Dental Care Insurance

According to a survey by Dental Town, the average American spends a jaw-dropping $3,000 a year on dental care. And if you're not careful about your oral health, it can lead to tooth decay, gum disease and cavities that will necessitate expensive dental procedures. So how can you prevent your checkbook from bleeding dry every time your dentist's bill comes in?

There are plenty of good options out there for reducing the cost of such treatments with various plans available at different price points and coverage levels. But which one is best for you? To help you decide, here are some questions to ask your doctor and our expert, Kathleen O'Grady, RDH, CNZM.

What's your bottom-line cost?

When you're comparing plans with different coverage levels and benefit options it's important to look at the total cost of the dental plan over a lifetime. That means costs in front and back as well as early and late in life. In general, lower monthly premiums mean higher annual costs. A 7% discount off your premium for every $100 in annual deductions could mean an extra $60 in annual fees each year if you don't have enough money saved to get the discount.

How many visits to the dentist do you have a year?

An annual check-up at your dentist gives you the best estimates of when you'll need treatment. An interval longer than three years is considered a "non-emergency" and can lead to higher costs for emergency situations. Read more about some common preventive visits in "What's Not Covered by Dental Plans?" But if four or fewer visits a year can be covered by your plan, talk with your doctor about combining dental care with non-dental health care benefits. Here's why: Many plans require that the dentist who performs your work must be part of the network. So while coverage may sound unlimited, it isn't always unlimited.

How much is your annual deductible?

Another important consideration when choosing a plan is the amount of deductible you'll need to pay before the insurance kicks in. The average annual deductible for dental plans in 2010 was $425, according to Dental Town. But there's no rule of thumb here; be sure to compare options from different companies so that you can get a better idea of what your costs will really be. Also, consider how much you'll have left over after paying for dental and health care costs after the deduction for your plan's maximum annual benefit has been reached by looking at a chart that shows how much coverage will remain after deductibles and maximums are taken into account. The chart shown below is from Dentaltown.

What steps do you need to take before getting covered by your plan?

Some plans have some pre-existing conditions that need to be taken into account. Some carriers require you to go through an annual physical exam with a dentist before they will cover treatment. So it's never too early to ask your doctor which health insurance companies participate with her practice and which ones don't. And if she doesn't participate in dental plans, never hesitate to ask about alternatives because sometimes there are payment arrangements that can make coverage possible for the rest of your family members.

What fees are not covered by your dental insurance?

This question is sometimes left out for obvious reasons; people don't like to think about what they might have to pay out-of-pocket. But it's important to know because you can always ask the doctor for a less expensive treatment or see if the treatment can wait until your next checkup. Or, if you know that it isn't a covered service, ask about alternative treatments that are cheaper and more affordable. Filling cavities is still an option even without coverage—if you find a dentist who won't try to sell you the most expensive treatment as soon as you walk in his office door.

Are you covered for your dental procedures?

Most plans cover only the basics of cleanings, check-ups, fillings, extractions and other common procedures. But some hospitals and clinics have agreements with their providers to make more expensive services available. For example, a cleaning may be covered by a plan but an exam with X-rays would not. These types of agreements are typically referred to as "limited benefit plans." Be sure to tell the doctor about your insurance coverage in order to avoid confusion or misunderstanding about what is covered and what isn't.

What if you have to make a claim?

Having insurance is worthless unless you file a claim. So before you go in for dental treatment, be sure to get all of the information on your plan from your doctor. Also check with your insurer directly about amounts not covered by the plan or medical conditions that have exceptions. For example, some patients are not covered for any treatments related to their diabetes or their high blood pressure unless they're also taking medications for those conditions. And if you need a root canal, some plans require that it be performed on an endodontist—a dentist who specializes in treating pulp tissue inside of teeth and has additional training and expertise in this area of dentistry. The idea is that if you get a problem after receiving care from an endodontist, you can still receive treatment if you have one in your area.

Is your plan offered by a provider or a third-party?

While some plans are offered directly through employers, it's also common for carriers to offer coverage through the practices of doctors. Find out what the process is like between your doctor and the company, and be sure that you're covered for all of your services. If you have any questions about this aspect of insurance, be sure to ask your doctor.

What's not covered by dental insurance?

There are many services that aren't covered by dental plans, and some of them can be very expensive. Some of these procedures include wisdom teeth removal, some orthodontic work, cosmetic or restorative treatments such as veneers and bleaching, periodontal treatment, implants and other similar procedures. And depending on the plan you choose, there might also be annual limits to what they will pay before deductibles are taken into account.

Conclusion

Choosing the best dental coverage for your family is always a work in progress. Being knowledgeable about what's covered by your plan can help you decide which one to choose. And if necessary, letting the insurance company know that you have dental-only coverage so they can make appropriate payments for those services is always a great idea.

For more help and advice on choosing and managing dental plans, visit DentalTown.