When deciding on an individual dental plan, it is essential to know some key features. Depending on how you purchase your plan (you can buy it separately or through the health benefits exchange), it may have different cost-sharing terms and coverage limits. Make sure the dentist you like is in-network. Also, consider if you prefer a DPPO plan or a DHMO.
Deductibles
When choosing individual dental insurance plans, it’s essential to consider the monthly premium or cost and any deductibles, copays, and annual maximums. These amounts represent the amount you pay for services before coverage kicks in.
Once you’ve met your deductible, you and your insurance provider share costs for covered procedures – this is called coinsurance. The lower your deductible, the more you save on out-of-pocket costs. Individual plans are generally more expensive than group coverage, but they often provide more comprehensive coverage for less.
Whether or not these restrictions are worth the added cost is a personal decision. Consider asking friends and family for feedback about their experiences with particular insurance carriers, or contact eHealth’s team of licensed insurance agents for personalized assistance.
Premiums
The premiums associated with dental insurance vary between different plans. Some plans, such as those offered through group coverage (such as through a workplace), offer lower premiums than individual policies. However, you may have to pay a deductible and coinsurance.
Regardless of the type of plan you choose, it’s essential to know the coverage details. For example, some plans include a least expensive alternative treatment (LEAT) clause, meaning that the plan will only cover medically necessary procedures.
You should also consider the size of the dentist network, particularly if you have a preferred provider you’re comfortable working with. Then, compare the costs of various plans to determine the best fit for your needs and budget.
You can also find information about costs and coverage limits by examining the fine print on individual marketplace health insurance plans. Many of these plans are designed to help make dental care more affordable for individuals and families, especially those who do not have access to employer-sponsored coverage or government-funded programs.
Co-payments
When choosing an individual dental insurance plan, it is essential to understand how much of a contribution you will need to make toward your care. This includes knowing your deductible, annual maximum, and co-payment amounts.
Another factor to consider is whether the plan you are considering has a preferred provider network. These networks contain dentists who have negotiated fees with the insurer, which can result in lower out-of-pocket costs for patients. It is also a good idea to look at the reputation of the insurance company providing the plan, as this can often affect how efficiently claims are processed and paid.
Purchasing a stand-alone dental plan is typically more expensive than an employer-sponsored plan. However, the cost can be well worth it if you take the time to thoroughly compare plans on various factors, such as premiums, deductibles, and coverage limits. In addition to these factors, you should also consider the size of a dental plan’s network, which can be essential when choosing which dentists to visit.
Benefits
Dental insurance plans cover various services, from preventive visits to fillings and crowns. Some important aspects to consider when choosing a plan include:
- The monthly premium (which is usually deducted from your paycheck).
- The annual deductible.
- The amount of coverage that’s available per service.
Individuals can purchase dental insurance plans from their employers or privately. When purchasing a plan, it’s essential to understand the type of coverage offered and any restrictions that may apply. One such consideration is whether a plan is an HMO or a PPO.
HMOs typically limit coverage to dentists in the plan’s network, while PPOs allow you to choose your provider and often have lower out-of-pocket costs. It’s also worth comparing the size of each network to see if it includes your preferred dentist. This will help you avoid finding a new dentist if you switch plans.
Networks
If you’re purchasing dental insurance independently of an employer-provided program or the Affordable Care Act marketplace, paying attention to details like provider networks is essential. If your preferred dentist isn’t in the network for a particular plan, you must change providers or consider alternative plans.
Also, be aware that even employer-provided dental insurance may have a limit on the amount of coverage you receive for specific procedures. Some plans work exclusively with specific networks, while others allow you to use dentists in or out of the network for a lower fee.
You’ll want to find companies that offer large nationwide networks for HMO and PPO dental insurance plans, giving you more flexibility when choosing a dentist. Indemnity insurance plans, which pay a dollar amount regardless of what the provider charges for a service, often work with smaller networks than PPO and HMO dental plans.
However, many indemnity plans allow you to go to a dentist outside the network, although the benefits will be lower. This can be a good option for people who prefer to work with in-network providers for routine services.
