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Dental Insurance Guide - How to choose a dental insurance

dental claim form

Why you need a dental insurance

Some toothaches are described as the worst pain a human might suffer. Immediate toothache pain relief is something you will definitely seek if it happens to experience such a tooth pain. Although in many cases only the dentist can provide the treatment for the toothache, several remedies can help relieve some of the pain, especially if you can not visit the dentist immediately.

Know your needs - What dental insurance you need?

It is very difficult to say which dental insurance policies or dental discount plan is the best. Not everybody has the same kind of problems or needs the same amount of dental care. If you have kids you have to consider their needs too. If you already have experienced severe dental health issues your needs are different from one that has no dental problems. All these should be taken into consideration before you choose a dental insurance plan.

Know your options - Research dental insurance plans

  • Check which dental insurance providers are available in your area.
  • Check which providers offer the type of dental insurance plan you need.
  • If an insurance plan is provided only through its own network of dentists, check the availability in your area.
  • Ask for details on which dental procedures are covered. You will need to have a clear view on each policy's terms before you choose.
  • You should compare several dental insurance policies so that you get the best value for your money depending on your own needs.

Choose a Dental Insurance - Evaluation

There is a large number of factors that can affect your choice of a dental insurance plan. The importance of each factor should be based on your individual needs. Some of them may be more or less important for you than for someone else.

Monthly premium

The cost you have to pay for your insurance is always important. Make sure that the fees for your dental insurance can fit in your monthly budget.

Treatments covered

All normal dental procedures, such as 6 month cleanings, gum disease and tooth decay treatments such as tooth scaling, dental fillings, root canals, in-depth check-ups, x-rays should be fully covered under your plan. Most insurance plans do not cover cosmetic dental procedures. Other procedures like braces may be covered from some policies but up to a certain limit. Coverage of certain procedures such as implants and braces may justify a higher monthly premium. Learn exactly what is covered before making your decision.

Maximum annual limit

The majority of dental insurance plans cap the amount of reimbursement to an annual maximum that is usually $1,000 to $1,500 per year. You will be responsible for any costs beyond that amount. Some insurance providers offer special plans with higher annual limits up to $3,000, which despite their higher premium may be more suitable for individuals with bad dental health. Some plans have a limit not only in the amount covered but also in the number of certain procedures allowed per year.

Deductible

Usually, insured individuals must meet their deductible before the dental insurance company begins to cover their dental care, so the cost of deductibles should be considered when calculating the overall costs associated with dental insurance. Annual deductibles can vary from $25 to $50 per covered individual, depending on the dental insurance policy.

Waiting period

Dental insurance plans have exclusions on pre-existing conditions or impose long waiting periods from 6 to 18 months before paying for major dental treatment. This could be a serious problem if you need some serious dental work in the near future.

Special terms

UCR (Usual, Customary & Reasonable) indemnity dental insurance plans will check the cost of your treatment against the average cost from other similar treatments in their database. If the cost of your treatment is lower than average you will receive the agreed percentage of the amount you paid. If you paid more than the average you will have to pay the additional cost on your own.

Choice of treatment

The most common clause used by dental insurance companies to allow them refuse to pay for expensive treatment that you may need, is a term called “least expensive alternative treatment” (LEAT), also known as the least expensive professionally acceptable treatment clause. Under a LEAT clause, when there are multiple viable options of treatment available for a specific condition, the plan will only pay for the least expensive treatment alternative.

Choice of dentist

Make sure that the dental insurance plan allows you to choose your dentist. Many plans will force you to choose one of the dentists participating in their own network. Even though insurance providers claim that they work only with the best quality dentists, you might not feel comfortable with the proposed dentist.

Family members covered

If you have a family you should choose a family plan. Ask how the various restrictions (deductible, annual limit etc) are implemented; by individual member or in total. If you have children check if fluoridation, sealants or braces are covered by the dental insurance.

Paperwork

Nearly all dental insurance policies will request you and your dentist to fill a number of forms, every time they have a claim. Ask for more details if you want to avoid a time consuming claims process.

Tips & Warnings when Choosing a Dental Insurance

  • Cheapest is not always cheap. Keep in mind that the lowest price is not always the best price. Never choose the lowest cost plan before examining all the other factors described in this page.
  • Plan for the future 1. Kids will most probably need some kind of orthodontic treatment. Make sure that you get the proper dental insurance coverage before it's time to use it.
  • Plan for the future 2. If you have a history of dental problems, expect more with aging. Get on time the best dental insurance you can afford with broad coverage e.g for dental implants.
  • Do not start any special dental treatment before you check your dental insurance's coverage. Don't hesitate to phone them for clarification if you are in doubt.
  • Dental treatments covered by a dental insurance plan will vary from policy to policy, but there is usually a general rule that excludes cosmetic dentistry procedures.

A good dental insurance policy can help cover the costs of dental treatment whether it be an emergency or a routine check up, meaning you never have to worry about the cost of keeping your mouth, teeth and gums healthy.

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