Dental Insurance Plans

Submitted by avengerki on Tue, 04/29/2008 - 20:47

What are the dental insurance plans to go for?

Dental insurance plans are primarily of 2 types:
  • 1. Indemnity plans
    2. Managed Care Plans

Indemnity/fee-for-service plans
This plan allows the insured to pick a dental care professional of his choice from the existing network of the insurance company. The claim may be then forwarded to the insurance company. You will be reimbursed for part or all of your dental care as mentioned in the policy. This plan may be favorable for those who seek more options in dental care.

Managed Care plans
:

Managed care is classified into:
  • Dental Preferred Provider Organization (PPO) Insurance Plan: The PPO plan allows individuals to avail treatment and discounts from dentists who are a part of a network. This insurance plan allows you to visit dentists outside the network too, but in this case it may cost you more than what your plan covers.

  • Dental Health Maintenance Organization (DHMO) Insurance Plans: There is a group of dentists who are part of the network formed by the DHMO. Only individuals covered under family DHMO or individual DHMO can avail the services. If you are not a part of the same plan then you are not entitled to any coverage.

  • Dental Point of Service (POS) Insurance Plans: In this plan there are 2 options. You can either visit a dentist who is part of the insurance plan network or you may visit a dentist outside the insurance plan network. If you choose to visit a dentist who is outside the network, you will end up paying more.



Dental plans too, like so many other policies can be opted either under individual plans and group plans.

Individual Dental Insurance:

Individual dental insurance is a very popular form of coverage and is sold directly by the insurance company to its client. However, this policy is not easy to find. Some employers may provide such coverage. Insurance companies often sell these plans as “referral plans” and sometimes also as “buyers' clubs”.

Group Dental Insurance
It is recommended by experts that you should get a group dental insurance if you can. It costs less than an individual dental insurance policy and also provides the most comprehensive care. There are several group dental plans where you may also declare dependents in which case you may be allowed to insure your entire family. This group dental plan helps in reducing the cost of dental care to a great extent.


What are the benefits of a group dental insurance policy?
In a group dental insurance policy, the insurance provider offers coverage for an entire group instead of an individual alone. The benefits include:

  • Insurance providers who offer group insurance mostly charge lower monthly or yearly premiums. The entire group in this insurance policy helps keep the dental insurance costs down.

  • Individual plans and many discount plans cover preventive and diagnostic care. But group dental insurance plans allow the insured to cover their family members, major dental work, orthodontic treatments and children.

  • Group dental insurance plans often offer their members a wide range of services. Special discounts on family plans, special offers on individual plans for single employees, and special plans for employees who are in need of extra care. Many insurance providers offer such plans in a group policy that meets the requirements of individual members. This means that the insured (you) can get the benefits at prices that is affordable for them.

  • Employers can retain more employees if they provide such benefits like dental coverage. Companies and organizations offering such group dental insurance may be entitled to or may claim tax benefits as a result.


Family Dental Insurance
Family dental insurance is an effective plan created for couples and their children. Such plans may also offer free or low cost service for younger children in your family. Costs for check ups, cleaning, dental x-rays, orthodontics, fillings, and root canals may be lowered as a result of this family dental insurance. Many employers too may offer such a family plan for their employees. If not you can get one on your own.

Family dental insurance has 3 major types:

  • Family Managed Care Dental Insurance – Many individuals go for managed care insurance because the out-of-pocket costs for family dental DHMO and PPO becomes lesser with every visit. However, in this case you need to visit a dentist who is part of the approved network.

  • Family Indemnity Dental Insurance – This plan gives you the liberty to choose the dentist you or your family members would like to visit. There may be a certain amount of deductible that you will be entitled to pay to receive dental care. You and your family will receive more flexibility in terms of benefits and services with this plan.

  • Family Discount Dental Plans – The program under family discount dental plans provides many dental services at lower costs. The advantage of such a plan is that as a member you will be provided with a discount card which you may present to the enlisted dentist to avail the discount.

Posted: 29 Apr 2008 09:41 Post Subject:

So basically in my long winded approach here I am asking if anyone has had any experience with the discount dental plans or supplemental insurance and might recommend one.



Take a look at dentalplansonly.com . . .

There are links to locate providers in your area and you can actually see the reduced fee schedule for each dentist.

