It’s a fact that getting dental work done can be expensive. Even the most basic care can eat away at your budget. Without acquiring specific health insurance, you might land up living with unhealthy gums and painful cavities.
However, not all plans are equal, and sometimes you might have the coverage and still need to pay. Find out all you need to know about dental health insurance below.
Does Medicare Cover Dentistry?
If you have Medicare, you might assume that you have Part B dental coverage. But this is an incorrect assumption. Strictly speaking, there isn’t any coverage for routine dental services.
There are allowances for specific hospital procedures for dentistry. For example, if you should ever be in a car accident and damage your jaw, the plan would cover particular services. It would include any reconstruction or treatment of your jaw related to the incident.
If, however, you need complex dental surgery that must be performed in a hospital, Medicare will cover the hospital but not surgery. For the more comprehensive coverage, you’ll need to have Medicare Advantage or what’s known as Part C.
These are private plans, and many offer routine preventive care such as cleanings, regular checkups, and X-rays. They may also have some coverage for extractions, root canals, crowns, fillings, and other non-emergency treatments. Various options provide partial or full payment for dental procedures.
Dental health insurance varies widely across providers and plans. It would be best if you read up on each package to understand better what it covers. Although individual features vary between policies, the most common fall into the following categories:
Direct Reimbursement Programs
It’s a program designed to reimburse the patient a set percentage of the total amount spent on dental care, regardless of the treatment. There aren’t any exclusions based on the type of care needed, and it allows patients to go to their preferred dentist.
The plan also provides incentives for the patient to work with the dentist towards healthy and cost-effective solutions.
The UCR Plan
This “Usual, Customary, and Reasonable” package lets patients use a dentist of their choosing. The provider gets paid a set percentage of the fee or the plan administrator’s “reasonable” or “customary” amount limit, whichever is less.
The limits are listed in the initial plan purchase contract. The downside is that although these limits are known as “customary,” they may not accurately reflect the fees that dentists are charging. There’s very little government regulation on how these prices are determined.
Table or Schedule of Allowance Programs
These plans have a list of covered services and the authorized amount payable for each one. That dollar figure shows how much the policy will pay for those specific options.
The fees are fixed regardless of how much the dentist charges. If there’s a shortfall between what the plan pays and the provider’s rate, you must fork out the difference.
The plan pays contracted dentists a set amount per enrolled family or patient. These charges are made monthly. In return, the provider agrees to give certain treatments at no cost for the specific members.
More intensive care could require patient co-payment. The premium given to the provider may differ a lot from the amount the package offers for the patient’s actual dental needs.
What to Consider When Choosing a Dental Plan
When you’re comparing dental insurance plans, consider the following when deciding if the coverage will meet your needs:
- Do you have the freedom to choose your dentist, or are you restricted to certain providers?
- Who makes the treatment decisions? Ideally, it should be you and your dentist and the dental plan.
- Does the plan cover preventive, diagnostic, and emergency services?
- What routine treatments are covered, and how much of the cost do you pay?
- What are the primary dental services covered?
- What are the limitations and exclusions of the plan?
- Does the policy allow referrals to specialists?
- Who is eligible for coverage, and when does it go into effect?
Your dentist won’t know the answer to any of these questions; you’ll have to speak to your broker or insurance company.
Having problems with your teeth and gums isn’t a pleasant experience. Regular checkups to your dentist will help pick up issues early, which can be treated before they get worse. If you’re looking for dental coverage, you’ll need to get specific insurance since Medicare doesn’t offer routine care.
Study each plan carefully as they differ with regards to how each pays the providers. When comparing packages, ask some of the questions listed above to narrow down the perfect plan for you.