What Makes Dental Insurance Different From a Dental Discount Plan?

What Makes Dental Insurance Different From a Dental Discount Plan?

By Elizabeth Ann West

Dental benefits cover routine care and restoration of a patient’s teeth and gums. Health care plans omit dental benefits like cleanings, restorations such as fillings, and therapies such as root canals or periodontal treatments. There are some instances where a health care plan will cover costs associated with dental care, but only when there is an underlying medical condition causing the dental distress or the dental issue is leading to serious medical problems.

In addition to health insurance, there are two primary ways to cover the majority of your dental needs: dental insurance and a dental discount plan. How can you tell which type of plan you need?

Dental Insurance

Dental insurance requires monthly or quarterly premiums just like regular health insurance. After you have your dental care appointment, your dentist will submit the cost of the appointment as a claim to your insurance company. With everything computerized, your dentist’s office staff will calculate your projected share and ask you to pay your co-pay the day of treatment.

Another benefit of dental insurance is allowable charges. It is important to read your insurance paperwork thoroughly. Accepting your insurance may lock your dentist into only charging up to the allowable charge for a procedure, and he or she cannot ask you to make up any difference.

For example, a dentist may normally charge $110 for a single surface amalgam filling, but insurance only allows $95 for the procedure. If your portion is 40%, you would be expected to pay $38, or 40% of $95. In addition, the dentist cannot bill you for the $15 difference between the normal charge and the allowable charge. Patients must remain vigilant when it comes to billing and checking it against their dental insurance records.

There are restrictions to dental insurance plans. First, pre-existing conditions are rarely covered. So if you wait until your teeth are bothering you to buy dental insurance, your claims could be denied. Also, yearly caps on benefits are common in dental insurance plans. This means your company will only pay a maximum amount of money each year in dental coverage. For example, the current military dependent dental plan has a cap of $1,200 annually for any covered family member.

Dental Discount Plans

A dental discount plan is called a discount plan because the patient only receives a lower price on procedures, but is responsible for the full cost of the procedure after the discount is applied. There are no claims filed, and the cost of dental care is very straight forward.

Patients can purchase dental discount plans online or possibly through their employer. There are individual and family plans, just like dental insurance. However, instead of monthly premiums, the patient pays a flat upfront annual fee to become a member of the dental discount plan. The patient will carry a card similar to an insurance card that has a unique member number the dentist can use to verify membership.

Dental discount plans do not limit the amount of benefit for a patient. If the discount program saves $200 off of crowns, then a patient needing saves $600 in dental care costs. Meanwhile, the dental discount plan could cost as little as $100 annually for an individual, meaning $500 in savings. However, the patient would be the only one responsible for remaining cost of the crowns. Pre-existing conditions are covered with dental discount programs, however previously completed dental work is not. Your dentist will apply the discount to your treatment cost as long as you purchased the membership prior to the appointment.

Dental health is very important as infections and loss of tooth structure can become serious health problems very quickly. Unfortunately, many health care plans only offer dental riders, or dental insurance plans that require a separate premium. For some families, a discount dental plan may be beneficial if the dental plan doesn’t cover very much, or if the premiums are too costly. Overpaying for any insurance is wasted money each year, so everyone should scrutinize their insurance needs and payments at least on an annual basis.


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