Posted: 30 Apr 2008 10:39 Post Subject:

After you find a plan you like and before you purchase it talk with your dentist to be sure they subscribe to that particular plan...also inquire about things like the dental insurance claim form and the associated documents.

Posted: 30 Apr 2008 07:01 Post Subject:

That is my plan I try to do as much research as possible prior to purchasing anything anymore after getting burned once.

Posted: 03 May 2008 03:20 Post Subject: dental

I found out alot of the 'supplemental' dental plans my dentist does not accept. I haven't been able to find Dentl Insurance ( except for 'group plans' for employers). Any suggestions/

Posted: 04 May 2008 03:51 Post Subject:

Just find out which ones they will take, to me the individual dental plans are a wast of money because they are usually designed to take in more premium than to pay out in benefit..

mac

Posted: 04 May 2008 03:58 Post Subject:

I went in to see my dentist with a list of different plans and had them tell me which ones they accepted. That way I wasn't using grapeshot to find a plan that they will accept and I like.

Posted: 04 May 2008 11:09 Post Subject: dental

That's a good idea. Never thought of doing that. Thanks for the advice.

Posted: 08 May 2008 04:38 Post Subject:

I'm dying to know . . . What is "grapeshot"??

Ok, back to dental insurance/dental plans.

Someone made a comment about dental insurance premiums being designed to take in more money than they pay out in benefits.

If your insurance company paid more claims than they took in in insurance premiums, they would be broke and your insurance wouldn't be worth the paper it's printed on.

There is good dental insurance out there, but all dental insurance plans have terms and conditions and policy limits. Most that I have seen have an annual maximum of $1,500 or less. Most have deductibles, co-payments, limited benefits on major dental services, pre-existing conditions, and waiting periods.

A person must understand all of these dental insurance features before deciding on a particular plan.

There are good "Discount" dental plans out there. These discount plans are not dental insurance, therefore, they do not have deductibles, annual maximums, co-payments, pre-existing condition limitations, or waiting periods. These plans are limited by the fact that you must get your dental work done by a network provider. But that's the same with most dental insurance.

We must understand the difference between "dental insurance" and a "discount dental plan".

Maze

Posted: 09 May 2008 02:49 Post Subject: dental

Good point, INSMAZE.......I did talk to my dentist. ALOT of the 'dental plans' ......I would have to pay 'out of pocket' for the visit and work done. Then, i would have to send in the paperwork to the 'dental plan.' THEY would send me so much money back. Well.........with the work I NEED done, I can't reallt AFFORD to 'pay out of pocket.' 'Dental Insurance'......I've looked around. I haven't found one that actually has a 'individual' plan. They would mostly be for 'group' plans ( employers, etc.).

Posted: 09 May 2008 05:15 Post Subject:

BlueCross BlueShield now has individual dental insurance plans in some areas. Go to bcbs.com and click on "Blue Finder" at the top left.
You may have an individual dental insurance plan in your area.

Also, check Humana.

Maze

Posted: 10 May 2008 01:11 Post Subject: dental

Thanks..i will look into it. Humana?..never heard of it. Is it Medical, Dental, etc.? :roll:

Posted: 13 May 2008 08:53 Post Subject:

Humana?..never heard of it. Is it Medical, Dental, etc.?



Humana offers both individual and group health insurance, as well as, dental insurance. Humana Dental Insurance company is one of the 10 largest dental insurance providers in the United States.

Your only problem with buying a "dental insurance" policy at this poing is the "waiting period" for pre-existing conditions. Somewhere I think I read that you had alread been to a dentist and received an estimate on your proposed dental work, is that right or did I read that on Yahoo?

Anyway, a new dental insurance plan will more than likely require a 3-6-12 month waiting period before you can get this dental work done.

You will also be limited to the dollar amount of dental work that you can get done in a year (like $1,500 or less).

Discount dental plans require that you pay the dentist at the time you get the work done, but sometimes the savings on the reduced fees is just amazing.

