Most everyone acknowledges that they should have dental insurance. Without it, even the most affordable dental clinic is often too expensive. Yet many Americans still underestimate its importance. Believe it or not, 80% of the U.S. population has some kind of gum disease, which could lead to other, more serious oral complications — such as tooth loss.
However, dental care plans vary more than you’d think, and it’s vital that you understand how yours in particular works, since it affects your coverage and out-of-pocket expenses. Though each plan is different, most have a lot of commonalities and can be categorized. Knowing how your coverage works can help you choose the most affordable dental plan.
In order to help you get these affordable dental services, here are the different kinds of dental care plans.
Direct reimbursement dental care plans reimburse patients a predetermined percentage of their total dollar amount spent, regardless of the treatment’s category. This kind typically doesn’t exclude coverage based on the type of treatments needed, which allows patients to go directly to the dentist of their choice. These dental care plans also provide an incentive to patients to work with the dentist towards healthy and affordable solutions.
Usual, Customary, and Reasonable.
UCR dental care plans usually allow patients to go to the dentist of their choice, but not necessarily all the time. These kinds of plans pay a percentage of the dentist’s fee or the plan administrator’s “reasonable” fee limit — whichever one is less. These aforementioned limits are a result of a contractual agreement between the purchaser and a third-party payer. It should also be noted that there are wide fluctuations and lack of governmental regulation of how these dental care plans determine this “reasonable” fee.
Table or Schedule of Allowance.
These dental care plans assign a dollar amount to a list of covered services. This dollar amount represents just how much the dental care plan is going to cover, regardless of the fee charged by the dentist. There are also certain service that may not even be on the list, which means that they’re completely uncovered. The difference between what’s covered and what’s still owed is charged to the patient.
These plans pay contracted dentists a certain, fixed amount that’s usually based on a monthly basis per enrolled family or patient. In exchange, these dentists agree to provide certain kinds of treatments to patients free of charge. Some treatments may have a co-pay, though.
Dental insurance is paramount to getting the most affordable dental work. Unless you’re willing to pay completely out of pocket, you need to get insurance. If you have any questions about dental care plans, feel free to ask in the comments.