Are you looking for a dental insurance plan that provides complete coverage for every sort of dental disaster? As in – no matter what kind of treatment you may need, now and into the foreseeable future, your dental insurance will reimburse you for virtually all of the cost?
Frankly, you have a better chance of finding a polka-dotted unicorn hiding under your bed that you do of locating this sort of dental insurance.
Or perhaps your needs are less aspirational. You want dental insurance that covers braces for your three kids. You’re a baby boomer who needs a significant number of implants – and probably a bone graft to support them. Or your gums may need some quality time with a Periodontist. Whatever the issue is, you’re looking for a dental insurance plan that “covers everything” – in that you need help managing the high cost of an extended treatment plan.
Dental insurance plans that come the closest to the description “covers everything “are typically referred to as indemnity or fee-for-service dental insurance plans. They typically cost at least twice as much as more restricted plans - $780 a year for an individual for a plan that has a maximum annual benefit of $2,500 compared to $350 a year for the typical dental insurance plan with a maximum annual benefit of $1000-$1,500. And the fees you pay for treatment at your dentist may be higher too.
All that said, indemnity plans can be the right choice for some people. Read on for the pros and cons.
If you’re a baby boomer, you may remember having dental insurance that was accepted by any dentist or dental care professional. You paid for the care you needed, out of pocket, and the insurance provider then reimbursed you for most of the costs. Your dentist was happy to work out a billing plan, so you didn’t have to produce a large sum immediately to get care.
If you want this type of dental insurance, search online for “indemnity dental insurance.” It’s sometimes also called a “fee-for-service” plan, or “traditional dental insurance”. Independent insurance brokers sell it, the Obamacare marketplaces currently do not and are unlikely to do so.
Indemnity insurance is as close as you’re likely to come to getting dental insurance that covers everything. With indemnity dental insurance, you can visit any dentist – there are no networks or approved providers. You pay a deductible on your indemnity dental insurance, after which the insurance provider will cover a part - typically between 50% and 80% of "reasonable and customary" dental costs, as well as 100% of your preventative care. So far, this is essentially the same deal as you’d get with other dental insurance plans, but you will be able to see your own dentist – assuming he or she accepts the plan, and most will.
What may also be different is the maximum benefit amount (cap) for your indemnity plan. It will be higher than the usual $1000-$1500 that more standard dental insurance plans provide. You’ll want to find a policy that provides a maximum benefit that is in line with your expected dental treatment needs. And you’ll also want to have a clear understanding of what your insurance provider considers to be "reasonable" and "customary" costs.
See if your dentist will provide you with a treatment plan with costs outlined for each procedure (along with the ADA codes for all necessary procedures), which you can then compare to the insurance providers’ "reasonable and customary" fee schedule. What is considered reasonable and customary is based on the standard fees charged by most dentists in your specific geographic market area.
Your insurance provider will reimburse you after receiving and reviewing the dentist’s bill, and your claim. Some plans also allow you to assign payments directly to your dentist, which can be a big help if your dentist is comfortable with such an arrangement.
If you are concerned about whether the insurance provider will cover a major service, or how much you will be reimbursed for, you can often make a pre-claim or ask for a claim review.
And yes, just like “regular” dental insurance, indemnity dental insurance plans do impose a waiting period before major treatments, are covered. There will also likely be exceptions such as a “missing tooth clause” – your insurance doesn’t cover restoration for any teeth missing when you purchased the plan - or limitations on “preexisting conditions.” That cracked molar or loose tooth you have right now probably won’t be covered. In general, if you know you’re going to want dental insurance someday, its best not to delay purchasing it until the very last possible minute.
Chances are, the typical dental insurance plan doesn’t meet your needs if you’re looking for dental insurance that covers everything. But do be aware, as discussed previously in this article, that the premiums for indemnity dental insurance are pricey. For a plan that has a $2,500 annual cap on coverage, the average monthly premium is $65 - $780 a year for an individual. The typical cost of a preferred provider/ in-network individual dental insurance policy is around $350 a year.
Additionally, you may not get the discounted rates on services that insurance providers negotiate with dentists who are part of their approved provider’s network. That can make your costs considerably more expensive – 30%-60% higher than the negotiated rate.
You may find that, rather than looking for insurance to cover everything, you’ll save more by teaming dental insurance that has a lower annual cap with a dental savings plan. After you hit your annual cap – the maximum amount your insurance will reimburse for in a single year – you can use your dental savings plan to save on additional treatment.
And as you look into dental insurance and other ways of paying for dental care, you may also find that dental savings plans – the alternative to dental insurance - offer the affordability and flexibility that you need. Dental savings plans offer discounts of 10%-60% on average dental care costs, have no annual caps, no waiting period is applied for accessing care, and there no restrictions on obtaining care for preexisting conditions.
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