Dental-Determining your Coverage Needs
The below information will provide insight on choosing a medical plan based on your family status.
A Young Single Employee
Young people often do not have concerns with a limited provider directory as they do not have an established dentist. If you do not have dental problems, you may be better off choosing a lower cost plan such as a Dental Maintenance Organization (DMO). However, you should consider out of pocket expenses that may occur. Typically, most dental plans offer preventative care services like routine cleanings but at different frequencies.
An employee with Young Children
Orthodontia is one of the most frequent expenses for families. The maximum allowable benefit per lifetime and in how benefits are paid may differ between plans. Some plans may limit orthodontia treatment by requiring a separate deductible and imposing annual or lifetime maximum benefits. You should also consider whether the plan allows a pediatric dentist for your children.
An individual with frequent dental problems
If you or a covered dependent have significant dental expenses, the plan with the least amount of out-of-pocket costs may be the best choice. It’s also important to review the provider list to ensure the established physicians are on the plan. Typically, people with chronic dental issues tend to select plans with freedom to choose your doctor. Also consider how much the plan pays for diagnostic, preventative and emergency services.
An individual with established dental providers
Consider whether your dental providers are included in the Dental Maintenance Organization (DMO) network. If not, a traditional dental plan that allows freedom of choice of dental providers would make sense as long as you could afford this option.
An employee with a dependent living away from home
Most managed care plans (DMO) only provide emergency care for a student away from home. Since your dependents must be on the same plan, you may need to consider a plan that offers freedom to choose your doctor. A lot of colleges also offer separate coverage just for students.
An employee whose spouse also has dental plan coverage
It’s best to base your decision on which coverage is best by comparing the types of coverage available and the costs. If one employer offers plans that provide more choice of higher employer contributions, the employee may prefer one above the other. You should confirm whether or not the employer’s plan has any requirements for the spouse to take their coverage or pay a penalty.
You should consider that joining a managed care program (DMO) is usually a one-year commitment. If your employer offers other plan options, you can switch health plans during open enrollment or if you move outside a plan's service area. If you are healthy and would like a lower cost plan you should consider a managed care plan to see if it fits your lifestyle.
A concern for some people is the issue of "capitation."
Capitation is when the Dental plan pays a fixed amount of money to a provider each month per covered member. In return, the dentist must provide all care that is necessary. Some people believe this is an incentive for the dentists to withhold care. Proponents say that this payment method provides more efficient care by emphasizing preventive care.