By Dean George
Have you ever thought about how shopping for a dental plan is like shopping for a car? A new car, that is; we don’t offer pre-owned insurance plans and would discourage anyone from enrolling in one.
If you haven’t thought about the new car/dental plan analogy, that’s okay; it’s our job to think about these topics to share with you.
What really got us thinking on this topic were the comments and emails we receive from people writing, “I need good insurance,” or “I’m looking for dental insurance that covers a lot.”
Imagine walking into a car dealership and telling a salesman, “I need a car” or “I’m looking for a car that goes really fast and has a loud horn.”
Whether shopping for a dental plan or a new car, it’s always best to think about the features most important to you. For instance, if you’re shopping for a car but have never driven a stick shift, you’re most likely shopping for a car with an automatic transmission.
Or if you live in a humid climate where the only climate change you know is sticky warm and sticky hot, a car with a reliable air conditioner isn’t a luxury, it’s a necessity.
Likewise, if you have an immediate dental need like a painful tooth or a broken crown, you’re not going to be satisfied with a plan that has a 6-month waiting period. Or if you have a favorite dentist, you want to confirm he/she accepts the plan you are considering before you enroll.
As far as I know, there is no DentalPlanTrader or TRUEDental; so below are six keys to consider before enrolling in any dental plan:
Immediate Need – Can you wait a short time before seeing a dentist, or do you need help ASAP? Both HMO’s and discount dental plans have no waiting periods. Dental Insurance Store has one discount plan, Patriot Premier, with a next day effective date. Generally, the first question asked when inquiring about a dental plan is whether or not a caller has an immediate need.
Effective Date –You know the food labels that read, “Best if used by?” With dental plan effective dates, the plan cannot be used until the effective date. Effective dates vary from plan to plan, and the effective date is determined by when you enroll in a plan.
Effective dates are generally the first of the following month if the completed application and initial payment are received by a specified date like the 20th. Let’s say you awoke with a throbbing tooth and are looking to enroll in a plan today, June 25th. You find a PPO plan with a July 1st effective date, but there’s a waiting period for fillings and an even longer waiting period for extractions!
The next plan you look at is an HMO plan, but the effective date is August 1st. With a throbbing tooth, the effective date may as well be in the year 2020. If you enroll in a discount dental plan and use a participating dentist, your toothache could be a not-so-fond memory in just a couple of days.
In-Network/Out-of-Network - If you have a favorite dentist or live in a remote area where the nearest dentist is “down the road apiece,” meaning 200 miles as the crow flies, you may want to consider a PPO plan that allows you to go in or out-of-network. PPOs, such as Delta Dental or Renaissance Dental, have larger networks than most HMOs; both of which are accepted at more than 114,000 dental locations.
Annual Limit or Yearly Maximum Some dental plans like PPOs restrict the amount they will pay in a calendar year ranging from $1000 to $1500. If you think the ol’ pie hole is going to require some major remodeling (root canals and crowns, dentures, implants or orthodontia), you will want to look at HMO plans with no annual limits like Humana, Dental Health Services, PrimeCare or Healthplex. Discount dental plans like Dominion Dental Services and Patriot Premier also have no limits on what their plans will pay.
Deductibles – PPO and indemnity plans often have deductibles. There are two kinds of deductibles: annual deductibles and lifetime deductibles. As previously noted in Agent Straight-Talk, an annual deductible is a fixed amount you must spend out-of-pocket before your plan benefits begin. A lifetime deductible only requires you to pay it one time as long as you have your plan and uninterrupted coverage.
Dental plan deductibles work similarly to those in auto insurance, but deductibles on the former are generally just $50 to $100, compared to $500 to $1000 for the latter. Deductibles are pretty straightforward. Plans with deductibles generally pay 50% to 80% for covered procedures once a deductible is met.
Waiting Period – Does the plan have a waiting period? Indemnity plans and PPOs have waiting periods. As previously reported in this space, a waiting period is the period of time in which the insurance company will not pay for specified procedures. Why do plans have waiting periods? Waiting periods prevent people from dropping coverage immediately after getting an expensive procedure done. Without waiting periods, insurance companies would have less money to pay for other members’ oral care, including those members who may have been paying premiums for years.
Waiting periods are one-time only for as long as the member has a plan, and they generally apply to more costly procedures like root canals and crowns. Most dental plans have no waiting period for diagnostic and preventive services.
We may not have any dental plan showrooms or annual dental plan shows, but we invite you to kick the tires of any of our dental plans after enrolling during a 10-day free look period. To browse plans available in your area click here.
Thanks for reading Agent Straight-Talk, and for more dental chatter that matters, follow us on Facebook, Twitter, Pinterest, Google+, and LinkedIn.
Photo source: assets.cobaltnitra.com
Copyright 2015, Bloom Insurance Agency, LLC