How To Evaluate a Dental Insurance Plan

Should I Have (or Buy) Dental Insurance? Part 2

Evaluating a Plan Once You Decided it's for you...

In a previous post or article, we discussed the concept in general. If you missed that, go back and read it before going on with this information.

In this article, we will make some assumptions: The fact you have decided that you as an individual is not a large enough risk pool, and you don't want to  accept 100% the risk of a predictable event (or unpredictable, as the case might be) of a major dental expense.

You are probably pretty sure that you won't need a major procedure because you do practice good oral hygiene and regular checkups.. but you never know. You probably feel that a need for a cap, bridge, implant, alignment, etc is remote.. but again, you just are not sure.

You want, and can afford, the “knowing” that if a need comes up, it won't mean either an outlay of significant cash or putting major expenses on a credit card.

You would rather “pay me now and not pay me later”, but you know this is an option, and if you have not really saved, you have balanced the cost of maybe $40 a month for the next 5 years vs a major procedure that could easily cost $5000. You may question this $5000 so you have talked to your dentist and asked, “Doc, if I had to get two teeth removed and replaced by implants, what would it cost?” and you have confirmed, “Yes, it could well run into that kind of expense”

You have read the first article in the series and learned that the dental cleanings you get with your insurance are not “free” or “good guy benefits” but are there to benefit you as well to prevent you having that extraction and implant procedure... because you had the tooth maintained before you ever go to this stage..

But you want, and can afford the idea of the dental insurance and you want the comfort level of knowing your risk is minimized.

In short, you have decided to purchase dental insurance.

So what are the things you should look for and in fact, demand, from any dental insurance plan? In somewhat random order, these include:

• Waiting period for coverage, if any. Most plans have a minimum 3 month waiting period for routine procedures and up to 12-18 months for major work. If you have pain and a need for that root canal, you sure do not want to wait for a year or more!

• Annual benefit caps or max. Most plans have annual caps in the area of $1000 to $1500. If you require major work, you can easily exceed this, particularly if more than one tooth is involved... and remember from the first post, it is MAJOR unexpected work you are getting your insurance for.

• Wide choice of dental providers. Make certain you have a wide choice and you have the flexibility to change providers if you don't like one you are working with.

• No age limits. Funny thing is that seniors often need dental work as well. Maybe there's some fillings they had done when they were 40 or 50 and now at 65+, those fillings are worn, cracked, etc. Most insurance plans have an auto cancel at 65+ or don't allow enrollment at all. Then there is the other end... how about kids, maybe needing orthodontic work. Check the age availability carefully.

• What you would pay or owe, and how it is calculated. This is really, really important. The vast majority of dental insurance plans quote benefits as paying out a percentage of costs. But few state on the basis those costs are, so if you save or get paid 60% of bill.. what is the bil based on? If you were to choose a plan of this type, make certain that the bill is paying on UCR. But there's also another very important part: Make sure the provider BILLS on UCR. The provider can charge more, and many “prestige” dentists actually do. Another form of costing is that the company has a fee schedule for what you will pay for any given procedure. The better dental plans tell you this. Also, see if you are entitled to benefits on enrollment of if you must satisfy a deductible first.

• Contract length. Are you signing up for a contract for X years, or do you have the ability to leave the plan at any time, and ideally, with no penalty.

• Network and other affiliations. A very large percentage of dental insurance plans are add ons with health insurance plans. We suggest that this is not a good idea, because if you want to change health insurance plans, you lose the dental. If you want to keep a dental plan going and have to start with a new company, you face new waiting periods. The best idea is to have a plan from an independent dental insurance provider who specializes in this niche. If your provider is not in the network and you are in a network based plan, is there a written provision for coverage out of network?

These are the most significant items to consider when you purchase a dental insurance plan. Print this post and use it as a checklist.

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