The insurance industry has been providing dental insurance since the 1960s. The early plans were called Indemnity plans where the insurance company paid 80% of the claim and the patient paid 20%. The patient had the right to go to any dentist that accepted the insurance. These plans were considered on the costly side because of the flexibility they gave you and it wasn’t unheard of to be paying over $150 a month for a family plan, however, this insurance was usually paid for by an employer so the costs were largely transparent to the employees.
The entire insurance industry has made some significant changes over the years, and one has been to turn dental insurance away from the standard Indemnity plans to the now familiar HMO and PPO plans. Many patients don’t even realize there is a difference between the two until they try to make an appointment with a new dentist and run into problems.
HMOs in the dental area have the same purpose. You have to stay in network and if there are problems you will need a referral to a specialist in order to get the treatment that was recommended. The insurance company will also have a big say as to whether they’ll pay for the treatment. They might recommend something cheaper. People with PPOs usually don’t have many of these problems.
In either case, different plans have of course different coverages. A few provide free routine care such as cleanings twice a year and annual xrays. These usually require a nominal co-payment of $5 to $15 per visit. Some plans provide higher coverages for things like extraction, root canals or caps but it doesn’t really matter if it’s an HMO or a PPO. When it comes to what is paid, the type of insurance has little impact on what’s covered and what’s not.
Some of the older plans had waiting periods for pre-existing conditions. For instance, if you knew you needed a root canal, you couldn’t run out to buy insurance and make an appointment right away for the procedure. You probably needed to wait six months or so. Today, this pre-existing condition clause is all but limited to regular medical insurance. With dental plans, it’s rarely seen or put into effect any more.
Along with dental insurance, there are other options that are almost identical, and in some cases are even better. These are “discount” plans. Run almost like an insurance program, the patient buys a plan that suits his needs, and they vary widely. There are family plans and individual plans, and plans that cover all sorts of cosmetic dental procedures like whitening and implants. When you are covered with one of these discount plans, there is a set fee that your dentist has agreed to, along with a standard co-pay of about $10 or so.
The only difference between these discount plans and a dental insurance plan is that whatever you need to pay for a procedure (a cap or root canal for instance) is all the dentist gets. There is no supplemental payment from an insurance carrier.
Many people buy one of these discount plans to use in addition to their regular insurance sometimes just to get their teeth whitened or to get veneers that are covered.
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