Maze

Posted: 14 May 2008 10:50 Post Subject: dental

Yep..MAZE. I DID get an 'estimate' from a local dentist, on how much all my dental work would be. However.....I just found out Tricare (Military Insurance) has a Dental plan for Reserves and National Guard. Ya see, my problem was, Tricare would have covered me if i was on Active Duty 'status' ( ie..overseas). NOW..I found out us 'part-timers' can be covered, too!! The Health care, part of it, I;m not really worried about. It is the Dental part. Would ya believe it..i would pay $11.00-$20.00, per month and it comes out of my Military pay!! They would pay for 50% of dentures ( if I needed them) and 50% of retainers ( if I needed them. Pay 80% of 'extrations'. And everthing else is 100% covered!! I'll tell ya, I was thrilled when I found this out!!

Posted: 14 May 2008 12:49 Post Subject:

They would pay for 50% of dentures ( if I needed them) and 50% of retainers ( if I needed them. Pay 80% of 'extrations'. And everthing else is 100% covered!! I'll tell ya, I was thrilled when I found this out!!



Wow, I bet you're thrilled. It's good to know that all of the Tricare benefits are also available to those in the reserves or national guard.


P.S. This would be a good article for your Military Insurance Blog.

Posted: 15 May 2008 04:30 Post Subject: insurance

OHH...I agree, MAZE!! I KNEW the military had Tricare that covered 'part-timers' ( me), but, i din't know I could purchase a dental policy seperate from medical. I sure will add this to my Blog, when I'm not so tired and I can see straight!!LOL

Posted: 19 May 2008 05:33 Post Subject:

I hate to disagree, but the truth of the matter is that dental insurance is a total rip. Your better off going into the dentist office and negotiating a price. Look at the premiums compared to the Maximum benefits... Its just not worth it...

$400 a year for a max payout of $1,500... Makes not sense... Your could reduce the cost of your bill by $1,500 with a simple question asked... "Hey can we reduce that by $1,500"... Simple as that....

Just look at health insurance... Lets say $2,000 a yr with an unlimited payout... Thats real Insurance...

My Opinion (And Ive been doing this for a while now) Dental Insurance is just not worth it. Its the same as asking for a discount.

Posted: 19 May 2008 03:41 Post Subject:

You may be paying the $400 a year but that $400 is saving you ~$1100 total not to mention that dental plans negotiate prices so you also save money there. Sure you can talk and negotiate with the dentist yourself but may not get as good of a negotiated price.

Going with the discount dental plans is basically just getting the negotiated lower price and most of those you can get for $75-200 a year.

Dental insurance or the discount dental plans are worth it since they help lower your overall expenses. Yes you can negotiate a discount price but you don't necessarily have the same pull as the insurance companies. And even though you get a lower price with the insurance you can still negotiate for lower prices still.

And grapeshot is basically like bird shot in a shotgun except it was used in canons and were about the size of musket balls.

Posted: 19 May 2008 06:20 Post Subject:

Hypothetically your concept may work, but in real life dentists will give you the same discount.
If my clients tell me they want dental insurance I tell them I wont sell it, I wont sell a product just to sell a product, its just not good.
Truth of the matter is that dentist will negotiate with anyone, they rather make a little bit over some dentures than nothing.
When you come in with a discount/insurance card you have lost your negotiation power. Im sure there are many seniors who have been able to negotiate the price of dental work and end up paying less than the price on someone who is paying a premium, I would venture to say most seniors are better off without dental insurance.

Posted: 20 May 2008 12:40 Post Subject: dental

BROKERDEALER........I don't know if you are familiar with Ticare ( Military Benefits..dental and health). I'm sure you are, however. Tricare is just that.for Military personnel ONLY!! I've looked at other plans ( on the 'civilain side') I haven't found ANYTHING like Tricare at all. They pay for 100% of EVERYTHING.....50% of dentures ( if you need them). So..if somone needs alot of dental work and REALLY can't pay out of their pocket, then what do you suggest? ALOT of dentists will not let you make payments to them.

Posted: 20 May 2008 12:46 Post Subject:

Actually alot of dentist will allow you to make payment arrangements, as long as your credit is decent and they prefer to setup the arrangements ahead of time.

Posted: 20 May 2008 01:09 Post Subject: dental

I have ALOT of dental work to be done. My dentist does have Financing, however...I was denied because of my credit. The dentist 'evaluated' everything I needed ( dental wise) and it would be a VERY HIGH payment ( for me, anyway), to them, per month.

