Basically, individual dental insurance is created to help citizen deal with their larger dentist bill. The dental insurance is supposed to cover most types of the provided dental care in the dentists. However, a newest survey conducted by The Centers for Disease Control and Prevention’s National Health reveals shocking facts that most Americans have never went to a dentist before in their lifetime.
One of the reasons for Americans citizen absence for any kind of dental cares is money. American Dental Association data shows that almost 40% American adults could not afford for even a basic care for their teeth. The dental care price tag is not surprisingly a heavy weight for your purse but you can defeat this situation by considering individual dental insurance plan.
Understanding How Individual Dental Insurance Work
Most individual dental insurance cover basic teeth diagnostic, treatment, and prevention. The typical services are annual exams that can be done twice, teeth cleaning, X-Rays, fluoride treatments, and routine checkups. Meanwhile, the real benefits from the dental insurance can be concretely observed from major and big procedures, such as fillings, root crowns and canal. The dental insurance is a big savior for your savings since it covers most of the treatment payment.
Delta Dental Plans Association and NADP state about two-third Americans have their own dental insurance in 2016. If you are not one of the two-third people, perhaps you have to consider having your own insurance. But remember; be wise and careful because every provider has their own rules and policies. Figuring out the best plan for you may be more complicated than remembering to brush your teeth before you sleep.
There are several individual dental insurance providers that you can freely choose according to your need and payment qualification. Meanwhile, the majority of the insurance providers have similar plan with each other. Each plan can be distinguished from the providers’ network with specific oral specialists or dentists. In short, individual insurance plans can be classified into three types:
1. HMO (Health Maintenance Organization) Network
This is the most restrictive plan among all. If you decide to apply this plan, you have to use the dentists preferred by the provider. If you don’t go to the network dentist, the plan will not pay your dental treatment at any cost. It may sound bad but actually it is good for you who have no idea which specialist you should meet. In addition, the providers guarantee that the dentists that are recommended are all qualified. So, it is a pretty convenient choice.
2. PPO (Preferred Provider Organization) Network
There is still a network dentist rule but not as strict as the HMO individual dental insurance plan. The provider will still give you recommendations of the networks specialists but you are also allowed to choose a non-network dentist. However, you will need you to sacrifice higher payment if you do so.
3. Indemnity Plan
The indemnity plan is considered as the most flexible yet complicated plan. Using this plan means you can choose to go to any dentists that you want. On the other hand, you must pay upfront first. After the payment, you need to submit the claim for reimbursement. The reimbursement process can take a lot of time to be processed.
You may think indemnity plan gains the most individual dental insurance member, but you are wrong. The top three from the list above is the PPO network. PPO network is chosen widely by its member because its flexibility and convenient. The PPO network is upper hand because most of the network dentists within the PPO are typically agree to set the procedures on lower fees. A crown treatment that usually cost $500 within the indemnity plan might mean only $400 for patient under PPO plan.
The next thing you should aware of is the term of “100-80-50” coverage. The term refers to the way individual dental insurance plan pay your dental care in a percentage manner. The most common “100- 80-50” policies cover:
100% payment for preventive cleaning and checkup
80% payment for regular and minor procedure, for instance cavity filling and root canals
50% payment for a big procedure, for example extractions and bridges
Most of Americans got their dental insurance for their workplace or another group. Usually, the plan used by employers charged annual premiums which cost about $324. The coverage option means you get $32 each month excluding the employer’s contribution. Meanwhile, the average amount that Americans spent to have dental care is around $544 each year. This average amount is reported by American Dental Association’s Health Policy Institute in 2016.
For other people who are not lucky enough to get the group dental insurance don’t worry. There is a plan for private dental insurance which can be bought from trusted dental plan website or through insurance broker. The cost is around $20 up to $60 monthly for each member.
Individual dental insurance works the same with the group plan. They will pay your dental care treatment and bills according to the agreement. However, the individual plan contains additional rules that may not be encountered in the group plan. Here are some of them:
The contracts should be more than 1 year (12 month)
There is a waiting period for about six up to eighteen months which means the plan will not pay your major procedure bill if the waiting period has not over yet
The waiting period is one of the disadvantage form the private dental insurance. In contrast, such rules are applied in order to prevent people from buying the dental insurance plan only when they need to have teeth treatment. It also discourages people to cancel the plan after a big procedure has been paid by the company. So, let’s just say it is a win-win solution for both parties. As summary, individual dental insurance is surely worth the cost you pay. It does really save both your pocket and your valuable smile. This is the best thing that can be done for your lovely teeth.