Dental Health Insurance

Dental health care is a must for everyone. In the US, dental care is very expensive. Hence, people prefer dental health insurance, since paying a regular premium ensures that a person can avail the services of a dentist at a reasonable cost. 97% of the people having dental health insurance are covered by their employers. This seems like a significant number. However, considering that 43% of the US population is without dental health coverage, very few people actually enjoy the luxury of employer-based dental health insurance. A majority are forced to pay for dental care out of their pockets. The different types of dental insurance plans thus assume importance, since people are rendered service according to their ability to pay.

Dental Health Insurance Plans

Traditional or Indemnity Plan or Fee for Service Plan
In this case, a person pays a premium on a monthly or on a regular basis. The person is then entitled to visit a dentist of his choice. The insurance company reimburses the dentist for the usual, customary and reasonable services (UCR) provided. In case of UCR services, the insurance company will cover the entire cost of preventive services like cleaning, and 80% of restoration services like root canal treatment, filling and other dental work. Generally, in case of major orthodontic work, around 50% of the cost of the service is covered. According to the Least Expensive Alternative Treatment (LEAT) clause, the insurance company will only cover the cost of the least expensive treatment. In case a person opts for a more expensive alternative, he would have to bear the cost himself. The biggest advantage of this dental health insurance plan is that a person has the ability to visit a dentist of his choice.

Direct Reimbursement
In this plan, a person is required to pay the dentist up front for the services provided. On submitting the bill to the employer, he can claim either a part or the entire amount of the money paid to the dentist. This is the most expensive plan but one that provides a great deal of flexibility, since the employee can visit any dentist of his choice. The reimbursed amount is tax deductible for the employer. This is also the only dental health insurance plan that covers pre-existing conditions. The person undergoing the dental procedure requires no prior authorization from the employer. In case of other dental insurance plans, prior authorization may be necessary for certain procedures.

Managed Care Plans
Managed care plans are cost-effective. The Dental Health Maintenance Organization (DHMO) Insurance Plans and Dental Preferred Provider Organization (PPO) Insurance Plans are the most common managed care plans.

DHMO: Capitation dental insurance plan or DHMO requires a person to pay a premium on a regular basis. In return, the dentist is paid by the insurance company on a yearly basis for the services provided to the insured person. The dentist is generally paid a flat rate.This is the cheapest dental health insurance plan that covers the cost of preventive and basic services. A person can however, seek treatment only from the designated network of doctors. In case he decides to seek treatment from a doctor outside the network, he would need to pay for the entire cost of the dental service. Moreover, pre-existing conditions are not covered, and in general, the waiting time for dental procedures is longer.

Dental PPO: In this case, a dentist signs up for the PPO network and in return for referrals from the insurance company, he agrees to provide services at a discounted rate to the insured person. Dentists prefer these plans since they get paid without any hassles. Unlike a DHMO plan, which pays them a flat rate, they are paid the entire fees. Patients prefer this plan since they get to choose the doctor, the waiting time for the procedures is short and the services provided are better than those provided under a DHMO plan. In case a person visits a doctor who is outside the network, he is not denied coverage but is expected to pay a greater portion of the bill. Pre-existing conditions are however, not covered under a dental PPO insurance plan.

Dental Discount Plans: They are a good alternative to dental health insurance. In this case, a person belongs to a group or a club which ties up with a few local dental care providers in order to provide dental health care services to the members of the group at discounted rates. This plan covers a person regardless of his claims history and there is no need for prior authorization, regardless of the procedure.

A person thus has the option of attending to his dental health at a reasonable cost, and without any delay. It is no wonder then that these dental discount plans have caught on in a big way.