What to Consider When Choosing a Plan
There are various factors entailed in choosing a health plan. This section will highlight some of the areas you should consider.
What to consider when choosing a Dental plan
Cost of Coverage
Some people feel the cost of coverage is the most important factor, but you should also consider the out-of-pocket costs for care. Traditional indemnity dental plans generally cost more because they do not limit your choice of provider. DMOs generally have low co-payments and no deductibles where Traditional dental plans pay a set percentage of "Usual, Customary and Reasonable" (UCR) fees. Traditional Indemnity plans sometimes use a benefit reimbursement schedule. This type of plan determines the covered services and set dollar amount that the plan will pay for each service. This is usually less than the dentist's total charge which leaves you to pay the difference.
Freedom to See Any Dentist
Dental Maintenance Organizations (DMOs) generally restrict care to limited lists of providers. This means that your ability to see the dentist of your choice may be restricted. With DMOs, you select a member dentist to be responsible for all your dental care. In some cases, your member dentist will refer you to another network dentist for specialty care. Your current dentist may already be a member of a dental network. Call the plan's customer service number to request a provider directory. Of course, you can always go to the dentist of your choice, even if he or she is not a member of the plan's network of participating dentists. However, under these circumstances, you'll generally be responsible for paying for your treatment out of pocket. Dental Maintenance Organizations (DMOs)) generally restrict care to specific lists of providers which you must use. DMOs usually require you to select a dentist to be responsible for your primary care. You would not have the freedom to choose any doctor. If you would like to select your own doctor and facility for treatment you will need to consider a Traditional Indemnity dental plan.
Geographic Restrictions
In general, DMOs do not provide coverage to members seeking service outside of the plan's service area, except in an emergency. You’ll want to consider the service area, when you have dependents living outside the area or if you travel a lot. Typically, Dental Indemnity plans will treat the care as any out-of-network service, which generally at a higher expense to the patient. make sure to select a dentist whose office is easy to get to from your home or work and whose office hours are convenient.
Exclusions
Dental plans often require a process called pre-treatment review. The dentist will estimate the total cost of the treatment before providing services. This allows you and the insurance company to review the proposed treatment and estimated costs before your treatment begins. With this information, you can determine your budget or possibly decide on a less expensive treatment.
Orthodontia Benefits Orthodontia benefits differ from plan to plan. Some do not cover adults, or they differ in the amount of benefits paid per lifetime for each covered person. Generally, DMO plans do not have a lifetime maximum while traditional dental plans may range from $1,000 to $1,500.