INSURANCE

Dental Insurance in the United States is insurance designed to pay the costs associated with dental care. Dental insurance pays a portion of the bills from dentists, and other providers of dental services. By doing so, dental insurance protects people from financial hardship caused by unexpected dental expenses.

The most recent data (2006) from the National Association of Dental Plans shows that 57% of the population in the United States has dental benefit coverage. Some 96% of those who do have dental coverage get it through their employer, most often as a policy separate from their health insurance plan. Depending upon the type of medical coverage you have, it may be a good idea to have a compatible program to eliminate any gaps or overlap within the two plans. That may save money while allowing you to take advantage of receiving necessary preventive care.

Not all dentists are pleased about participating in any type of dental plan. It means more work for them (and especially more paperwork), and less pay. It is also important to have adequate coverage for your situation, so you can access the features you need and are not paying for something you will not use. Most group dental insurance plans do not have restrictions, such as pre-existing conditions but do have annual maximum payments.

The most common types of dental insurance plans are either Preferred Provider Organization (PPO) or Dental Health Maintenance Organization (DHMO). Both types are considered managed care, and each dental insurance plan has benefits and disadvantages.

Dentists participating in the PPO plans have negotiated their fees with the administering company, and provide their services under the plan, but this usually does not cover all fees. Dental plans usually have small deductibles to consider about $50 and DPPOs and traditional indemnity plans usually pay a percentage of the charges, leaving the patient with a co-pay. DHMOs usually state their co-payments as a fixed dollar amount per procedure.

If your employer is paying the monthly premiums for the dental insurance plan and the dentist you use is part of the PPO, this might be an attractive option.

A Dental Health Maintenance Organization is another dental insurance plan option, based on the model of medical HMOs. Here, too, the patient is enrolled in a program, and can visit any dentist in that program. However, dentists may end up having to provide services at 'below cost' rates, and not be able to spend as much time with each person as a PPO could offer. Working in an HMO setting, the dentist has many more people to see and is compelled to function in an environment where volume matters. Although a patient will be seen and treated, the relationship with the dentist may not developed if there is a lack of time. If you want to be seen by a dentist who takes time with his or her patients, this may not be your optimum dental insurance plan.

Usually called Discount Plans or Reduced-Fee-For-Service Plans, these non-insurance programs offer subscribers access to dental care at a discounted rate from participating dental providers. Having been around since the early 1990s, these dental benefits programs offer their members discounts on a variety of dental services, such as fillings, braces, exams and routine cleanings in exchange for a fee. Members typically receive a discount of 30%-35% off retail prices.

Unlike traditional indemnity-based dental insurance, discount dental plans have no annual limits, no health restrictions and no paperwork. In addition, consumers must pay either a monthly or yearly membership fee in exchange for the ability to get these discounts on dental services. Most of these plans provide a price list or fee schedule with the discounted dental fees and/or costs listed either on their web site or in membership materials to ensure consumers receive the savings they were promised. However, the dentist must be participating dentist in the plan for you to receive the discount.

For example, your typical discount plan would point you to a dentist who has agreed to participate in the plan that would only charge, say, $625 for a crown instead of the standard rate of $800 to $900. However, keep in mind dental insurance may pay up to 80% of the standard rate and a discount plan may not be your best option.

Discount dental plans are designed for individuals, families and groups looking to save money on their dental care needs. Participating providers have agreed to accept a discounted fee from plan members as payment-in-full for services performed. Discount plans activate anywhere from the same day one enrolls to five business days later.

Be careful if you do not have dental insurance coverage in addition to a discount dental plan, you can be left with a substantial liability for payment to providers. For example, a 25% discount applied to a $2000 dental bill would still leave a person with a $1500 liability. In addition, because payment due at the time of service (i.e. when your dental work is completed), be prepared to pay your dental bill in full before leaving the dental office.

Studies done by the NADP show national average costs for dental coverage for an individual range from ranging from $14.74 to $37.62 monthly or $177 to $451 on an annual basis in 2005 - depending on the type of coverage. Even at the high end of that range - dental benefits cost annually what medical premiums cost an individual on a monthly basis.

