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Dental Insurance

August 26th, 2011

We are often questioned in our office by patients who are considering getting dental insurance plans.  It is very important, but often difficult, that you understand just how some of these plans work.
Some plans are not insurance at all. You, the consumer, pay a yearly fee to the company and they send you a membership card and a list of participating dentists.  You need to go to one of these offices and they charge you a reduced amount for each procedure which has been set by the company.  Anything that is excluded, you need to pay for at full price.  This is basically just a membership club.
Some individual plans offered through groups such as the Chamber of Commerce are more typical insurance plans.  But beware, the companies offering these plans are not looking to lose money.  One recent plan offered individual coverage for almost $43 a month.  That’s $516 a year and the maximum benefit for the year was just $1000.  That’s a pretty steep ratio of cost to benefit.
Group plans through employers are often offered.  You need to check and see if your dentist participates with the plan being offered.  Sometimes you will be able to stay with a non-participating office and just pay any difference in the fee yourself, while with other plans you can only see a participant or you receive no benefit at all.
As an employer, providing dental coverage for your employees can often be done best with a direct reimbursement type plan.  This is a type of self insurance benefit that is cost controlled and very versatile.  The American Dental Association has endorsed these plans and will assist you in setting up the system tailored to your business.
If you are thinking of getting a plan, check with your dentist and have the staff explain the details of the insurance you are considering.  They can sort out any confusing details so that you understand what you are buying.
A note about individual insurance plans.  When insurance companies sell policies to large groups, the expected usage is about 50%.  That means that half the people with the insurance never use it even though the premium has been paid.  When individuals purchase insurance by themselves, they usually have an intention of using it and the utilization borders on 100%.  The companies are in the business of earning a profit, and so the premiums for these policies make it very difficult for the insured patients to recoup their expense in most years.  You are usually better off just paying for your dental work directly.

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