Dental coverage in America is an untapped market. According to the American Dental Association (ADA), only 51.3% of children below the age of 18 and 59% of adults have private dental health benefits.
While a majority of the population has dental insurance through Medicaid, not all dentists accept Medicaid insurance. In fact, only 38% of dentists accept Medicaid or Children’s Health Insurance Program (CHIP).
It can get confusing to choose from the various dental plans available.
In this blog, we’re going to talk about the various plans offered in the U.S.
Insurance vs. Benefits
There’s a difference between the terms ‘dental benefits’ and ‘insurance.’
The purpose of insurance is to absorb the risk of patients getting a dental procedure and cover the costs accordingly.
And a benefits plan covers things partially so you won’t be compensated for every dental procedure.
Insurers can be compensated in a number of ways by the insurance company. Some are completely hassle-free while others may require the patients to follow certain procedures to receive the benefits.
The simplest one is the direct reimbursement program, which places a limit on the dollar amount that can be spent by policyholders. It doesn’t matter when and what type of dental procedure you go through, if it’s within the dollar limit, the company will pay for it.
“Usual, Customary and Reasonable” or UCR for short doesn’t restrict patients to selected dentists. They’re free to go wherever they want for treatment. The insurers pay a “reasonable” amount and as there’s no regulation which determines what “reasonable” is. This amount is usually less than what the dentists actually charge.
Allowance programs have a predetermined list of procedures along with their dollar limits.
Capitation programs involve contracted dentists who are paid a fixed amount directly by insurance companies. The patients can receive treatment from the selected dentists free of charge.
Things to Consider
A few things you should consider before choosing an insurance plan:
- Can you choose any dentist in your area or only the selected ones? It’s better to choose your dentist before your insurance plan.
- You may want to check if insurers require the dentist to follow the “cheapest alternative treatment” or not.
- What are the limitations? It can be in terms of the dollar amount or the number and type of treatments.
Make a list of the dental procedures you intend to receive in the coming years and then choose from the various dental insurance plans available to suit your needs.
At Dr. King’s Family Dentistry, we work with major insurance companies who provide their cosmetic dentistry in Virginia Beach. Our staff handles insurance-related queries and conducts follow-ups on your behalf to make sure you’re appropriately compensated. Call us at (757) 453-5498 and schedule an appointment with our orthodontist!