Dental Insurance Plan

Having a dental insurance plan in place will help manage the cost of this important part of health care. Some benefits packages offered by employers include dental care, but not all of them have this type of coverage. A number of providers offer individual, family, and group plans to help make oral health care more manageable.

Indemnity Dental Insurance Plans

Indemnity dental insurance is a fee-for-service plan. This means that you will submit your claim for any procedures you have and the insurance company will reimburse you for a percentage of the cost. Usually, you will need to pay up front at the dentist's office. The percentage of cost covered by a dental insurance plan varies from policy to policy, but the standard rate is 70-80 percent of preventative dental care (exams, cleanings, X-rays etc).

For more complex procedures such as crowns and bridgework, the plan may cover a lesser percentage of the cost or none at all. Cosmetic procedures, such as whitening and caps, are usually not covered by dental insurance plans.

Closed versus Open Dental Plans

Indemnity dental coverage is a type of insurance that utilizes an open panel of doctors. In contrast, dental health maintenance organizations (DHMOs), preferred provider organizations (PPOs), and exclusive provider organizations (EPOs) utilize a closed panel of doctors. With open panel health insurance, you can seek care from the doctor of your choice. With a closed panel policy, you are completely constrained by the network or financially penalized for seeking care outside the preferred range of doctors.

Most people select a managed care or closed panel dental health insurance plan for financial reasons. However, be sure to read the fine print before making your final decision. Carefully evaluate the plan and ask the following questions:

• Will I have access to dental care if an emergency occurs out-of-town?
• Is specialized care available if needed?
• Will I have access to orthodontists, periodontists, and oral surgeons if expert care is required?
• What percentage of cost will be covered for specialized procedures?

Indemnity plans allows you the flexibility to seek treatment from your preferred provider. However, if you do not want to pay up front, you can opt for a managed dental care program, which operates in much the same way as standard health insurance policies.

Types of Managed Dental Care

There are several types of managed dental care. Understanding the options is the first step in making an informed decision.

Dental Health Maintenance Organization Plans

With DHMOs, a certain group of dentists are contracted to provide dental care for the members of the plan. Participating dentists are paid a fixed fee for services. This service model is more economical for consumers, who pay one monthly rate for their coverage. To have dental procedures covered under the plan, members must consult with a dentist who is part of the coverage network. Companies offering these types of plans include:

• Cigna
• Humana
• Metlife

Preferred Provider Organization Plans

PPO plans offer patients a wider selection of care providers to choose from. To be included in a PPO network, dentists must discount their fees for plan members. Whether you choose a dentist from inside or outside the network, you can count on a portion of the costs being covered. However, as with standard health insurance, your out-of-pocket costs will be lower if you choose a network healthcare provider. This is a good choice for people who want a higher level of flexibility in their choice of a dentist or who travel often and may need care when away from home. Companies carrying this coverage model are:

• Delta Dental
• Aetna
• Kaiser Permanente

Exclusive Provider Organization Plans

EPOs are similar to PPOs in that you are offered a choice of dentists to select from. However, it is important to note that there is absolutely no flexibility with regard to seeking care outside of the network. The following companies can provide this coverage option:

• Madison National
• Cigna

Choosing a Plan that's Right for You

An employer-sponsored dental insurance plan may not offer participants a choice in the plan model, but consumers who are looking for individual or family coverage should take the time to consider their options carefully before making a decision. The more flexibility that a plan provides, the higher the premium rates are likely to be. Buyers should consider what types of services they are likely to need, as well as their budget, before making a final selection.