Dental Insurance and Plans

Since the early 1990's it has become widely accepted medical knowledge that good oral and dental care has a profound effect on overall health.  Good oral health has been clearly associated with a lower incidence of heart, kidney and liver disease, as well as fewer complication of childbirth, and longer life expectancy.

Employer sponsored dental plans are a tremendous value to employees as well as r employers.  It is valued by employees as a benefit second only to health insurance, and at a much lower cost.  Dental insurance as a benefit may also provide the employer with improved morale, lower turnover, improved productivity and reduced absenteeism. 

Individual dental plans, however, are a different story. Be sure to read why below.

How Dental Plans Work:  Dental insurance typically provides for a maximum annual benefit of from $750 to $2,000, with covered dental services divided into three general categories:

• Category One services include preventative care, annual check ups, routine xrays, cleanings, and floride treatments. 
• Category Two services are considered "basic restorative" care like fillings and simple extractions.  Other services like root canal therapy (endodontics) and treatment for gum disease (periodontics) may be in this category, or the next category, depending on the plan.
• Category Three services include 'major restorative" services crowns, birdges, or other services designated by the plan.  
• Some plans cover optional services like orthodontia or implants as a seperate benefit.

Category 1 services are usually covered atrtthe highest benefit level, 100%.

Category Two services are usually subject to a calendar year deductible of $25-75, (which applies commonly to both Category Two and Three services.).  Then expenses are coverd at 50-80%.

Category Three services are subject to the common annual deductible, and often paid at 50%.

When covered, orthodontics benefits typically pay 50% and have a "lifetime maximum" benefit of $1-2,000.

 Coverage for implants is new and just beginning to be more available. 

What an insured plan pays, or reimburses, is governed by the "maximum allowable charge" for a given procedure.  Using an "average" charge that varies nationally by zip code where a service is performed. Different carriers use different data bases to determine their maximum benefit.  There is no standard data base in the industry, so it can be nearly impossible to compare what one carrier might pay for a given procedure in a given zip code vs another carrier.  This is important because (if you are not using a provider network with pre-negotiated fees) your dentist may bill you for what the insurance company does not consider a covered expense. Therefore, a less expensive plan may not be as good because they will reimburse a lesser amount of what you are billed by your dentist.  A knowledgable broker can usually help you identify which carriers and plans will generally pay better.

Many dental plans allow you to choose your dentist. But more plans include access to a dental provider network with reduced fees.  When you use these providers you will generally get more care and services under the annual maximum benefit amount, and avoid having your carrier deny charges deemd above their maximum accepted amount.  But beware: if you use a dentist not in their network, this type of plan may have a very low "allowable fee" they will cover from a non-network dentist or lab. Ask what they allow out of network.

Why I DON'T RECOMMEND INDIVIDUAL DENTAL PLANS, and WHEN I DO...

Most individual/family dental plans are NOT a good deal for consumers.

People purchase individual/family dental plans as a way to pay for dental work they expect they will need and use. They sign up with the expectation that they will recieve more in benefits than they pay in premiums. 

This simply cannot happen if the insurance company is to stay in business. After the cost of marketing, claims, and administraion, insurers will loose money if they pay out on average more than 70% of the prmeiums they recieve.

Most individuals who purchase dental insurance will, at the very best, end up swapping dollars with the insurance carrier, and rarely come out ahead at the end of a year.

If you find an exception, I assure you it is temporary. For most of us, my suggestion is, save the money you would otherwise pay in dental premiums, and pay your favorite dentist directly.

One small factor may be that your dental premium is tax deductible, but your out-of-pocket expenses are not, depending on your tax staus as self-employed.  That may mean a $700 a year tax deductible dental premium is better than $700 in uninsured non-deductbile dental expenses. 

We can help you evaluate your situation, options, and decide what may be the best aolution. Call or email me to discuss your situation and needs. 

There is ONE TYPE of individual/family dental plan that makes sense:  Discount Dental plans are national networks of dentists and labs that give you reduced, often deeply discounted, dental fees when you use a dentist or lab in the plan's network.  These plans offer several advantages, including much lower cost, no annual or lifetime limit on coverage, a broader list of covered services, no waiting period for full benefits to begin, no claim forms to fool with, no monthly pormeioums to pay or track, and the potential to save thousands of dollars from the very start.

Some of these plans are paired with discounts on prescriptions, vision and hearing products and services and chiropractors, and sometimes include very low cost or free annual exams. Some plans are put together buy large national insurance firms from their own insurance provider networks. However, they are generally not insurance plans and so are sometimes sold by non-insurance sales people.

They work because of thier low cost and the deep discounts they have negotiated with dentists all over rthe country.  Your dentist may already be in their network, but will not usually tell you that they are. They joined the network to attract new patients, not reduce their fees for existing patients.  Still, they must offer you the lower fee if you become a member of their plan and ask for them.

Would a discount dental plan be a good idea for you? 

Click on the link below to view many of the BEST plans available anywhere from the leading providers in the USA.  Feel free to look around on the site; but if you will call me, I will show you how to quickly find comparison tables to compare benefits and costs of all the plans there. Of course, call or email with any quesitons you may have, or for help finding your Best option.

For FREE information on discount dental plans: CLICK HERE: