How to Choose the Best Dental Insurance Coverage for 2016

Even as your current dental insurance expires this December, you should be thinking ahead and discussing upcoming dental needs with your dentist. Often, the dentist is already preparing a treatment plan to send to insurance that you can use to choose the best benefits program. A great way to do this is to use your second dental exam for the year toward the end of it. By doing so, you’ll make the wisest decision on what sort of dental insurance will cover your costs and be the most beneficial for you and your family members. Let’s take a look at some terms you need to know, things to be aware of, and a few questions you should ask yourself before you pay that first deposit or premium for 2016.

Contact your Employers Human Resources Rep

If you received benefits through your company or employer in 2015, you should have received a dental insurance plan with all the details about your coverage. Benefits should have been clearly laid out, limitations or exclusions have been clarified, deductibles and copayments should be listed, and any other factors explained. It should also show who in your family is covered and start/expiration dates for the plan. Can’t find the paperwork? You HR person should have a copy.

Most plans cover two cleanings per year, X-rays and fluoride treatments at no extra cost. Other services are usually divided 50/50 with the insurance company and patient, hitting the preset maximum payout of your plan.

Once you know what this year’s plan looks like and have discussed next year’s needs with your dental professional, you’ll know if you’ll need a plan that covers more dental work. Then you can ask the HR rep about alternate plans.

Please note that while you dentist may be a part of an insurance network and bill them for work done, he or she doesn’t know the ins and outs of your dental plan.

What if my Employer Doesn’t Offer Extension Dental Coverage?

Often, employers only have 1-2 dental plan options. Usually what they offer will be more affordable, but if major dental procedures are needed then it’s worth exploring other options. It will take a little research to figure out which plan will work for your needs. Here are some questions you need to ask yourself before you wade through the options.

• What work do I need done?
• What dental work do my dependents need done?
• How much of a deductible or copay can I afford? A $100 deductible is typical for most individual or family plans. This will depend upon your needs and the insurance company’s policies.
• Is my preferred dentist part of the insurance’s network? If not, considered another plan or a reimbursement plan option. You’ll pay more upfront, but you’ll be more comfortable and that’s important.

Questions to Ask Your Dental Office Staff

In addition to things you need to consider for you and your family before choosing a dental plan, you might also want to ask your dentist admin team a few things. This can make the difference on which plan you choose.

• Do most of my dentist’s fees fall under the insurance company’s UCR plans? The insurance administrators of these types of plans set what it considers a “customary fee” for each dental procedure. If your dentist’s fee exceeds this amount, what they pay will be based on a percentage of the predetermined customary fee instead of what your dentist charges. Keep in mind, this doesn’t mean your dentist is overcharging for the work done. The plan’s fee limit is just preset. So if your dentist’s fees are higher than the plans predetermined numbers, you should expect to pay more out-of-pocket.
• Does Your Dentist Limit Insurance Clients’ Appointment times and days in a way that is inconvenient for you?
• Is the treatment plan your dentist recommends the cheapest option and will your insurance consider it so? Certain dental insurance plans will constrain payment to the most economical treatment of a dental issue, even if another treatment is recommended by your dentist or better for your oral health. The American Dental Association encourages patients to “base treatment decisions on their dental needs, not on their dental benefit plan.” It’s also possible to explain extraneous circumstances to your dental insurance provider but it is not a guarantee that they will change the policy or your benefits to suit the situation. Reading reviews on insurance companies can also help you choose one with high patient satisfaction rates.

Choosing a Dental Plan Can Be Easy

This seems like a lot to take in, but it’s important to know ahead of time how best to approach it. With the above considerations in mind, you’re sure to figure out the best plan to invest in for you and your family. As always, we hope you’ll consider Josey Lane Dentistry if you are in the Carrolton, Texas area. We accept most insurance plans and are happy to answer any insurance questions that we can. Together, we can make 2016 the best year for your oral health!