, and in return the plan covers a portion of your dental care costs. Most plans follow a tiered model:

• 100% coverage for preventive care (cleanings, exams, X-rays)

• 80% coverage for basic services (fillings, simple extractions)

• 50% coverage for major services (crowns, root canals, dentures)

You may also have a deductible to meet and an annual maximum benefit, typically between $1,000 and $2,000. But for many Tennesseans, especially those with families or ongoing dental needs, that coverage can represent thousands of dollars in savings.

Pros of subscription-based plans

One of the strongest supporting arguments for a subscription-based dental plan is it incentivizes people to get preventive checkups. Visiting the dentist twice yearly for preventive care is important, and these appointments provide much more than a deep clean. Preventive dental visits identify oral health problems at their earliest stages, so they’re easier and generally less expensive to treat. Exams also include t an oral cancer screening, which can be lifesaving if it is detected early on.

Many patients, particularly those without insurance, only see a dentist when they’re in pain or have a specific dental issue that they need to urgently treat. Subscription-based plans often include preventive care, such as X-rays and twice-yearly cleanings, as part of the annual membership fee. Along with encouraging preventive care, subscription plans appeal to a real and underserved need with:

• No waiting periods. Unlike some insurance plans that require a waiting period before covering certain procedures, most membership plans let you use your benefits the day you sign up.

• Simplicity. No claims, no paperwork, no reimbursement delays. You pay your membership fee and you're done.

• A bridge option. For Tennesseans in transition, between jobs, waiting for benefits to kick in, or recently retired, a subscription plan can provide immediate access to discounted care while you sort out longer-term coverage.

Subscription-based dental plans also offer an alternative option to traditional insurance to achieving dental care at a discounted rate. More choice for patients is a good thing.

Cons of subscription-based plans

The drawbacks of subscription-based coverage compared to traditional insurance are related to network, discounts and quality assurances.

• You're limited to one practice. Your membership only works at the specific dental office that created the plan. If you move, your plan doesn't come with you. You'll need to find a new dentist and start over.

• Discounts, not coverage. A subscription plan reduces your costs, it doesn't eliminate them. When major work is needed (a crown, a root canal, an implant), you're still paying a significant portion out of pocket. For Tennesseans with complex or ongoing dental needs, that can add up quickly.

• Discount depth varies.  As the largest dental insurer in Tennessee, Delta Dental of Tennessee negotiates deep discounts with dentists, and those discounts get passed along directly to plan subscribers. While individual practices can work with patients on pricing, those discounts may not be as deep as what a major insurer negotiates on behalf of over a million covered members.

• No third-party quality oversight. Delta Dental of Tennessee regularly reviews its in-network providers to ensure quality of care standards are met. Because subscription plans are a direct arrangement between patient and practice, that independent oversight may not exist or be as stringent.

Side-by-side: How the plans compare

Questions to ask your dentist

Below are some questions to ask your dentist to learn more about the details of their subscription dental plan to help you make the most informed decision:

• What is the total annual fee and fee schedule (ie, do I pay monthly, yearly, etc.)?

• What services are 100% covered in my subscription fee?

• What is the discount for other common dental services?

• Will I be asked to pay for services not 100% covered in my subscription before the procedure or will I be billed later?

• Does the plan have an annual out-of-pocket maximum?

• Will I have to deal with paperwork or reimbursement claims?

Which option is right for you?

The honest answer: it depends on your situation.

A subscription plan may make sense if you have a trusted long-term dentist who offers one, you need immediate access to care without a waiting period, you're between coverage options and need a short-term bridge, or you primarily need preventive care and don't anticipate major dental work.

Dental insurance is likely the better fit if you want the flexibility to choose from a large network of dentists across the state, you have a family with varying dental needs, you're concerned about unexpected major procedures, you want the security of third-party quality oversight, or you want coverage that stays with you no matter where you live or work.

Delta Dental of Tennessee has individual and family plans designed to ensure you and your family can access quality dental health care at a competitive price. Not sure which plan is the right fit for you? Learn more about the different plans online.

SOURCES:

https://www.dentaleconomics.com/practice/patient-communication-and-patientfinancing/article/14190117/will-more-patients-be-left-without-dental-insurance-in-2021