Individual Dental Insurance

Individual Dental Insurance Coverage

While some employers offer the benefit of individual dental insurance to their employees, many do not. If you need dental treatment and find yourself without dental coverage, you will be responsible for paying the bill on your own. Because many people find themselves in this predicament, some companies have begun to offer individual dental insurance benefits.

Many of these plans are actually “referral plans” or “buyer’s clubs”. With these types of dental plans, individuals pay a monthly fee or premium to a third party, who gives them a list of dentists that offer reduced fees. Though the individual is still responsible for paying the dentist bill in full, the fees are reduced, which makes dental care more affordable.

There are many other types of plans available to individuals from insurance companies and plan sponsors (employers). Some of these dental insurance plans include:

• Direct Reimbursement Plans – These plans reimburse patients for a percentage of the money spent on dental care. In most cases, it doesn’t matter what type of treatment is given or which dentist it came from.
• Allowance Plans – Sometimes known as Table programs, allowance plans provide coverage for specific services at an assigned dollar amount. For example, if the plan allows $50 for a regular cleaning, and the dentist charges $75, the plan will pay $50 and the patient will be responsible for paying the difference ($25).
• Preferred Provider Organization (PPO) Plans – With these plans, contracted dentists offer lower fees for PPO patients. This is meant to be an incentive for patients to select their dental practice. If the patient chooses to go to a dentist who does not participate in a PPO plan, the dental visit may not be covered by the plan.
• Capitation Plans – These plans pay contracted dentists a fixed dollar amount per patient. In return, the dentist provides specific dental treatments, such as cleanings, x-rays, and fillings, at no charge.

If you are eligible for individual dental insurance from your employer, you may have access to one or more of these plans. In fact, the right to choose between two different insurance plans may be a law in your state, depending upon where you live. To make an informed decision, you will need to understand exactly how the plans work. The best way to do this is to make a comparison of the benefits that are being offered and the cost savings that will be derived as a result.

Purchasing Individual Dental Insurance

There are many advantages to purchasing individual dental insurance, but you will want to make sure that the premiums you pay do not exceed the expected treatment amounts. If your insurance premiums cost $600 per year, and you end up having only $400 worth of covered dental bills by the end of the year, you have lost money.

To make sure you are getting a good value and to ensure that you are properly covered, you will want to ask as many questions as you can about the individual dental insurance plan before purchasing a policy. Pay special attention to features, such as:

• Exclusions
• Limitations
• Co-payments
• Annual or Lifetime Benefit Maximums

Knowing what is covered and what is not will help you to make informed decisions about individual health insurance. It will also prevent unpleasant surprises and unexpected costs at the dentist office. To learn more about employer dental benefits visit The American Dental Association.