Many people are confused by the difference between dental insurance and dental discount plans. Dental insurance is intended to provide payment for oral health care, which typically includes preventative care, x-rays, fluoride treatments, and cosmetic procedures. Dental discount plans generally offer lower pricing on selected services for dental professionals in a given network. It s typically limited to a fixed percentage of the overall cost (i.e., half of what it would cost for a single dental office visit), but coverage for routine oral services such as fillings, crowns, and root canals is usually included.
There are a number of factors that can affect the cost of dental insurance plans. One of the most significant factors is the calendar year. Yearly increases or decreases in the cost of care may vary depending on a number of factors including the amount of time left before a policy expires, how long you may have to remain on the plan, when your current policy will end, and what conditions you currently have. Some policies do not offer annual maximum benefit limits; however, most policies do offer a yearly maximum benefit limit that may vary. You should review your dental insurance plans annually to see if you will need to maintain certain services or if the prices on your existing plan will be higher after the year is completed.
Other factors that affect the cost of dental insurance plans are age, type of coverage, and type of provider. Most plans focus their coverage on young adults or those with clean and healthy teeth. Coverage for individuals over age 30 is usually minimal. Most plans require individuals to undergo a dental exam prior to obtaining coverage, and individuals over the age of 20 typically cannot be covered under dental insurance plans if they have not had a dental exam within the previous year. Some plans require individuals to undergo a Pap test prior to coverage, but this is not always a requirement. Many insurance companies do not require any annual preventive care visits, such as x-rays, regardless of your age.
The type of provider matters when it comes to dental insurance plans. In general, the more dental providers a plan covers, the more expensive the overall premiums will be. If you have children, it is important that you find a dental insurance plan that offers coverage for children’s needs. Plans that only cover a portion of dental care can often result in an extremely high monthly premium. Additionally, you may be required to pay a co-pay for preventative care visits.
Another aspect of dental insurance plans is whether they offer payment options. Some basic plans simply reimburse you for each visit to the dentist, regardless of whether they are used or not. If you need more detailed coverage, you may be required to pay a co-pay. Monthly premiums often differ depending on which payment option you select.
Most dental insurance plans also contain provisions that allow the provider to set deductibles and out-of-pocket expenses. Generally, this will result in higher premiums, but there may be benefits to choosing a higher deductible. For those who are concerned about being covered for preventative care visits, it may be better to choose plans that don’t require annual deductibles or co-pays. However, if the primary care doctor you see is covered by your provider, the annual deductible won’t likely affect your visit rates.