Factors to consider when choosing a dental plan

You finally made a decision that you need to buy a dental insurance plan. Now, your next move is to choose what type of coverage you need.

To help you arrive at a firm decision, you need to consider a number of factors. In this article, we look at the various factors that should be given weight because they impact on the kind of dental coverage you will eventually get. 

1. Establish what you need

There is no such thing as the best dental plan in the market because each one of us has his or her own unique dental care needs. You have to know what your needs are and start from there when buying a dental insurance plan.

When you have children, you need to take into consideration their needs, too. This is where a good relationship with your dentist can help a lot as he can help you chart your current and future needs.

2. Know your options

In today's market, there is a wide range of dental care plans. Check out what plans are being offered in your area.

3. Key plan features

As you shop around for a plan, look at the following important features:

  • Monthly premium - you need to reckon what you need and what you can afford. Therefore it is important to look at your overall financial situation and see how your monthly premium payments will fit in.

  • Minimum treatment covered - the plans you are considering should cover the following at the minimum:
    • Initial oral examination - when seeing a dentist the first time; one time for each dentist.
    • Regular check ups - every 6 months
    • X-rays (complete) - once every 3 years
    • Bitewing X-rays - once per year.
    • Hygiene appointment or tooth cleaning - every 6 months.
    • Topical fluoride treatment - two times in a year
    • Sealant application - for children less than the age of 18.
  • Maximum yearly limit - Most dental plans have a limit on the amount that they will reimburse in a given year - which may range from $1,000 up to $1,500. If the total expenses exceed the limit, the consumer becomes responsible for the costs that go over the limit. Some insurance companies have dental insurance plans that carry higher yearly limits of up to $3,000. These plans may be suited for individuals with bad dental health. There are also dental plans that have limits on both amounts per year and also the number of procedures allowed.

  • Deductible - Dental plans that have deductibles require that the policyholder pays the deductible first before the insurance company pays for anything covered under policy. Deductibles can range from $50 to $250 per year depending on the policy. There are dental plans that do not include some procedures or services from being considered in the deductible. These may include cleanings and routine examinations. In these policies, the insurance company will pay its share of the cost even if the policyholder has not yet met his deductible. When shopping around for a dental plan it is advised that one should estimate how much of the services he will be paying for all his family's needs for each year so that a good estimate on the total deductibles are arrived at.

  • Waiting period - In cases where major dental work is needed or when there is an individual has a pre-existing condition, there may be a waiting period before the insurance company agrees to pay for treatment or services covered. That waiting period can range 6 to 18 months. If you think you will need some major dental work or if you have a pre-existing condition, you should consider this when looking for a dental plan.

  • UCR fee guide - The majority of dental insurers follow their own Usual, Customary & Reasonable guide for service fees. This guide sets the amount they will shoulder with respect to a certain procedure or treatment. This is different from the dentist's actual charges. For instance, if the dentist charges $80, the company's UCR may only allow $60.

    For individuals with dental plans that require them to get the services of in-network providers, usually they will NOT be asked to pay the difference between the dentist's charge and what is provided in the UCR. In-network dentists have an agreement with the insurer not to require the consumer to shoulder the difference. If the dental plan allows you to get the services of providers outside of the plan's network, verify with the UCR first so you will know how much you are expected to pay.

  • Choice of treatment - The majority of dental insurers use a clause that calls for the cheapest treatment available when a number of treatment options are available. This means that the company will only cover charges of treatments that cost the least.

  • Option to choose own dentist - Look for a dental plan that gives you this option. A number of plans available in the market today will not provide you this option, however, you may never know if you will be comfortable with any of the dentists in a plan's network.

  • Coverage for family members - A family plan should be considered by one who has a family. Inquire about how annual limits, deductibles, etc. apply to the members of the family. Those with children should clarify if braces, sealants and fluoridation are included.

  • Papers to prepare - Check how the documentation requirements go with your coverage. In some cases, the claim process may take a lot of your time because your dentist will be involved in preparing the necessary papers.

4. Payment plan

Check how you send in payments. If there is an online system it could provide you have some convenience. Also, see what the schedule is, is it monthly, every six months or a yearly payment scheme?

5. Quality of customer service

See how the company communicates with its customers. Does the company's website offer extensive information on the products? Does it provide convenient ways to get in touch with the company (email, phone numbers, online chat, etc.)? How do current customers rate the company? What are the common complaints?

The answers to these questions will show the kind of customer service you will get from a company once you get coverage from them.

6. Less-known factors that also impact coverage

  • Purchasing the first cheap coverage that comes along. Many consumers are easily lured by dental plan advertisements. But, this is no guarantee that what they purchased is what they need or will cover their dental requirements.

  • Using only price as a factor. Pretty much related to the first factor, this one is also a cause of problems for many consumers. There are a many cases where policyholders get surprised that the procedure they assumed is covered is actually not included in the policy.

  • Focusing only on low premium payments. While this could save money, low premiums can mean that somewhere something has to give --- be it extra charges or hidden costs.

  • Not asking for discounts. A lot of consumers purchase their policies without asking for discounts because they assume the insurance company will not provide this to them. One good way to get a discount is to buy coverage from the same insurer who sold you health insurance.

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