Posted: 20 May 2008 01:59 Post Subject:

Well without a doubt Tricare is great coverage, IM not challenging that, Tricare is one of the best in the health insurance industry... Im arguing the fact that civilians should not pick up a private policy, its worthless...

As for Tricare its one of the best out there hands down.

Posted: 20 May 2008 10:51 Post Subject: dental

OHH......I see. I din't mean to 'challange' your expertise on this subject, BROKER. I do know what you mean about OTHER Dental plans, however. For a while I think Tricare was for Active Duty only. Have you dealt with Tricare much? I'm VERY surprised some dentists, in my area WILL NOT take it.

Posted: 20 May 2008 07:00 Post Subject: dental insurance

...also, I'm surprised to hear SOME of the dentists, in my area, said they won't take Tricare because they ahve had " bad experiences with insurances through the military." Never heard of that before.

Posted: 20 May 2008 07:20 Post Subject:

You know Im really not that familiar with Tricare, I sell insurance to retired people, so I do come accross people with Tricare, they are usually happy with it. Very little out of pocket, small copays (if any), and little to no premium.
To my understanding Tricare is through Anthem/Blue Cross Blue Sheild, so its not a matter of government insurance its based on the Anthem Network. Try calling the Consumer Hotline on the Back of your card and see if there are any dentists in your area who are contracted.
Anthem has a pretty good name here in OH, and you should have a PPO, so realisticlly there is a "loose" network if you will. I find it strange that dentists wont accept it.

Posted: 22 May 2008 05:23 Post Subject:

Hi! My friend from Origon, search dental insurance too! He recomend this is website http://www.ehealthlink.com/Dental/Dental.asp! Good luck!

Posted: 22 May 2008 06:58 Post Subject:

what s the differernce between this plan and another... they loook the same

Posted: 22 May 2008 11:35 Post Subject: dental insurance

Well..........some dentists won't take it AT ALL, in my area. SOME will take it ONLY as a 'supplement' insurance (I pay 'up front' and Tricare pays me back). However......ALOT willtake it as 'regular' insurance ( they bill it DIRECTLY to Tricare). I don't know why some people won't accept it, either.

Posted: 28 May 2008 05:45 Post Subject:

Sounds like a network problem, call Anthem and get a list of doctors in your area.

Posted: 27 Jun 2008 09:58 Post Subject:

Hey, what are normally covered under a standard dental insurance plan?

Posted: 27 Jun 2008 10:17 Post Subject:

That depends on the individual plan.

Posted: 27 Jun 2008 01:05 Post Subject:

Hi...there are a lot of things to be covered by your plan such as the basic dental costs associated with cleaning, dental checks, treatment of tooth & gum. This would also help towards providing you with a future security. The costs covered could just be part or the entire cost associated till the recovery. Thanks,
Plasticmind

Posted: 30 Jun 2008 11:04 Post Subject:

Hi seith, the other posters are absolutely right. Depending upon the type of the plan and the provider, the dental insurance plan covers a wide range of costs associated with oral health care.

It covers the costs of regular dental check-ups, filling the cavities, whitening the teeth, care of the gums, root canals and bridges and so forth. There are dental plans available which covers the costs associated with fitting and maintaining the braces.

With the rising cost of dental care, investment in a good dental plan may save a lot for you in the future, though with an individual plan you may face problem with your budget. Many insurers now a days offer dental plan and health plan as a package. This may help you to lower the cost on individual policies. Also you can check with your employer for health and dental combo pack.

Posted: 30 Jun 2008 11:16 Post Subject:

Hi All, thanx for all the info :)

Roddick, I can't go through the employer's plan, as I'm only a sophomore. Is there anything available that will fit into my situation?

It seems that individual plans will be quite expensive.

Posted: 30 Jun 2008 11:38 Post Subject:

Can't the students avail the health and dental care policy from their college authority?

Posted: 07 Nov 2008 04:38 Post Subject:

My insurance through my husbands job covers a different % on each proceedure done and only up to 1000 a year. A root canal can take all of that. However I have found that with a lot of dental work a Dental Discount Plan called Ameriplan is even cheaper than insurance. You can get more info at mybenefitsplus.com/rrolson. Hope this helps.

system edited-link deactivated

Posted: 15 Nov 2008 02:26 Post Subject: dental

I thought i would 'throw this out there' , for those in the military....Reserves and National Guard ( to be specific). Tri-Care Dental is wonderful!! I recently purchased it. It REALLY covers quite abit of denatl work.

