Information on Dental Insurance Plans
Like most types of insurance, dental plans differ in terms of coverage and payment options. Plan costs also vary depending on the company and types of coverages included. Whether issued through an employer or purchased individually, each plan type comes with certain coverage conditions that determine when the plan will pay and when it won't.
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Coverage Options
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Dental plan coverage options include basic preventative care and restorative treatments. Regular checkups and cleanings fall under preventive care while fillings, crowns and root canals fall under restorative treatments. A basic insurance plan typically covers preventative care and costs less when compared to plans that offer additional coverages. Coverage options also vary depending on a plan's structure, or network. A plan's structure will determine which providers or dentists the plan works with and how payments for services are made. In terms of employer-based versus individual plans, employer-based plans typically provide more coverage at a lower cost because insurers can spread potential risk across a pool of participants.
Managed Care Plans
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A managed care dental insurance plan is based within a network of service providers that work under contract with an insurance company. The different types of plan networks include health maintenance organizations (HMOs), preferred provider organizations (PPOs) and exclusive provider organizations (EPOs). HMO and EPO plans only pay for services rendered within their assigned network of providers. HMO and EPO plans differ as to how the provider, or dentist gets paid. Under HMO plans, dentists receive payment on a "per patient" basis, whereas EPO plan providers are paid on a "per service", or treatment basis. PPO plans pay for both in-network and out-of-network providers, although services provided by out-of-network providers generally include higher costs.
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Payment Options
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Payment options for dental plans vary according to the type of plan used. Some plans require patients to pay a co-pay amount at the time of service. Others may require a deductible amount be paid before insurance coverage applies. Other plan types require the patient to pay the full amount and receive reimbursement after submitting the bill to the insurance company. Employer-based plans can also use the direct reimbursement model, in which employees pay for services upfront and receive reimbursement from their employer afterwards.
Provider Options
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Provider options have to do with the range of service providers a person has access to under a particular dental insurance plan. In the case of managed care plans, the more flexible the plan in terms of provider options, the more expensive the plan runs. Another plan type, known as indemnity insurance, allows participants to see any dentist they choose, although these plans can be considerably higher than managed care insurance. Rather than pay a portion of the cost of a service, indemnity plans pay a percentage of the overall cost while the participant pays the difference.
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