Paying for Dental Services

Dental Insurance Information

imageWhy Can't I Buy Dental Insurance?
Most companies do not offer coverage to individuals because dental needs are highly predictable. You would not pay premiums for a dental plan if the premiums were more expensive than the cost of the treatment you need. Insurance companies would lose money on individual dental plans. The company would spend more on benefits than they receive in premiums.

Dental Plans Help Pay for Care

Almost half of all patients have some kind of dental plan. Most plans will reimburse patients up to $1,000 - $1,500 each year. This usually covers the cost of preventive services and helps pay for part of any needed treatment.

 

What are Dental Plans?

Dental plans help patients by paying for a portion of the cost of their dental care. Employers (or union groups) pay for (sponsor) almost all dental plans. The plan is a contract between the sponsor and the insurance company. All benefit plans have limits: of the kinds of treatment that will be covered, how often treatment will be covered and how much of the cost will be covered. These limits affect the cost of the dental plan to the sponsor. You get what you pay for. The cheaper the plan, the greater the limits. When the patient pays more of the treatment cost, the sponsor pays less for the plan. If you have a dental plan, you can discuss questions about your plan and its limits with your plan sponsor.

 

Types of Dental Plans

Insurance: Some dental plans reimburse you for part of the cost of your treatment. They are not like health insurance because they usually pay for only part of your cost. The amount you receive is based on the insurance company's own fee list, its "UCR." It is not based on your dentist's fees. Patients usually receive 70-80% of the actual cost. The amount is determined the insurer's contract with your employer.

 

Self-funded: Many companies do not buy insurance plans for their employees. Instead of paying premiums to an insurance company, the employer reimburses the employees directly. A third party or insurance company may administer the plan

 

Managed Care: Like health insurance, some companies provide managed care dental plans. These plans may offer care through an HMO. Treatment provided by the HMO may be free or cheaper. Participating Provider Organizations (PPO) are the most common kind of dental managed care. In PPOs, the benefit company signs contracts with individual dentists. The dentists agree to accept discounted fees. When patients receive treatment from a "participating dentist," their out-of-pocket costs are lower.

 

Discount Buyer's Clubs: Patients can purchase discount club memberships. With these plans, you pay a monthly fee to a company. In return, you receive a list of dentists who have agreed to a reduced fee schedule. The "club" only helps match the patient to the dentist. You pay your dentist directly. The dentist and the patient do not receive any reimbursement from the plan. Before buying a discount buyer's club membership, you should discuss your treatment needs and cost with your dentist. Then ask four questions.

    • Are the club's fees really lower than the fees charged in my area? 
    • Is my yearly cost for dental treatment more than the cost of the club membership?
    • Are there dentists on the plan near me or dentists that I would consider using?
    • Is there a real cost savings?

    Who Decides What Treatment is Right for You?

    Treatment decisions must be made by you and your dentist. You should find out what your dental plan offers. But, your plan should not be the deciding factor in your choice of treatment.

     

    Can I Limit the Cost of My Dental Treatment?

    Yes, you can. Most dental disease is preventable but it gets progressively worse over time if not treated. Visit a dentist regularly and take care of your oral health by brushing, flossing and maintaining a healthy diet. 

     

    Acrobat PDF FilePaying for Dental Services

    Information from the American Dental Association about dental benefit plans.