January marks the start of a new year, the start of many new resolutions, and most likely the start of a new dental insurance plan. Open enrollment changes made in late 2012 will be effective starting Jan. 1, 2013, so it’s good to know what these changes will mean once the year starts.
Dental insurance plans differ in what you pay for them, how much they cover, if there is a deductible and co-insurance and the annual maximum (the total amount they could possibly pay in a year). Employers negotiate these details to get the best rate, but nevertheless every year the cost for insurance goes up and the benefits go down. So it’s wise to know the five main types of dental insurance, as well as the most important aspects of them to consider.
This type of dental insurance allows you to visit any licensed dental provider, and receive benefits either directly or they can be sent straight to your provider. No network is needed and the provider changes his or her regular fee, the insurance pays a portion and the patient pays the difference. This is the plan with the least restrictions but also the most expensive to purchase.
This is regular dental insurance with a hitch. Most PPO plans allow their patients to go to any licensed office. However, if a patient chooses a network provider they will potentially pay less out of pocket. These network providers are dental offices that have signed a contract with the insurance company stating the office will write off any difference between their regular fee and the insurance company contracted fee. This option can save a patient money, but can also cause a lot of confusion.
DMO/HMO Dental Coverage
This type of dental coverage is where you choose a dental provider, and their office is paid a small token payment each month for each patient on their list. A reduced fee is required when the patient sees the dentist. However, if the dental office is closed or the dentist is away, you have no benefits anywhere else.
Dental Discount Plans
These are the dental plans that you can sign up for online or with a postcard. You pay the discount plan a fee and they send you a list of dentists in your area that have agreed to give a discount. You pay for all of your services out-of-pocket, but at the reduced rate with some limit on the total amount of discount in a year.
MSA’s Medical Savings accounts and Direct Reimbursement plans
These plans are administered by an employer and allow patients to pre-pay for health care with before tax money or submit paid invoices for direct reimbursement. They may be available instead of dental coverage or in addition to dental plans.