Dental Plans versus
Most people as well as many insurance agents use the terms “dental insurance” and “dental plan” interchangeably.
However, they are not the same and understanding the distinction is important when you are shopping for dental coverage.
is, for a lack of a better expression, "real
The agent who sells it must be licensed in your state and there is an
insurance carrier underwriting or guarantying the plan and paying the claims.
With dental insurance, you will either pay a percentage of the covered costs or receive reimbursement for part of the
covered costs. It all depends on which type of dental insurance plan you purchase. But the important thing to remember is that there are
claims being paid to some extent. It is not just a discounted rate.
In other words, the dental office submits an actual claim to an insurance company on your behalf. As a result, either you or the dentist,
depending on how the paperwork was filed, gets paid.
With a PPO plan you generally pay a percentage of the costs and the insurance company pays the rest, up to a
certain yearly maximum amount.
With an Indemnity plan, the insurance carrier pays a fixed amount that is dependent on the procedures performed. For example, they might pay out
$50 towards a cleaning or $300 towards a crown.
In the end, whether you have a PPO or Indemnity plan, the consumer's portion is about the same.
are membership-based programs where a consumer
pays a membership fee in exchange for discounts
on most routine dental services, such as dental exams,
routine cleanings, fillings, extractions, root
canals, dentures, crowns, and braces.
In simple terms, this is a discount plan or a discount card.
Since it is not an insurance product at all, it may be sold my just about anyone over 18 with a pulse. There are no licensing
requirements and most states have no oversight as to what is covered or not covered.
The only rules that are enforced are that the seller may not refer to the product in any way as “insurance” or imply that this is a
dental insurance plan.
Discount plans are considerably less expensive than insurance. Depending upon which plan you choose, an entire family can be
covered for less than $15 a month.
It is important to understand that we do not want to disparage dental plans in any way. The cost versus the potential benefits received of
these types of plans is excellent.
You can save ten to sixty
percent off standard out-of-pocket fees when
visiting a participating network provider. There
are no pre-existing condition limitations,
maximum limits or deductibles to pay. Some of
these plans offer free preventive services such
as cleanings and exams.
Keep in mind that you are
responsible for paying the dentist directly at
the time of service when using a dental plan.
The key to using these plans effectively is to find a dentist that accepts the plan that you are comfortable with.
If there is a dentist in your
area that you like who accepts one of these
plans, you should consider it.