How Does Dental Insurance Works In The Us

Dental Insurance

First, most dental plans have provider networks or preferred oral dentists. In other words, when you choose a dental plan that has a network of providers, you must attend a consultation exclusively with one of them. In this way, you can guarantee the saving of your money.

The types of dental insurance networks are:

Dental Plan DHMO (Dental Health Maintenance Organization) . It is a restrictive plan where you must go to a network dentist if you want the insurer to cover your expenses.
Dental PPO (Preferred Provider Organization) Coverage . It is a less restrictive plan, where you can visit the dentist of your choice.
Compensation Plan . In this plan, you can go to the dentist you want but you will have to pay up front, file a claim and wait for reimbursement from the insurer.

How Does Dental Insurance Work?

Benefits of a PPO Plan

PPO dental plans are the most common and can have an annual deductible as low as $50 or $100; this is usually the amount you must pay the dentist before the plan covers more expenses. That is, after that, the plan will pay a set percentage of your dental care.

For example: The most common PPO dental plan is the “100-80-50 plan” which covers:

100% cleaning and preventive care.
80% of routine procedures, such as cavity fillings.
50% of major works such as bridges and extractions.
Note : PPO and indemnity dental plans limit the amount of coverage you can use per year; this is known as the annual maximum benefit.


Benefits of a DHMO Plan
On the other hand, DHMO dental plans do not have as many benefits but you do not have to pay a percentage of your medical expenses. Likewise, the possibility of making co-payments is open in this type of plan; In this way you only need to pay a fixed fee on each visit . Also, HMO deductibles are lower ; being $25 or less.

Important : You must choose a dentist or dental health center that allows you to build your own dental benefits package and that is close to your current residence.

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Group Dental Insurance

In this section, government dental plans enter for the first time . These types of plans are usually obtained through a job or a specific group, such as: A government entity. Employers often offer special group rates for dental health; and they often pay a portion of workers’ insurance premiums. Therefore, this type of coverage is known as the lowest cost.

So if your employer offers dental insurance, go ahead and sign up. Since, it can become the cheapest coverage option you find. Currently, the deductible for group dental plans is between $19 and $32 per month. That’s about $228 to $390 per year , not including the contribution your employer is (by law) required to make.

Note : There are other types of non-employer group plans. For example, AARP members can sign up for group dental insurance through the association.


Individual Dental Coverage
Individual dental insurance plans are the most feasible option for those whose employers do not offer a dental policy. In the first place, these types of plans can be purchased from the insurer’s website . They will generally cost an average of $20 to $60 per month (per family member).

On the other hand, bills for this type of benefit are paid in a very similar way to group plans; with the difference that the individual plans have some additional rules such as:

Minimum contracts of 12 months .
Waiting periods of six to 18 months before they pay for serious or expensive procedures.
Important : These rules are meant to discourage people from buying dental insurance only when they need treatment or canceling (dropping) the plan once a large bill has been paid.

Discount Dental Plans
Dental discount plans are not insurance and cannot be combined with a dental policy to reduce medical bills. Also, these benefits are often called a dental savings program; They are a kind of alternative to dental insurance and function more like a membership club than an insurance plan.

To avail this type of benefit, you must pay an annual fee and sometimes an enrollment fee. However, you should not worry as it is usually much lower than dental insurance premiums. In exchange for that, you get a discount at the dentist’s office , but you pay more than you would with dental insurance.


On the other hand, you can purchase a discount dental plan for yourself or your family ; and since there is only one annual fee, you will have the discount for one year. Dental plans average between $70 and $200 for an individual and between $120 and $300 for a family . Remember that all benefits are valid for 1 year.

Like dental insurance, discount plans use networks, so you’ll need to find a dentist that accepts your plan to get the discount. Some discount networks include thousands of dentists , while others include fewer than 100, so make sure you choose a plan that includes dentists near you.

