Dental Insurance Plans
Dental insurance has been around for about thirty years. The original insurance plans were known as Indemnity plans. These plans were also called 80/20 plans. The insurance paid 80% of the bill no matter what it was for, and the patient paid 20%. Premiums were pretty high but there were many benefits. You could go to any dentist that took the insurance and you didn’t need referrals or permission from the insurance company to change dentists.
The entire insurance industry has made some significant changes over the years, and one has been to turn dental insurance away from the standard Indemnity plans to the now familiar HMO and PPO plans. Many patients don’t even realize there is a difference between the two until they try to make an appointment with a new dentist and run into problems.
HMOs in the dental area have the same purpose. You have to stay in network and if there are problems you will need a referral to a specialist in order to get the treatment that was recommended. The insurance company will also have a big say as to whether they’ll pay for the treatment. They might recommend something cheaper. People with PPOs usually don’t have many of these problems.
In either case, different plans have of course different coverages. A few provide free routine care such as cleanings twice a year and annual xrays. These usually require a nominal co-payment of $5 to $15 per visit. Some plans provide higher coverages for things like extraction, root canals or caps but it doesn’t really matter if it’s an HMO or a PPO. When it comes to what is paid, the type of insurance has little impact on what’s covered and what’s not.
Typically, the HMOs are less expensive for the plan itself. Since any type of insurance can be expensive, many people do choose the HMO when given the choice. Almost all employers who elect to provide this coverage to their employees will choose a group HMO plan.
Another option has come on the scene as well. These are discount plans rather than real insurance plans. How the patient uses them or pays for them has little difference. The plans are purchased on an annual basis for either an individual or a family. They have co-pays just like dental insurance and you may or may not need to restrict your dentists to those who accept the plan you choose to buy.
Many of these discount plans include very generous coverage for purely cosmetic procedures like teeth whitening and veneers. They can also be used in conjunction with dental insurance.
The major different between discount plans and insurance policies is that when a dentist agrees to accept payments using one of these discount plans, that’s all he gets – the amount that the plan says you need to pay for a procedure. He doesn’t get additional money from the company as he would with dental insurance.
Many people buy one of these discount plans to use in addition to their regular insurance sometimes just to get their teeth whitened or to get veneers that are covered.
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