Posted: 16 Nov 2008 11:58 Post Subject:

I am with WAHm on this one. I didn't relize until recently that our dental only pays out $1500 a year. I haven't had to have a lot of dental work. My hubby who detests dentists has recently started to go and had enough work to keep a dentist in business for a few years LOL. Anyway we got half way to getting him that eprfect smile and now we have to wait until 2009 to finish. They are raisng the total amount of allowed care this coming year but that doesn't help us now. Thank goodness the new year is around the corner.

Posted: 17 Nov 2008 11:54 Post Subject: dental

Ya know, FIREYONE. I was scared to death of dentists, at one time!! Never really felt 'comfortable' with any of them. This dentist, I go to now, is wonderful!! VERY understanding, doesn't judge me, etc. I think it's great.

Posted: 17 Nov 2008 11:36 Post Subject:

Thats how my hubby was but I got sick of hearing him whine about a tooth ache ans told him the pity party was over unless he started making good use of his dental insurance. Basically I feel $1500 would cover most yearly debtal work as long as you keep your appointmensts and tackle problems as they accur instaed of waiting for them to build up.

Posted: 18 Nov 2008 01:45 Post Subject: dental

Now.........I can FINALLY get all of this dental work done that I need. I feel 'pretty good' about all of this. I have a pretty 'high pain threshold', but...when it comes to a toothache..OOUUUCCCCHHH!! Holy COW!!! I had a tooth infection, in late October. Was REALLY having a problem with it.

Posted: 18 Nov 2008 03:27 Post Subject:

You never should put off a tooth infection whether you have insurance or not SD. A tooth infection can travel straight to the brain and kill you!!! I heard of a guy from around my area that ended up ion intensive care over an infected tooth. He ended up having to have the teeth taken out. The insurance company wasn't going to pay the bill since it had to do wiht dental except sonce it was life or death they did pay. Seriously...do not let one go too far.

Posted: 19 Nov 2008 04:55 Post Subject: dental

Trust me.....even if I DIN'T have Dental Insurance, i would have gone SOMEWHERE!! Had to go to the Emergency Room, a few times, because I was in SOOO much pain. Doctor wrote out an Anti-botic and a pinkiller...enough for a few days, until I got to a dentist. Boy..I was hurting. FINALLY got it taken care of. :)

Posted: 06 Aug 2010 09:41 Post Subject: info

it does cover that stuff, you just have to be in it at least a year to cover the “major stuff”

I also was apprehensive about this plan but after checking plans and calling a few dentists the info I get is your gona pay for this stuff one way or another and all plans seem to have a waiting period for major items, and ALL have some kind of co pays and deductible. What all I read the TriCAre plan seems to be fair on this stuff, although I agree the whole plan could have been written a bit better. As in my case as a 27 year retiree I was told I’d HAVE FREE care for life. So the only thing a retiree (or dependent) has is this plan and hope the Senate or Congress gets a better deal for us at some point.

I just found yesterday after paying $204 for a cleaning and a couple Xrays I needed perio work and a crown my cost would be $2,338, with no ins.

So with ins at least I can get a break on the perio as its included right off, the crown will have to wait a year. So I decided to join up this month and become effective the 1st Sept. So I can start the perio work at least.



============================================================
Benefits available during the first 12 months of enrollment: *Delta Dental Pays:

Diagnostic services(such as exams) 100%
Preventive services(such as cleanings) 100%
Basic Restorative services(such as fillings, including tooth-colored fillings on back teeth) 80%
Endodontics(such as root canals) 60%
Periodontics(such as gum treatment) 60%
Oral Surgery(such as extractions) 60%
Emergency (such as treatment for minor pain) 80%
Dental Accident Coverage 100%

==============================================================

Additional services available after 12 months of continuous enrollment or if enrolled within four months after retirement:

Cast Crowns, Onlays & Bridges 50%
Partial/Full Dentures 50%
Dental Implant Services 50%
Orthodontics 50%

============================================================
Deductibles & Maximums