Compensation Policy or Cash Payments
Making cash payments for dental treatment can work if you have a clean “dental billing” history . Also, it may be the best option for those who need a cleaning every six or nine months. In some cases, you can consult with your trusted dentist and request a payment plan ; If you are a punctual and responsible person, dentists will have no problem offering you this benefit.

How to Choose Dental Insurance in the USA?

How Does Dental Insurance Work?

Before selecting a dental insurance plan , it is important to consider some relevant factors such as your dental health history, your family history, budget and what type of insurance you think you need. Still don’t know which plan to choose? Then continue reading…

Evaluate Your Needs
If you are an adult under the age of 30 with very good dental health and no history of oral disease, then your dental insurance needs will be very different from other people who are married, have children or have oral problems. Remember that you must be honest and ask yourself how many times a year you visit or need to visit a dentist. Therefore, to fully understand the requirements you need, consider creating a list where you group your visits to the dentist, cost and regularity ; this way you will have a good reference point to evaluate options and anticipate costs.


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Study the Different Types of Dental Plans

As we mentioned before, there are several types of dental insurance plans. So each one will work out differently in terms of out-of-pocket costs, benefits, deductibles, etc. So, to make a decision you will have to choose between:

Preferred Provider Organizations (PPO) . Remember that PPO dental plans are contracted so that plan members have access to a network of dentists that accept reduced rates for covered services. The rate members pay for this insurance is a designated percentage of the reduced rate, called a co-pay. After this, the plan provider pays the rest.
Dental Health Maintenance Organizations (DHMO) . Members of this plan must visit in-network dentists to obtain coverage. Remember, a DHMO plan’s dentist network size is smaller than a PPO, but the premium is also much lower, with greater savings potential.
Discount Plans . Members of this plan pay fees directly to the dentist at the time of treatment; no additional paperwork is necessary. Lastly, discount plans typically have a lower premium than PPO plans.
Traditional or Compensation Plans . They offer the largest network of dental providers to choose from. Just like a PPO plan, members pay a certain percentage for each service provided by a network dentist.
Choose The Dental Plan That Is Available In Your Area
Remember that depending on where you live you may not have access to all of the types of dental insurance plans listed above. And it is that, the plans from which you can choose will depend exclusively on what is available in your area. Therefore, it will always be important to contact the dental insurance companies that serve your region.

Know the Coverage of Each of the Dental Plans
Once you know about the types of plans available in your area or those offered by your employer, you can begin to do more research on what the coverage you want includes. Remember to consider important things like waiting periods and annual limits . Our recommendation is that you make a list of pros and cons to guide you through the decision-making process.

Before making a decision, ask yourself the following questions:

What is the maximum annual limit?
Is there a waiting period? Remember that a trial period is the amount of time you must wait after purchasing coverage to access its benefits.
Can I receive full or partial coverage when I visit an out-of-network dentist?
Does the plan cover cosmetic procedures? Please note that most dental plans do not cover these types of benefits. But, if those procedures are important to you, contact the dental insurance company before making a final decision.
Network Size
Each type of dental insurance plan will have a different size network . If you live in an area where there are relatively few dentists nearby, then the size of the network may be a critical factor. On the other hand, you may want to find out if your current dentist offers coverage for the plan you want to purchase. Finally, keep in mind that you will probably have to pay more money out of pocket to continue seeing your current dentist (if he or she is not affiliated with the network).


Consider the Costs and Compare Them to Your Budget
Different dental insurance plans will work differently in terms of costs. Generally, the PPO is the most attractive plan because it balances cost and access to care. However, to determine which dental plan fits your budget best, take the time to estimate your dental costs from previous years. If you are going to perform the calculation, pay special attention to:

Cost of premiums (annual and monthly).
Co-payments.
Deductibles.
Annual coverage amount.
All these points will help you better understand what your options are from a financial perspective and make the decision that best suits your lifestyle and family budget.

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