Supplemental dental plans are intended to fill in the gaps in coverage that are inevitably present in dental benefits offered as part of an existing health insurance plan.
Generally such additional dental coverage is purchased to address out-of-pocket expenses for regular, annual visits to the dentist for teeth cleanings, routine X-rays, and other aspects of preventive care.
In many cases, policyholders don’t know what their regular health insurance provides in terms of dental services. The first step in evaluating the need for a supplemental plan is simply finding out what degree of protection you already have.
It’s then a good idea to consult with your dentist and to look ahead for your likely needs over the next one to two years.
Shopping online has made it much easier to compare plan provisions and pricing. It’s important to consider the stability of the insurer, and their reputation for delivering high-quality customer service.
Also, understanding insurance industry language is key to balancing a good price against solid coverage. Often consumers are attracted to dental “discount” plans due to their low price, but these are not insurance policies.
The most common dental coverage models include (but are not limited to):
- The traditional direct reimbursement model in which patients receive a pre-determined percentage of the total amount spent on dental care. Often these packages are incentivized to help the policyholder work with the dentist to maintain good dental health via preventive care.
- Plans that work on the “usual, customary, and reasonable” model allow the policyholder to visit the dentist of their choice. The policy pays a percentage of the resulting fees that are deemed “usual, customary, and reasonable.”
- Schedule of Allowance coverage operates via a list of services, each with a dollar amount assigned, which indicates the limit to which the plan will cover those services. The actual cost of the service does not figure into the payment schedule.
It is not unusual for dental insurance to require that a treatment proposal be presented in advance for review. Benefits may be limited per year or by number of procedures.
In evaluating dental insurance plans, some of the questions that need to be answered include:
- Can any dentist be used or must the dentist be selected from an approved list?
- Are treatment decisions made by the patient in concert with the dentist or is prior approval required from the insurer?
- Are preventive, diagnostic, and emergency services included, and if so, what are the out-of-pocket expenses?
- How is “major dental” defined by the plan?
- What limits are associated with the coverage and how are they determined?
Be prepared for the fact that almost all dental insurance plans do cap services per year either in number of procedures, amount spent on care, or some combination of both factors This is an effort on the part of the company to control costs, and something the consumer should understand in order to plan when dental work will be performed to maximize the benefits received.
In the final analysis, the best supplemental dental health insurance plans fill the gaps present in primary insurance, address out-of-pocket expenses, and are flexible and affordable. Since these plans vary widely, there’s no replacement for careful comparison shopping to arrive at the right combination of dental insurance protection.