Things
To Consider When Choosing Your Dental Plan
What looks like
a bargain today may not be a good buy in the long run. While your out-of-pocket
costs are, of course, an important part of your decision-making process
when choosing a dental plan, they are not the only criteria to use when
evaluating your options. Your primary focus should be to determine whether
the coverage will satisfy your dental care needs. Consider the following:
1. Does the plan give you the freedom to choose
your own dentist or are you restricted to a panel of dentists selected
by the insurance company?
If you have a family dentist with whom you are satisfied, consider the
effects changing dentists will have on the quality or quantity of care
you receive. Because regular visits to the dentist reduce the likelihood
of developing serious dental disease, it's best to have and maintain
an established relationship with a dentist you trust.
2.
Who controls treatment decisions--you and your dentist or the dental
plan?
Many plans require dentists to follow treatment plans that rely on a
Least Expensive Alternative Treatment (LEAT) approach. If there are
multiple treatment options for a specific condition, the plan will pay
for the less expensive treatment option. If you choose a treatment option
that may better suit your individual needs and your long-term oral health,
you will be responsible for paying the difference in costs. It's important
to know who makes the treatment decisions under your plan. These cost
control measures may have an impact on the quality of care you'll receive.
3.
Does the plan cover diagnostic, preventive and emergency services?
If so, to what extent? Most dental plans provide coverage for selected
diagnostic services, preventive care and emergency treatment that are
basic for maintaining good oral health. But the extent or frequency
of the services covered by some plans may be limited. Depending upon
your individual oral health needs, you may be required to pay the dentist
directly for a portion of this basic care. Find out how much treatment
is allowed in any given year without cost to you, and how much you will
have to pay for yourself.
Every dental care plan is different. It's your responsibility to be
informed about what your specific plan will cover. As a basis of comparison,
the following services should be covered in full, with no deductible
or patient co-payment:
Initial Oral Examination--once per dentist
Recall Examinations--twice per year
Complete x-ray survey--once every three years
Cavity-detecting bite-wing x-rays--once per year
Prophylaxis or teeth cleaning--twice per year
Topical Fluoride treatment--twice per year
Sealants--for those under age 18
4.
What routine corrective treatment is covered by the dental plan?
What share of the costs will be yours? While preventive care lessens
the risk of serious dental disease, additional treatment may be required
to ensure optimal health. A broad range of treatment can be defined
as routine. Most plans cover 70 percent to 80 percent of such treatment.
Patients are responsible for the remaining costs. Examples of routine
care include:
Restorative care - amalgam and composite resin fillings and stainless
steel crowns on primary teeth
Endodontics - treatment of root canals and removal of tooth nerves
Oral Surgery - tooth removal (not including bony impaction) and minor
surgical procedures such as tissue biopsy and drainage of minor oral
infections.
Periodontics - treatment of uncomplicated periodontal disease including
scaling, root planning and management of acute infections or lesions
Prosthodontics--repair and/or relining or reseating of existing dentures
and bridges.
Understand what routine dental care is covered by the plan, and what
percentage of the costs will come our of your pocket.
5. What major dental care is covered by the plan?
What percentage of these costs will you be required to pay? Since dental
benefits encourage you to get preventive care, which often eliminates
the need for major dental work, most plans are not generous when it
comes to paying for major dental work, most plans cover less than 50
percent of the cost of major treatment. Most plans limit the benefits--both
in number of procedures and dollar amount--that are covered in a given
year. Be aware of these restrictions when choosing your plan and as
you and your dentist develop treatment best suited for you. Major dental
care includes:
Restorative care--gold restorations and individual crowns
Oral Surgery--removal of impacted teeth and complex oral surgery procedures.
Periodontics--treatment of complicated periodontal disease requiring
surgery involving bones, underlying tissues or bone grafts.
Orthodontics--treatment including retainers, braces and/or diagnostic
materials.
Dental Implants--either surgical placement or restoration
Prosthodontics--fixed bridges, partial dentures and removable or fixed
dentures.
6.
Will the plan allow referrals to specialists?
Will my dentist and I be able to choose the specialist? Some plans limit
referrals to specialists. Your dentist may be required to refer you
to a limited selection of specialists who have contracted with the plan's
third party. You also may be required to get permission from the plan
administrator before being referred to a specialist. If you choose a
plan with these limitations, make sure qualified specialists are available
in your area. Look for a plan with a broad selection of different types
of specialists. If you have children, you may prefer a plan that allows
a pediatric dentist to be your child's primary care dentist. Since specialized
treatment is generally more costly than routine care, some plans discourage
the use of specialists. While many general practitioners are qualified
to perform some specialized services, complex procedures often require
the skills of a dentist with special training. Discuss the options with
your dentist before deciding who is best qualified to deliver treatment.
7.
Can you see the dentist when you need to, and schedule appointment times
convenient for you? Dentists
participating in closed panel or capitation plans may have select hours
to see plan patients. They may schedule appointments for these patients
on given days, or at specified hours of the day, restricting your access.
Some dentist's fees for seeing you on weekends or during emergencies
are high than those the plan allows. You may be required to pay additional
costs yourself. If you select these types of plans, have a clear understanding
of your dentist's policies as well as the plan's dentist-to-patient
ratio. It's the best way to ensure your access to care is not unduly
restricted and that you are not surprised by higher fees the plan does
not cover.
8.
Will the plan provide benefits to patients who may also be covered by
another dental plan?
It is not unusual to be eligible for dual benefits. You may be covered
under your company's plan as well as under that of your spouse's employer.
In analyzing your options, make sure to look for a plan that allows
coordination of benefits.
You should be entitled to either 100 percent coverage or some form of
premium credit. By coordinating benefits, you can eliminate being penalized
or denied coverage when the two plans have conflicting exclusions.
Making An Informed
Choice
The law mandates
that consumers with dental coverage receive a fully detailed patient
information handbook--a Description of Benefits--that clearly outlines
coverage, limitations and exclusions. Before selecting a plan that best
suits your needs, ask your carrier or company benefits coordinator for
a copy of the benefits handbook. If you have questions about coverage,
exclusions, calculation of benefits or payment of benefits, ask before
making your plan selection. Find out which plans your dentist participates
in and why. That's the best way for you to get care from the dentist
of your choice, and still take advantage of the costs savings due to
you.
Selecting an insurance program wisely isn't simple. But having the facts
to make an informed decision can make a difference. No plan is perfect;
each has its advantages and limitations. Read the fine print. And by
all means ask questions. The more you know about dental benefits, the
better equipped you will be to select the best coverage for your dental
health.
The Clarkson Financial Services team is available to answer any additional
questions that you may have regarding your dental insurance. Please
feel free to call our office to determine which plan is the best fit
your needs.
You
can contact us at 1-800-338-7148 or click
here for more information.
