The Basics Of Dental Insurance

Dental Health
By: Spirit Dental
February 9, 2015

Stacks of books and blocks

More than 40 million people in the United States still lack dental insurance, and this often means that they do not see a dentist for years at a time. Having insurance is positively correlated with better dental health. If you are fortunate enough to receive dental benefits through your employment, or if you are interested in purchasing an individual policy, you need to understand how this form of insurance works.

There are many different types of plans available, but most belong to one of four types. First, there are direct reimbursement programs. These plans reimburse a fixed percentage of the total cost of care to the patient. It does not matter what type of care you receive or which dentist provides the care. Such plans provide more flexibility for patients and cover virtually any care that might be needed.

Second, there are UCR plans. UCR stands for "usual, customary, and reasonable," and refers to an agreement between the patient and the insurance plan. The plan pays an amount that is considered "customary" or "reasonable." However, this amount is set by the insurance company, so how much coverage is actually provided can vary widely from place to place.

Third, there are table of allowance programs that cover a specific list of services. For each service, the plan pays a fixed dollar amount. The difference between this amount and the dentist's fee is the patient's responsibility, as is the cost of any procedure that is not on the list.

Finally, there are capitation plans. These plans pay a dentist a certain amount for every patient that they have enrolled. The dentist then agrees to provide certain procedures for no cost to the patients. However, any other procedures may not be covered at all by the plan.

Many insurance plans of all four types also have annual limits on how much coverage is provided. This limit may be on the number of procedures that can be performed or on the total cost of care. If your dental expenses exceed this annual limit, you will be responsible for any additional costs.

In most cases, the annual limit is more than enough to cover the cost of regular checkups and examinations, and even basic procedures such as fillings. However, before receiving care, it is important to discuss the cost with your dentist. This way, you can choose a treatment plan that will keep your costs to a minimum. If annual maximum limits are a concern, one of Spirit's $3500 Max Plans may be the solution you're looking for.

It is also important to find out how a specific plan treats referrals. If you need more specialized care, such as a root canal or a dental implant, will the plan provide any coverage? Is your choice of specialists limited, or can you see a dentist of your choice?

There are many factors to consider when choosing dental insurance. You need to balance flexibility against cost so that you can find a plan that is right for your individual situation. By doing some research ahead of time, you can find an affordable plan that gives you the coverage that you need.<

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