The thought of having to go to the dentist may be quite a terrifying mental journey that you take once and realize the actual trip would be too exhausting and stressful. And you always hear about those horror stories of people needing emergency root canals during a visit and the inability to communicate with words is lost for a day or so during recovery…from the procedure and the bill. So you forgo the entire process completely. “Is it really worth it to get dental insurance, then?” you may ask.
That’s a fair question. So since you like questions so much, let’s answer some common questions that people ask about dental insurance.
How Does Dental Insurance Work?
Well, insurance companies have a knack for creating catchy phrases to help folks like you remember what will be covered in their insurance plans. For dental insurance, it’s broadly called the 100/80/50 rule.
– The 100 is there to tempt you to get into the door of a dentist’s office. 100% of your bill will be paid when you go in for your bi-yearly dental exams.
– The 80 is there to convince you stick around to fix any simple issues. Around 80% of your bill will be paid to fill in that cavity, remove a bad tooth, or correct most problems with your gums.
– The 50 is there to lighten the burden of those more major, expensive, and necessary procedures. Around 50% of your bill will be covered for the root canal, crown, dentures, implants, etc.
At its root, that’s how dental insurance functionally works to encourage the occasional visit to the dentist.
What Kind of Dental Plans Are Available To Me?
The big three options of dental insurance are:
– HMOs: The majority of dental insurance opt for the Health Maintenance Organization plan. This type of dental insurance pays for nearly 100 percent of the dentist visit. The mindset behind this plan is to be better safe than sorry. The bi-yearly visit prevents most insurance holders from requiring major operations by keeping your teeth well-maintained.
The downfall of getting an HMO, whether privately or from your employer, is an HMO keeps you from choosing your own dentist. The plan delegates which dentists are supported as a part of the organization. If you discover the dentist you like the most isn’t supported by your HMO, getting this type of plan may not be for you.
– PPOs: A Preferred Provider Organization plan allows you to pick a preferred dentist outside the selected network of approved dentists in an HMO. If trusting your dentist is a higher priority for you than cost of care, PPOs are a much better idea for you.
However, if you follow through in obtaining a PPO, discounts may not apply to your bill, and you may find that your overall charges have increased. The benefit of a PPO is the dentists within the PPO network are allowed to discuss different prices for specific procedures.
– Indemnity Plans: An Indemnity plan is almost exactly like a PPO, but it provides less coverage than the average PPO. Indemnity plans are a good idea if you financially secure enough to pay all dental costs out of pocket and would simply appreciate the possibility of a discount if applicable.
What If I Wait?
It’s understandable if you approach dental insurance with the mindset, “I’ll get it if I need it.” No one likes paying anywhere from $120 to $350 a year for a plan they don’t foresee using on a regular basis. However, immediate coverage is never an option when buying insurance. Rather, dental insurance policies have what they call a waiting period. Although each policyholder has a differing allotment of time, on average, once you are enrolled in a plan, you must wait 12 months before your insurance company will cover you.
And, in case you think that stipulation only exists for major things like root canals and other intensive surgeries, that’s not the case. Insurance will not step in to pay for anything from a bi-annual cleaning to fillings or surgeries until you’ve been enrolled for a full year.
Your next step is to sit down with a trustworthy insurance agent like Michael Suhany to discuss your budgetary parameters and choose the plan that is right for you. Michael can help you ask the questions you may not have thought of and decide which plan will serve your future the best.