Dental Insurance

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Purchasing the Perfect Dental Insurance Plan

When times get tough, many Americans let their teeth go. Thirty-six percent of Americans leave dental care and checkups out when finances are tight — the second most common cost-cutting action of the six in 10 Americans who delayed or skipped health care in the past year, according to an April 2009 Kaiser Health Tracking Poll.

Maybe it seems that missing dental visits or eliminating dental insurance won’t hurt too much, but preventative dental care curbs the likelihood of bigger, more expensive dental problems down the road.

Studies show that people visit the dentist more often if they have dental insurance. As you shop around for a dental plan, ask your agent questions and keep the following in mind:

What benefits are provided?

Does the dental insurance plan cover preventative care such as routine cleanings and exams, basic procedures such as fillings, and major procedures such as surgical extractions? What procedures fall into which categories? For instance, some carriers consider X-rays as preventative, while others categorize them as basic.

How much will you pay on top of premiums?

How much is the office visit copay? What will you pay for coinsurance? Some dental insurance plans will cover a certain coinsurance percentage in the first year and then 100 percent in subsequent years. This amount may vary based on the type of procedure — preventative, basic and major.

Are there waiting periods?

Some carriers enforce waiting periods on certain procedures. Make sure you know if such restrictions are in place before you buy. For instance, if you need a basic or restorative treatment such as a filling or a major procedure such as a crown, you may pay out of pocket on top of your premium if it is performed before the waiting period expires.

What is the yearly maximum?

Most dental plans put a cap on benefits paid within a given year. Find out the amount and determine whether or not it fits your specific needs.

Can I choose my provider?

Under a preferred provider organization (PPO) program, you choose from a network or list of discounted providers; if you choose a non-network provider a PPO will cover you at a higher rate. Dental HMOs require you to see contracted providers. And dental fee-for-service plans provide set reimbursement for services rendered and allow you to choose your own dentist.

Determine how much coverage you need

The annual maximum is the total payout a dental insurance plan will pay for services for a member during a calendar year. Determine what dental services you anticipate having for the year. Make sure the annual maximum amount of coverage is enough to cover preventive care and the unknown. The higher the annual maximum is, the higher your premium will be for that coverage.

Basic and major coverage will help pay for the big stuff

Dental insurance can help pay for fillings, crowns, root canals and treating periodontal disease. These "big ticket" items are known as basic, major and endodontic care, and can cost from $100 to thousands of dollars. Look for a plan that will pay for a percentage of the cost (also known as coinsurance).

Good oral health is important not only to prevent oral disease but also to maintain good general health. Buying a health insurance plan is a good way to ensure you have access to routine exams and affordable dental care. Look for a plan with a network of dentists, identify how much coverage you and your family members need each year, and make sure the plan provides at least preventive and basic services.



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