Finding the best dental insurance plan for your family is tricky. Consider what treatments your family will need, such as braces or bridges. You must also look for providers with an extensive nationwide network to ensure your current dentist is “in-network.”
Other essential factors include cost, deductibles, and coinsurance. Read on to learn 5 Key Factors to Consider When Selecting a Family Dental Insurance Plan:
Cost
When shopping for dental coverage, it is essential to consider the cost. While premiums are one of the most significant costs, you should also review other costs, such as deductibles and coinsurance. In addition, some plans have annual maximums (a cap on how much the plan will pay for dental care in a year or lifetime).
Another consideration is whether your chosen plan requires you to stay in-network. Preferred provider organization (PPO) and dental health maintenance organization (DHMO) plans have dentists’ networks negotiated to provide discounted services. While you can go to out-of-network dentists, you will generally pay more for those visits.
Indemnity plans, on the other hand, allow you to choose any dentist. Typically, these plans have higher premiums but lower deductibles and MOOP costs. Finally, make sure to check your specific plan as some pre-existing conditions may not be covered.
Flexibility
Most dental insurance plans offer the flexibility to allow members to choose their preferred providers. However, most benefit plans also limit the number of procedures a policyholder can have in a year and the maximum amount of coverage in a given year. These limitations are intended to help control costs and minimize risk but may still leave the cost of care significantly higher than without a plan.
Most individual and family dental insurance plans have a coverage structure that uses coinsurance to share the cost of services with members. This typically results in a lower out-of-pocket cost for the member by only covering a portion of a procedure – such as 80% of the reduced fee – after the plan deductible has been met.
Many dental insurance plans on the health insurance marketplace have integrated dental coverage, but standalone dental savings plans are also offered. For example, New Yorkers can buy a separate dental plan not tied to a specific health insurance plan when purchasing their coverage in the Marketplace or directly from a health insurance company.
Coverage
Dental insurance helps pay for many of your family’s necessary treatments. However, you will still be responsible for some or all costs through premiums, copayments, and deductibles.
A deductible is the amount you pay before your insurance starts covering specific procedures, and it generally applies to primary services such as fillings or crowns. A copayment is a fixed dollar amount you pay at the time of each visit/treatment, and it does not count toward your deductible.
Most dental plans cover preventive care, basic procedures, and some significant procedures. However, knowing precisely what your family needs and what each plan offers is essential before selecting a plan.
Most dental plans are available through employers, private insurers, or as “riders” to medical insurance policies. Individual dental insurance plans tend to be more expensive than group coverage, and they may also come with more limitations on benefits. For these reasons, shopping around and comparing a wide range of options is a good idea before selecting a plan. Regardless of your chosen plan, reviewing all the details before deciding is essential.
Dentists
Dental insurance is often offered as a part of health plans by employers or purchased separately as a standalone benefit. Dental plans are generally not as restrictive as medical insurance & allow members to visit any dentist they choose. However, it is essential to select a plan with dentists in its network who have agreed to provide services at a discounted rate. This enables the dental insurance provider to minimize costs & ensures that covered treatments are received promptly.
These discounted rates are usually negotiated fees & 40-50 % lower than the dentist’s regular fee for similar procedures. These negotiated rates are paid to the dentist by the insurance company. Typically, PPO & HMO plans offer greater flexibility than DHMO &capitation programs, which require you to visit a specific in-network primary care dentist for referrals & coverage.
Depending on the type of dental insurance policy, there are various out-of-pocket costs, such as deductibles, coinsurance & maximum annual benefits. Licensed insurance brokers like eHealth can help you compare dental plans with the most essential features.
Convenience
In addition to finding a dentist who fits your family’s dental needs, it’s also essential to find one who is conveniently located and has hours that work your schedule. This will make it easier to keep up with routine care and stay on top of any issues that may arise.
Having a family dentist also makes it easier to schedule appointments for everyone simultaneously, which can help avoid missed school and work events. It can be a great way to ensure that your whole family gets the regular checkups they need and more complex procedures like fillings and crowns.
It’s also worth checking whether the dentist is in-network with your plan, as this can often save you money on out-of-pocket costs. If you’re thinking of purchasing a separate dental insurance plan instead of a QHP that includes coverage, be sure to take the time to read reviews and compare different plans to find the right one for your family. Each plan will offer slightly different monthly premiums and benefits, so thoroughly research before deciding.