Annual Deductible

per person $50
$150 cap per family, per benefit year

Annual Maximum (per person, per benefit year) $1200
Orthodontic Maximum (per person, per lifetime) $1500
Dental Accident Maximum
(per person, per benefit year) $1000

Benefit Year: October 1- September 30

*The percentage paid by Delta is based on the allowed amount for each procedure. While the coverage percentage is the same for all TRDP patients, total out-of-pocket costs may be higher if care is received from a non-network

Posted: 06 Aug 2010 09:48 Post Subject: tricare dental

it does cover that stuff, you just have to be in it at least a year to cover the “major stuff”

I also was apprehensive about this plan but after checking plans and calling a few dentists the info I get is your gona pay for this stuff one way or another and all plans seem to have a waiting period for major items, and ALL have some kind of co pays and deductible. What all I read the TriCAre plan seems to be fair on this stuff, although I agree the whole plan could have been written a bit better. As in my case as a 27 year retiree I was told I’d HAVE FREE care for life. So the only thing a retiree (or dependent) has is this plan and hope the Senate or Congress gets a better deal for us at some point.

I just found yesterday after paying $204 for a cleaning and a couple Xrays I needed perio work and a crown my cost would be $2,338, with no ins.

So with ins at least I can get a break on the perio as its included right off, the crown will have to wait a year. So I decided to join up this month and become effective the 1st Sept. So I can start the perio work at least.



============================================================
Benefits available during the first 12 months of enrollment: *Delta Dental Pays:

Diagnostic services(such as exams) 100%
Preventive services(such as cleanings) 100%
Basic Restorative services(such as fillings, including tooth-colored fillings on back teeth) 80%
Endodontics(such as root canals) 60%
Periodontics(such as gum treatment) 60%
Oral Surgery(such as extractions) 60%
Emergency (such as treatment for minor pain) 80%
Dental Accident Coverage 100%

==============================================================

Additional services available after 12 months of continuous enrollment or if enrolled within four months after retirement:

Cast Crowns, Onlays & Bridges 50%
Partial/Full Dentures 50%
Dental Implant Services 50%
Orthodontics 50%

============================================================
Deductibles & Maximums

Annual Deductible

per person $50
$150 cap per family, per benefit year

Annual Maximum (per person, per benefit year) $1200
Orthodontic Maximum (per person, per lifetime) $1500
Dental Accident Maximum
(per person, per benefit year) $1000

Benefit Year: October 1- September 30

*The percentage paid by Delta is based on the allowed amount for each procedure. While the coverage percentage is the same for all TRDP patients, total out-of-pocket costs may be higher if care is received from a non-network

Posted: 07 Aug 2010 10:59 Post Subject: tricare dental

only bad thing about it is the cap, at 1200 per year. that is actually 1150 cause you also have a 50 dollar deductible. If not for that the rest is OK.

Posted: 07 Aug 2010 11:01 Post Subject: tricare dental

only bad thing about it is the cap, at 1200 per year. that is actually 1150 cause you also have a 50 dollar deductible. If not for that the rest is OK.

Posted: 07 Aug 2010 11:09 Post Subject: tricare dental

only bad thing about it is the cap, at 1200 per year. that is actually 1150 cause you also have a 50 dollar deductible. If not for that the rest is OK.

You also HAVE to be enrolled for at least 1 year once you enroll.

I guess its one or the other, your gona pay somebody.

Posted: 09 Aug 2010 06:32 Post Subject:

the cap, at 1200 per year.



This is usually in excess of the deductible. At least it has been in all of the Delta plans I was ever covered under. And there was no requirement to be covered by the plan for 1 year before benefits were available.

Posted: 09 Aug 2010 08:31 Post Subject: tricare dental

Could be about the copay, the year commitment takes effect in 30 days, weather you used it or not. if you don 't call them to cancel, If you use it before that time yeah its effective for the year than too.

Its why I broke down and got it, "to use it", don't have a real warm and fuzzy feeling about it, but that's what it is.

Took it cause of a couple reasons, they back dated my enrollment to the 1st, which let me claim the 204 I just paid for a cleaning and Xrays, also I need periodontal work, and that's covered right off. I did some figuring and all in all I came out about 127 bucks ahead with it rather than pay out of pocket. even when I added in my years worth of premiums.

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