By Susan Braden
Healthcare can be a funny thing: just about everybody needs it at some point, but almost nobody actually pays the full cost out-of-pocket. Many medical procedures cost thousands to hundreds of thousands of dollars, and uninsured people can suddenly find themselves stuck with a six-figure hospital bill with no hope of paying it off.
It is fairly common for employers to provide a health plan for their employees, and we have programs like Medicaid and Medicare that, in theory at least, exist to cover those sectors of the population who cannot otherwise afford healthcare.
Even if you have an excellent healthcare plan, there is a good chance that your accompanying dental plan is not nearly as comprehensive. Although dental care is indeed a part of good overall health and just as important as regular checkups with a medical doctor, dental insurance plans tend to work very differently.
These plans don't restrict your choice of dentist, and they cover a good portion of the costs. Generally, an indemnity plan will cover up to 100% of the cost of preventative care, like cleanings and checkups, and 50-80% of the cost of more involved restorative procedures like root canals or fillings.
Some dental plans are classified as indemnity plans. While an indemnity plan may be the closest thing to “full coverage” you can find, it comes at a price -- extremely high premiums and limiting maximums each year that nearly ensure your carrier will receive more money from you than it will pay out to your dentist in claims.
Once you get beyond basic care, however, indemnity dental insurance is not as effective. You might have to deal with waiting periods for complex procedures, and no one wants to wait when they urgently need a filling or extraction. You'll still have to pay a deductible, and most plans will only pay what they deem the Usual, Customary and Reasonable, or UCR, cost. Anything over that amount must be paid by the patient out-of-pocket.
Also, many of these plans include a low-level cap on how much they will pay in a yearly period, usually $1000 to $1500. That's more than enough for basic cleanings and such, but even one crown or other emergency can easily exceed that limit.
Many employer-offered plans fall into either the Preferred Provider Organization or Health Maintenance Organization model. Both have their drawbacks, however: HMOs restrict you to a relatively small group of dentists while PPOs often require higher premiums than other alternatives. And again, for more complicated procedures, you may still find yourself responsible for a substantial portion of the bill.
Another alternative to dental insurance is a discount plan. This can be a great option for those of us who might tend to shy away from regular dentist visits due to cost. Instead of dealing with claims, paperwork and the wait time for an insurance company to pay the bill or reimburse your payment, these dental plans allow patients to purchase care directly from the dentist at a steeply discounted rate.
A discount plan can truly be an economical choice for many patients, but it is definitely the best choice for mouths that need a lot of work. Some people just have weaker teeth, and others, whether out of an irrational fear or a tight budget, avoid the dentist until the situation has simply grown too severe to ignore.
In cases like these, when a patient might need multiple serious procedures within a few months, a traditional dental insurance’s $1000 dollar maximum is not going to last long. A discount dental plan, however, can continue to provide patients discounts for as many eligible procedures as they need, without maximums or other limits of traditional insurance.