It is no secret that the cost of healthcare is rising. While medical coverage often does a decent job of subsidizing the cost of visits to the doctor, the same cannot be said of dental coverage. Dental insurance is frequently both expensive and limited in what it will cover. That begs the question: Does full-coverage dental insurance even exist?
What About Indemnity Insurance?
Traditionally, dental insurance invariably fell into what is called an indemnity plan.
- You are not restricted in your choice of dentist; you can see anyone you like.
- Covers up to 100% of preventative care.
- Subsidizes around 50-80% of the cost for basic care procedures like fillings and root canals.
- After you pay a deductible, your indemnity plan will cover a part of the Usual, Customary and Reasonable (UCR) costs of your visits and procedures, leaving you responsible for the rest.
- Most policies stipulate a maximum yearly amount they will pay, generally between $1,000 and $1,500.
- You may also have to wait up to 12 months before receiving any coverage on complicated procedures like dentures and crowns.
Indemnity plans let you choose from any dentist, but they often carry high deductibles, yearly maximums and waiting periods that make them impractical for many patients. They may be helpful for preventive care, but contrary to popular belief, indenmity plans should not be considered “full coverage.”
Medicaid and Medicare
Government-sponsored insurance programs can not be considered full coverage. Here’s why.
The Medicaid program is designed to oversee the medical needs of low-income Americans and some people with disabilities. It is a partnership between state and federal governments.
- Medicaid must provide recipients under age 21 with comprehensive care, including dental coverage. However, each state can choose the extent of coverage it will provide. If you are over 21, the quality of your dental coverage will vary according to where you live.
- Many dentists do not accept Medicaid, making it difficult for patients to access the services they need.
Medicare is a federal insurance program available to senior citizens and people with disabilities.
- By law, Medicare cannot help patients pay for regular dental care. This includes routine visits and cleanings, fillings, root canals, dentures and crowns.
- In fact, Medicare will only cover extremely complicated situations. For instance, the program will cover tooth extractions, but only if it is necessary before medical procedure such as a kidney transplant can go forward.
Clearly, you can not rely on Medicaid or Medicare for full dental coverage.
HMO and PPO Programs
If you are employed, you may be fortunate enough to get dental benefits of some kind from where you work. In most cases, your insurance will fall into one of two categories.
It may be a Health Maintenance Organization (HMO) in which you must provide a pre-payment. In exchange, you can receive a full range of dental services within a specific network of dentists.
- Often, basic services are covered in full, but you may be expected to pay a portion of the cost for more complicated procedures like dentures and crowns.
- If you choose to see a dentist outside the network, you must pay the entire bill yourself.
In the Preferred Provider Organization (PPO) model, you have more freedom to choose a dentist.
- Dentists in PPO networks get paid in full for the services they provide. This means that far more oral care professionals are members of PPO networks.
- The premiums you pay for PPOs are often higher, but you have much more flexibility and choice when it comes to the dentists you can see.
Still, neither HMOs nor PPOs offer the Holy Grail of insurance; finding full dental insurance coverage is virtually impossible in this day and age.
Can Discount Dental Plans Fill the Gap?
If you’re looking for comprehensive dental coverage at an affordable price, you might think there are no viable options. Most other plans fall far short of the mark.
Discount dental plans, however, may help patients most. In these models, patients visit dentists within a vast network to obtain affordable dental services. Because discount plans can guarantee dentists a steady stream of patients, they are able to negotiate extremely low prices for a full range of dental services, from the most routine to the most complex.
- There are no long waits for services, nor are there yearly maximums.
- Monthly fees are extremely affordable at just $15.95/month for an entire household.
- You will not have to fill out complicated paperwork or face any nasty surprises.
- Best of all, patients who join these plans can know beforehand exactly how much a procedure will cost and what they may be required to pay.
Choosing a Plan
In the best of all possible worlds, we could obtain dental coverage that would pay the entire cost of any and all procedures. Paperwork would not exist, and we would be able to see any dentist. Although we are far from this reality, discount dental plans might be the closest option. Sign up for one of these programs, and you can immediately receive the care you need at prices you can afford.
To learn more about a discount dental plan, visit 1Dental.com.