It only takes one uninsured root canal or crown to convince most people that dental insurance coverage is a good idea. While it is not intended to pay 100% of your dental care costs, it goes a long way toward taking the bite out of it.
The first thing you’ll notice when you start looking for dental insurance quotes online is that you have a lot of choices. Almost all of them pay in full for preventive services such as exams, cleanings and routine x-rays, and put a cap on the maximum dollar benefit you’re entitled to in a plan year. Most require you’re your dentist get authorization before performing a service.
Traditional or indemnity dental insurance coverage pays your dentist on a fee-for-service basis. What your insurance pays will be factored either on a Usual, Customary and Reasonable (UCR) or Table or Allowances basis. With a UCR plan, payments are calculated by what your insurer believes is appropriate for the service in your geographical location or the dentist’s fee, whichever is less. Table of Allowances polices list the set dollar amount allowable for a procedure. Generally, insurance picks up between 50 and 80 percent of the cost for covered services and you make up the difference. Most indemnity dental plans let you pick your own dentist.
Managed Care dental insurance plans come in a variety of flavors including capitation dental plans (aka Dental HMOs), Preferred Providers Organization plans (PPOs) and Exclusive Provider Organization plans (EPOs).
On a capitation plan, dentists contract with the insurance company to provide dental services for enrolled members. You pay a fixed monthly premium plus a co-pay for procedures like fillings and crowns. You have to use a dentist within the network. If you travel a lot, find out what your options are for dental emergencies away from home.
PPO dental insurance plans are a combination of a capitation plan and an indemnity plan. You are encouraged to use a dentist in the network and will receive the maximum cost benefit when you do. However, if you want to see an out-of-network dentist, you can but you will pay higher deductibles and co-pays.
EPO dental insurance plans are similar to PPOs except that you must use a network provider. If you go out of network, you will receive no benefits.