Dental Insurance – Different Types of Policies

It is well known already that dentist is one of the most profitable jobs in the world. Apart from the high revenues, dentists also keep contact with the newest medical discoveries and breakthroughs, desiring to offer the perfect smile with the minimum of discomfort and money. However, private dentist investigations are extremely expensive in all developed states, including the United States, Canada or Germany, which only encourages people to opt for a dental policy.

A dental policy is similar to any other type of health insurance policy, which gives its appointee the possibility of benefiting from dental services for a pre-established money value. Such dental policies can be ped down at any insurance company and are usually valid throughout the country, no matter the dental cabinet of choice.

Depending on your salary, dental medical history or dental needs, you may opt from a variety of plans each specialized on a certain type of dental interventions. Those with strong cavities and good dental medical history are not obliged to ensure their teeth, as their interventions are usually minor and can be paid for in cash. However, those with high dental risks are strongly advised to opt for a medical coverage as big as possible, in order to cover all possible future interventions.

But before deciding which type of dental insurance best fits you, you should know that each of them falls into a certain dental category or class, depending on its complexity:

  • Class 1: In this class dental insurances will include minor dental services, most of them of diagnosis and prevention. Professional dental cleaning, examinations and x-rays fall into this category and they are usually 100% covered by your dental insurance company for at least two times each year.

  • Class 2: this includes minor interventions like fillings, periodontal works and root canals. Most dental plans cover 80% of the costs of these interventions.

  • Class 3: this class includes major interventions, like bridges, dentures or crowns which are often covered in a proportion of 50%.

  • Class 4: here dental plans include orthodontia works such as braces. Usually this type of service is charged differentially and is not part of your annual dental plan. The costs are cumulated for the total amount of years in which the braces must be worn, thus it comes with a separate lifetime maximum.

It is important to mention that complicated dental procedures such as implants are not covered by all dental plans; usually you will have to pay more for a dental insurance to cover up these expenses. Moreover, cosmetic dentistry procedures such as teeth whitening are rarely covered by any insurance company. However, in these cases you might be able to obtain price reductions and discounts.

Another key-element that must be reminded before adopting any type of dental care program is the program’s limitations. These limitations usually deal with the yearly costs. Each patient is entitled to receive dental care services up to a certain amount of money which is previously established by the insurance company. Once the plan maximum is reached, the patient will have to bear all costs from his or her own pocket. There is also a limitation regarding the number of procedures one is entitled to each year; for example, a patient can obtain up to two Class 1 procedures per year (such as cleanings or x-ray investigations).

Having said that, let us take a look into the most common dental plans and their benefits:

  • Dental Health Maintenance Organization (HMO) is the cheapest dental plan you could opt for. The rules are simple and the prices for dental services are usually low as long as you stay in the network. Alike a regular medical HMO, the dental one implies that the patient will receive all dentistry care from dentists from your network plan. The patient must choose a primary specialist who will coordinate the entire mouth care and will point to specialists whenever required. The designated primary dentist must be consulted first before any further actions. Aside from the low costs, the main advantage of a HMO dental plan is that there is no additional paperwork; you will simply have to pay the co-payment or deductibles. These out-of-pocket additional costs are usually the smallest ones when receiving care and treatment from the network dentist. However, appealing to specialists outside your network will imply that you will cover the full costs of the service which might be high.

  • Dental Preferred Provider Organization (PPO) is genuinely preferred by those who don’t deal well with network limitations. A PPO plan means that you are not limited to your network specialists, but you can seek help from dentists outside your plan’s network. Moreover, you will not be obliged to choose a primary specialist or to obtain referrals for further specialized investigations. However, you still have an advantage if you choose a network specialist. On the other hand, out-of-network interventions will still be co-paid or co-insured, but generally the amount of reimbursed money will be smaller.

  • Dental Discount Plan. Although these are not actually insurances, you can benefit from big discounts at any dental interventions, based on your membership card. Similar to HMOs, such dental discount clubs are also networked based, with the mention that they are not entirely individual. Being part of a dental discount club will mean less money paid for dental interventions for you and for your family. Usually, such managing organizations negotiate with local cabinets to ensure price reductions of up to 70%.

  • Direct Reimbursement Plans are the most expensive, but the most efficient as well. Such plans are specific to companies which cover the employee’s dental interventions. The functioning mechanism is quite simple, which obviously makes it extremely efficient: the company creates a private fund in which it raises money for any dental interventions. Once an employee requires a certain dental intervention, the company uses the private fund to cover all the expenses. Although it does not profit smaller companies, a direct reimbursement plan is recommended by the American Dental Association (ADA).  

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