Determine your Need for Dental Insurance
Picking insurance can be overwhelming. There are thousands of plans to choose from, and every agent you speak with to get information will tell you that their plan is the most beneficial for you. So, how do you choose a dental insurance plan?
There is a process of picking the correct dental insurance. Before you venture out into the insurance world, I suggest writing down your specific needs. Everyone’s oral health needs are different.
Some can get away with the bare minimum and choose an insurance that just offers two cleanings and exams per year and at least one set of x-rays per year. They don’t need a very big yearly maximum (the maximum amount an insurer will pay OUT per year) because all they are using it for is their cleanings. They MIGHT get one filling per year covered if they need it.
Not everyone is that lucky in the oral health department. Some people need more. They may be prone to decay and need fillings more often, so they need a low deductible (the amount you must pay before the insurance will pay out), a decent yearly maximum, and 100% coverage for their preventative work as well. Fillings are typically covered under “Basic” coverage on the benefits tier (as I call it), so you want to make sure the basic benefits are covered at a good percentage (the average is 80%).
For those who are very unlucky and need frequent root canals, crowns, or more, you basically want the best insurance money can buy. The average benefits are 100% for preventive, 80% for basic (simple extractions and fillings), and 50% for major (crowns, dentures, bridges). As a frequent flyer to the dental office, you may want to find a plan that offers 80% in Major benefits and a high yearly maximum, at least $2,000…more if you can find it. Deductibles tend to be around $50 per year on average, so you want to pay attention to the deductible, but it shouldn’t be a big part of your decision.
Now that you know the Basics of Dental Insurance…
You need to determine what your needs are.
- Are you one of the lucky ones that never really get cavities, and when you do it’s a small one every few years? You could probably get away with a cheaper premium plan that basically just covers preventive.
- Do you get a cavity or two every year? Try to find a plan with a low deductible, at least $1,000 yearly maximum, and 80% Basic coverage.
- Do you feel like every time you turn around you have to get a root canal and/or crown? Then go for the gold! Find the best insurance plan you can. The higher the maximum (and percentage), the better.
WARNING: If you find a plan that covers 80% in Major work, but only has $1,000 yearly maximum, that’s not as good as it looks on paper. Think about it like this…80% of an estimated $1,300 for a crown is $1,040. So, with ONE crown (not a root canal, exam, cleaning, or anything else) you have gone OVER your $1,000 maximum and still have to pay your 20% AND the $40 you went over on your maximum. Keep that in mind. 🙂
Okay, so you’ve determined your needs…
Now you know what TYPE of coverage you are looking for. Time to make some phone calls (or if you’re internet-savvy, do your research online).
There are a lot of insurance companies out there to choose from, and I couldn’t possibly tell you about every single one. On top of that, each insurance company has several different types of plans to choose from.
Are you feeling overwhelmed again?
What I suggest is picking a few to research, see if they have the benefit plan that will work for you, and check to see if they are In-Network with the dentist of your choosing.
I can’t tell you which insurance companies to call due to the vast number of them out there, but I can give you a few questions to ask (or for you to find the answer to online).
- Do you have waiting periods? (Waiting periods are a specific amount of time you must wait to have treatment done AFTER your effective date. For example, some insurance policies require you to have the policy for 6 months before you can get a filling, and 12 months before you can get any major work. THIS IS AN IMPORTANT QUESTION.)
- What percentage do you cover Preventive, Basic, and Major services?
- What is the yearly deductible?
- What is the yearly maximum?
- Do you downgrade on white fillings and/or crowns? (A downgrade is when the insurance will pay as much as an amalgam- or silver– filling cost and you must pay the difference. For example, an amalgam filling total price is $70, and a resin -or white- filling is $100. Insurance will pay 80% of the amalgam filling and you will owe 20% PLUS the difference of $30.)
- What is the monthly, or yearly, premium?
These are just a few questions to ask. If you have additional questions, ask those as well! It is the insurance representative’s job to answer your questions so you can feel good about your decision.
Make sure you make notes as you find out the answers. When you have called the insurance companies you had written down, look over all of your answers and determine which insurance looks the best. If none of them meet your needs, write down a few more and start your research again. Doing it in blocks like that can make it seem less overwhelming.
As a billing clerk at a dental office, I will get phone calls from potential new patients, or existing patients looking for new insurance, and they will ask me my OPINION on the best dental insurance. I won’t usually give an exact answer…I will tell them who we advertise here at our office, and what types of things they should look for, but I won’t TELL them which insurance company to choose.
Think you want to forego the insurance search?
If you are thinking about choosing to be a cash pay patient and not fooling with insurance, just remember that a dental office’s fees are typically MUCH higher than the fees they have negotiated with insurance companies.
For example, a cash-pay patient that needs a crown and build up in our office will pay around $1,400…but if they have Delta Dental, the crown and build up fee is around $990. That is a $410 difference, and it doesn’t count the percentage that Delta Dental would cover.
Now get out there!
I know you may have been looking for something that said, “Choose this insurance! You can’t go wrong!” but that wouldn’t be fair to you. As I said, everyone has different needs, so there is no way to tell someone that one insurance is any better than another because it may not be for your specific needs.
I truly hope this helped you in starting the process of choosing insurance! Just remember, take it one insurance company at a time, and you’ll be fine! 🙂