Many consumers are confused by the difference between dental insurance and a dental plan. Both are geared towards making dental care affordable, but they do it in very different ways. You should understand the features of insurance vs. a dental plan, especially if you are seeking and paying for your own coverage rather than getting it through an employer.
Dental Insurance Features
Dental insurance pays for various services at a designated percentage. For example, it might pay in full for preventative care, but it might only cover 50 percent of a larger service like a crown or bridge. Coverage levels are spelled out in the insurance plan details; the patient must pay the difference if a dentist charges more than the covered amount for a specific procedure. The insurance company is billed and usually makes its payment directly to the dentist. The patient then pays for any remaining balance, explains DentalInsuranceHelper.com.
Dental insurance usually has a deductible. This is a set amount that must be paid out-of-pocket before the coverage takes over. It could be a minimal amount, but it can also be hundreds of dollars, depending on the insurance terms. Dental insurance is paid for by a premium, which is often covered by a person's employer, although individuals can purchase their own insurance as well.
Dental Plan Features
Dental plans require payment of a membership fee, which typically includes an enrollment fee and monthly dues. In return, participants receive set discounts on dental services if they go to a dentist who participates in the plan. The usual discount is around 30 percent, according to MSN Money. Dental plans may also give discounts for cosmetic dentistry that is not generally covered by insurance plans. A dental plan is usually purchased directly by the consumer, although some employers offer them as a benefit in place of an insurance plan. The employer might pay the entire membership cost or offer it to employees at a discounted rate.
Benefits
Dental insurance is beneficial because it significantly reduces the amount of money a consumer pays for dental care. It often pays 100 percent for checkups and preventative care, which encourages people to take care of their teeth and head off more extensive problems. It makes major work more affordable, since it will typically pay half of the bill.
Dental plans are beneficial because they can make dental care affordable for people who do not have insurance, states DentalInsuranceHelper.com. The patient can count on receiving a discount and knows the cost of the procedure upfront. Dental plan premiums are often affordable for those who do not get coverage through an employer.
Limitations
Dental insurance normally has annual limits on the total benefits it will pay out. The patient is responsible for paying any amount over the limit incurred during that year. The limit resets itself in the next calendar year. Dental plans do not typically have any limits because the plan itself is not paying for the work.
Warning
MSN Money warns that dental plans are not regulated by any state entity. This increases the likelihood of fraud by illegitimate companies. Get plan details in writing and check out the company with the Better Business Bureau before signing up. You should also review a provider list prior to enrolling in a dental plan to make sure there are several participating dentists in your area. Otherwise, if there are only one or two providers, your plan will be virtually useless if they close or move their practices.
