If your employer doesn’t offer group dental insurance or if you work as a contractor, you may need to pick out your own individual dental insurance plan, and this can seem confusing. There are a lot of terms and percentages to wade through, as well as network considerations. It can be hard to feel like you’re picking the right plan.
There are two key areas for you to focus on as you sort through individual dental insurance options:
“Cost and covered services are key considerations,” said Suzanne Ducote, director of individual business development at Starmount Life Insurance. “You want to make sure the services you need most are covered, and it won’t break your bank.”
Here’s how to pick individual dental insurance.
Identify Your Individual Dental Insurance Needs
Individual dental insurance generally comes in three “tiers”, Ducote said:
- Preventive care, which typically includes exams, cleanings and x-rays;
- Basic services such as fillings and extractions, and
- Major services such as root canals, oral surgery or bridges and crowns.
And there are many dental plans with different variations to choose from. Ducote said that when looking at plans, consider your personal needs now and in the future by asking yourself these questions.
- How much are you comfortable spending?
- Do you and your family regularly visit the dentist for routine cleanings and exams?
- What is your or your family’s dental history? What dental work have you had in the past?
The answers to these questions can help you determine which plan works best for you. You may need a plan that provides a level of coverage for all services with a higher premium cost, or you may decide you only need a plan, today, that covers cleanings and fillings, with a much lower price.
Understand Individual Dental Insurance Plans
There are several different kinds of plans to review as you pick your individual dental insurance.
Two of the most common plans offered include:
- Preferred provider organizations (PPOs). These plans are very popular today. They provide access to a network of providers who have agreed to negotiated, discounted rates for their services. These plans typically have an annual maximum per person and an annual deductible. Preventive services are usually covered in full, while other services are covered at a specific percentage (coinsurance) of the network-negotiated discount rates.
- Fee schedule plan. This plan will pay for covered services at a specific reimbursement amount in and out of network. These plans also have an annual maximum and deductible.
In addition to considering your own personal needs, picking the right plan also depends on factors such as what dentist you want to see and provider availability in your area. “A lot of plans may look the same, and that’s when you start looking at the network, the premium cost and customer service,” Ducote said.
Watch for Pitfalls
There are several things to keep in mind as you choose an individual dental plan. For example, networks can be an issue as you start comparing competing plans. If you pick a plan but find out later that your dentist isn’t in the network, you may be on the hook for charges you didn’t expect.
Before making your final decision, check to see if your current provider is in-network or if you can nominate your dentist to join the network. In addition, individual dental plans may have waiting periods for different levels of service. When comparing plans, make sure you know the various waiting periods and consider the relative likelihood that you might need services that carry waiting periods.
Finally, Ducote recommends paying attention to the coverage percentages. Many plans say the co-insurance is 100-80-50, meaning they cover 100 percent of certain costs, such as preventive dental care, then 80 percent of the costs for basic procedures and 50 percent for major procedures. But some plans list the numbers as the percentage of what the customer pays, such as 0-20-50. Make sure you fully understand whether the percentages displayed are what the plan will pay or what the customer pays.
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