Dental insurance plans help pay part of the costs associated with dental care. The best dental plans can take several forms in terms of family, individual, and group plans. These plans are categorized into three main types: Indemnity, Dental Health Managed Organizations (DHMO), and Preferred Provide Network plan (PPO).
Indemnity Dental Insurance
Indemnity dental insurance allows the individual to visit any dentist accepting this kind of coverage. This is a good choice for those who wish to stay with their dentist if they do not take part in a network. This type of plan means that the dentist is normally paid a percentage of the policy holder’s services by the insurance company. Policy holders should carefully review any co-payment requirements, stated deductible, waiting periods, and percentage scales.
Participating Provider Network (PPO)
The PPO is typically affordable dental insurance that functions much like a DHMO but uses a facility that is In-Network, depending upon the individual plan. However, it is possible to use a Non-Participating Provider or dentist Out-of-Network. The patient bears the responsibility for any difference in fees unless clearly stated in their policy. In some cases there is a maximum annual benefit and once that benefit is used, the patient is responsible for any remaining expenses.
Dental Health Managed Organization (DHMO)
Many people consider the DHMO to be among the best dental plans. A DHMO is where the individual selects or is assigned an In-Network dentist and can take advantage of the dental services in the network. When an insurance company signs a contract with a dentist, the insurance provider agrees to a fee schedule. They also lowers costs for services provided by an In-Network provider.
A large number of DHMO plans feature no yearly maximum benefits limitations and little or no waiting periods. Many people purchase this type of plan to help lower the high costs of certain dental services and procedures. Some offer free preventive treatment, while crowns, fillings, dentures, and implants may have certain limitations.
Normally, dentists have a fee schedule for the various procedures and services that are offered. Insurance companies also have fee schedules based upon the average cost of fees in the coverage area. This fee schedule is typically employed as the basis of transactions between the insurance companies, consumer, and the dentist.
Direct Reimbursement programs returns a pre-determined amount to patients of their dental care costs, no matter what type of treatment they receive. It does not normally bar coverage due to treatment type, allowing patients to see their own dentist. Patients are also given incentive to work with their dentists towards a goal of economically sound and healthy solutions.
Another type of plan is the Usual, Customary, and Reasonable (UCR) plan. Like other types of affordable dental insurance, UCR programs permit the patient to see their own dentist. UCR plans pay a pre-determined percentage of the dental fee or a fee limit set by the administrator of the plan, whichever is lower. The limits stem from the contract signed by the third-party payer and plan purchaser.
Dental Coverage and Seniors
Having a dental plan has been found to be a critical factor in whether or not a person seeks dental care. This is important because not getting early dental treatment usually leads to inadequate and more expensive care later on. There is a growing trend of adults retaining their teeth throughout their lives. Consequently, there is an expected increase in the number of dental procedures required in areas like root canals, periodontal disease, and inadequate prostheses among the elderly.
In spite of the clear and demonstrable need for adequate dental insurance, Medicare usually does not cover dental care unless it is the result of complications from another medical procedure. Although there has been interest in expanding Medicare to cover dental care, it is considered unlikely in the near-term future because of economic considerations. Over half of the non-elderly population have dental insurance, but only 24 percent of those over 65 do.
The loss of employer-based insurance coverage at retirement is a major factor in the lower rates of dental coverage among the elderly. By the time most become eligible for Medicare at age 65, over half are not working full time. Offers of retiree dental health plans have fallen by 50 percent over the last three decades, leaving seniors forced to buy coverage in a non-group market or pay expenses out of pocket. These options are very financially perilous for retired people living on limited incomes.
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