Dental Insurance is designed to pay a portion of the costs associated with dental care and works in much the same way that medical insurance works. For a specific monthly premium, you are entitled to certain dental benefits. These benefits usually include regular checkups, cleanings, x-rays and certain services required to promote general dental health. Some plans will provide more coverage than others and some will require a greater financial contribution on your part when services are provided.
There are different types of individual, family, and dental insurance plans that are grouped into three primary categories with the major differences being the customer’s choice of providers, out-of-pocket costs and how bills are paid.
1). Dental Indemnity: allows you to see any dentist you want who accepts this type of coverage. A Dental Indemnity plan is commonly known as a “fee-for-service” or “traditional plan”. If you select an Indemnity plan you’ll have the freedom to visit any dentist you wish. You will not be required to obtain referrals; however, some plans may require you to obtain preauthorization for certain procedures. Most Dental Indemnity plans require you to pay a deductible.
2). Preferred Provider Network dental plans (PPO): PPO dental insurance plans are perhaps the most common type of managed care dental insurance plans. Most Dental PPO plans require you to pay a deductible. With a Dental PPO plan the patient typically obtains care through a network of dental providers who agree to serve the plan’s members at reduced rates. When you use a network provider, you will typically pay a certain percentage (20%) of the reduced rate and the insurance company will pay the remaining percentage (80%).
3). Dental Health Managed Organizations (DHMO): HMO dental insurance plans typically require that members obtain services only from a select group of dental providers. Dental HMO plans may sometimes offer less expensive monthly premiums, but may also allow you less freedom to choose your own dentist. You are assigned or you select an in-network dentist and only use the dental benefits in the network.
Indemnity plans offer a wider selection of dental care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your insurance company).
Managed-care plans (HMO and PPO) typically maintain dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed-care dental plan and a wider choice of dentists with an Indemnity plan.
Although there is no one “best” dental insurance plan, some plans may work better for you and your family than others. Plans differ primarily in how much you’ll have to pay monthly for your coverage and how much you’ll have to pay when dental services are rendered. Some plans will require that you pay a certain co-payment for services, or meet a specific deductible before the dental insurance company begins payment. Other plans may limit coverage to a specific dollar-amount maximum per year.
When reviewing your dental insurance options, here are a few questions to ask yourself:
♦ How much will it cost me on a monthly basis?
♦ Will I be required to meet a deductible? Once the deductible is met, how much will the dental insurance provider pay for my services?
♦ What dentists participate in the plan’s network? Are these dentists that my family and I would like to see?
♦ If I used a dentist outside the plan’s network, how much will I have to pay?
♦ Are there waiting periods for certain procedures?
This is an example only:
♦ Full retail price of a Crown costs $1500
♦ “In Network” provider negotiated rate is $800
♦ Insurance will either pay a percentage like 50%, or a dollar amount, like $306
♦ You would pay the balance.
$800 – 50% = $400 (you pay)
$800 – $306 = $494 (you pay)
You must read the details of your plan and how it works. All plans will have waiting periods for certain procedures, Exclusions (which means they don’t pay for at all) and particular Network information (what dentists are in the “network”). This is why we recommend you read the details of your plan and how it works.
Vision Insurance is typically a supplemental insurance to other types of medical insurance policies. Vision insurance will help offset the costs of routine checkups as well as help pay for prescription glasses or contact lenses. Some plans also offer discounts on corrective surgery such as LASIK.
Most vision insurance plans are discount plans or wellness benefit plans that provide specific benefits and discounts for an annual premium. Make sure you read and fully understand the costs and benefits associated with the plan you have purchased. If you have vision care coverage through a plan at work, be aware that “vision insurance” plans usually operate differently than other health insurance plans or major medical insurance.
We suggest you speak to your eye doctor to advise you of the specific benefits of your vision plan prior to your exam and eyewear purchase so there are no surprises afterward.
Group vision insurance can be obtained through your work, certain associations, school districts, etc., or through a government program such as Medicare or Medicaid.
If you are not eligible for a group plan because your employer doesn’t offer insurance, are self-employed or for other reasons, most vision insurance providers also offer policies that you can purchase individually.
Vision Insurance is typically an added benefit linked to Indemnity Health Insurance, a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) that have contracted with vision care networks to provide certain eye care services.
Indemnity Plans: offer a wider selection of vision care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your insurance company).
Managed-care plans (HMO and PPO): typically maintain vision provider networks. Doctors participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed-care vision plan and a wider choice of doctors with an Indemnity plan.
Vision insurance may be a vision benefits package or a discount plan.
A vision benefits package will provide free eye care services and eyewear within fixed dollar amounts in exchange for an annual premium and a relatively small co-pay each time you use a service.
A discount vision plan provides eye care and eyewear at discounted rates after you pay an annual premium or membership fee.
In some cases, a vision benefits package or discount vision plan may also include a “deductible” which is a fixed dollar amount you must pay your eye care provider out-of-pocket before the insurance benefits take effect.