Here are 10 questions to ask before purchasing any type of dental coverage, whether it be a traditional indemnity based or a non-insurance plan:

1. Is your company licensed to offer this plan in this state?
2. Is your company registered with the Secretary of State?
3. Is your company registered with the Better Business Bureau?
4. Where are you located and what is your address of operations?
5. Can you mail me information on the plan, the providers and other details before I sign up with the plan?
6. Do you have a web site with more information?
7. Can I get a list of the providers on the plan?
8. Can I think about your plan and get back to you next week?
9. Is your plan endorsed by or affiliated with any national organization?
10. Are you a member of the National Association of Dental Plans?

Finally, be aware that discount plans are not usually regulated by state insurance departments. That doesn't mean these plans aren't legitimate, but you should take precautions when buying one. If you are not sure whether the product is insurance, you should ask whether a licensed insurance carrier is offering the product and verify this information with the insurance company.

You might not need to buy dental insurance if you're young and healthy, have no dental problems and only go to the dentist twice a year for cleaning. The cost of insurance and copayments might very well be more than the cost of the cleanings.

However, if you are not a healthy person or have had a rough dental history, you might very well want to purchase dental insurance or join a dental discount plan. Dental procedures can be very expensive. Even with fluoride in our water millions of Americans each year have cavities filled, root canals preformed and teeth extracted.

There are many factors that effect the health of our teeth. Some are as simple as dental hygiene (brushing teeth properly). Others factors like stress, personal habits and nutrition can also play a role in the health of our teeth. Even under the best of conditions most people will be faced with dental expenses, beyond simple cleaning, sooner or later. Listed below are some different types of dental programs.

Dental Insurance Programs:

• Indemnity Plans
• Preferred Provider Plans
• HMO Plans
• Discount Plans

INDEMNITY PLAN

These are the traditional fee-for-service insurance plans. You pay a monthly premium to an insurance company and in return it covers a portion of your dental expenses.

Some typical features of these plans:

• High deductibles before coverage begins (well-designed plans don't apply the deductible to preventive services).
• Probationary periods on certain procedures that last up to a year.
• Annual dollar limit on benefits.
• Freedom to choose your own dentist.
• Your average monthly cost: $40+ per person.
• Companies selling these plans are regulated by state insurance departments.

In general, an indemnity plan will pay 100 percent of the costs for preventive services, 80 percent for common restorative services, and 50 percent for major treatments, such as crowns and orthodontics.

DENTAL PREFERRED PROVIDER ORGANIZATIONS

Another true insurance plan, a PPO falls somewhere between an indemnity plan and a dental HMO. A group of dentists agrees to provide services at a deeply discounted rate, giving you substantial savings - as long as you stay in their network. Unlike the more restrictive DHMO, though, you can go out of network and still receive some benefits.

Some typical features of these plans:

• Monthly premiums.
• Annual dollar cap.
• You must stay within the approved network of dentists or pay higher deductibles and co-payments.
• Your average monthly cost: $40.
• Companies selling these plans are regulated by state insurance departments.

HMO DENTAL INSURANCE

These insurance plans, also known as "capitation plans," operate like their medical HMO cousins.

Some typical features of these plans:

• Monthly premiums (some require you to prepay a year's worth).
• Co-payments for office visits.
• Free preventive or routine care.
• You must select from an approved network of dentists.
• May have an initial enrollment fee.
• Annual dollar cap.
• Your average monthly cost: $20 to $40.
• Companies selling these plans are regulated by state insurance departments.

DENTAL DISCOUNT PLANS

Discount dental plans are a lot like coupon books where you get a percentage off when you shop at participating merchants. With a dental plan, you don't actually get coupons, but you must go to a dentist who has agreed to participate in the plan and offer services at a discounted rate - $450 for a crown instead of the standard rate of $750, for instance. For individuals and families discount plans seem to represent the best value.

Some typical features of these plans:

• Monthly fee to the dental-discount company.
• You must stay within the plan network.
• An initial enrollment fee.
• Your average monthly cost: $10 to $20.

It's important to keep in mind that a discount dental plan is not the same thing as an insurance policy. You are purchasing access to dentist who have agreed to reduced rates for their services and therefore you must use dentist within the network.