Because policy limits, deductibles, rand financial reimbursement caps vary, people have to make smart decisions and pay special attention to the fine details of their dental insurance plan before signing on the dotted line. When performing an analysis to decide which dental insurance plan is best, here are a few things to consider.
Because the dental insurance carrier recognizes the benefit and cost savings of preventative maintenance, annual checkups and cleanings are often covered 100%. Find out, however, how many well care visits per year are covered. Some policies cover one per year while others cover one every six months.
Dental insurance companies establish a standardized chart upon which they base reimbursement for dental procedures. Each company sets its own UCR, therefore it is important for insurance seekers to review the insurance provider’s UCR table and compare it with the dental prices in a given area. Unfortunately, the usual, customary and reasonable reimbursement chart and actual dental procedure costs rarely match. Most often the dental procedure will cost more than the UCR listed on the insurance company’s schedule. The difference ends up coming out of the policyholder’s pocket.
It is customary for dental insurance plans to limit the dollar amount of procedures a patient can undergo one year. For individuals who regularly visit the dentist to perform preventive procedures such as regular cleanings and fluoride treatment, the annual benefit cap does not pose a problem.
Families and individuals who have dental problems that go above and beyond the normal preventative measures and occasional filling may reach and exceed the annual benefit cap. Many insurance companies offer coverage on a sliding scale basis. For example, they may pay 100% of preventative measures, 80% of basic restorative services and 50% of major restorative services. Therefore, it’s best to coordinate care with the dentist to spread the work out over the course of several policy terms to in order to minimize out of pocket expense and maximize the dental insurance coverage.
Further to the annual benefit cap, which gets replenished each year, dental insurance companies also apply lifetime caps for certain procedures. It is common for dental insurance companies to put a lifetime cap on orthodontic coverage. Therefore, if a child needs braces to the tune of $5,000 and the policy only covers $2,000 (lifetime cap). The $2,000 is not replenished the following year and becomes an out of pocket expense.
Dental plans vary, but it is important to assess the true cost of purchasing a dental plan. In addition to the annual/lifetime caps and UCR, patients must review the deductible requirements and whether or not the deductible applies on a per person or a per family basis. Depending on the number of people in the family and the amount of dental work to be performed, the applicable deductible can be a substantial out of pocket expense.
If presented with more than one dental insurance option, it is prudent for one to take time and analyze each program. The decision should not be made hastily.