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Shopping for dental plans

The basics of shopping for a dental plan

Getting quality, affordable dental care can be difficult. It’s important to decide what matters most to you in making the best decision for you and your family.

Start by collecting old statements from your dentist or insurance company to get an idea of how much you spend on dental care each year. Think about additional expenses that might come up this next year – do you have a child who needs braces? Ask your dentist for cost estimates. Use this information as you answer the following questions, which will help you compare dental plan options:

9-point checklist for dental coverage shopping

1. What is the monthly premium for dental plan?

The premium cost is just one part of the total costs of your dental care. This amount varies depending upon the level of benefits provided by the plan. For example, a plan with a low deductible (e.g., $50) and a high annual maximum (e.g., over $1,500) would likely have a higher premium than another plan with a high deductible and a lower annual maximum.

2. Which dentists participate in the dental plan’s network in my area?

Consider how important choice of dentist is to you. It may be worth it to pay more in premium, coinsurance and other costs if it means you can keep your current dentist. If you’re choosing a new dentist, be sure there are conveniently located dentists in the network who offer the services and specialties you need.

3. Is my dentist in the dental plan’s network?

If your dentist is not in the plan’s network, are you comfortable changing dentists? You will probably pay more out of pocket if you choose a dentist who does not participate in a plan’s network.

4. How much will I have to pay if I see a dentist outside the dental plan’s network?

Some plans do not cover any charges from a dentist outside the network. Some will cover emergency care and others may covder a portion of the charges, but typically less than if you chose an in-network dentist.

5. Is there a dental plan deductible and how does it work?

If your plan has a deductible, you usually have to pay the deductible amount towards this care before the dental plan pays anything. After that, the dental plan will pay the percentage of the cost specified in your plan benefits for different services (for example, 80% for routine cleanings).

Some plans exclude certain services from applying towards the deductible, such as routine exams and cleanings. This means the plan would pay its share, even if you haven’t met your deductible.

Estimate your portion of the payment for any services your family needs (e.g., one crown a year, two fillings, etc.) in a year for each plan you are considering, factoring in the different deductibles offered by each plan.

6. Is there a maximum amount of coverage allowed each year for the dental plan?

The maximum amount is the total amount of dollars the dental plan will pay out for services you or your family receives. There can be different maximums: an annual maximum for most services, and a lifetime maximum which often applies for services such as orthodontia (e.g., braces).

Compare your estimated dental expenses to the plan maximums and consider the other costs: premium, deductibles, and coinsurance – how much will you pay combined?

7. What is the level of coverage for the dental plan?

Compare the copayment amounts or coinsurance percentages for each plan against the kinds of services you think you might need.

8. Are there waiting periods for certain dental procedures?

Some plans have a waiting period for certain types of dental treatments. For example, you might have to be covered for six months before you are eligible for orthodontic coverage. Think about the services that you may need this year – are you comfortable with having to wait for treatment?

9. Which dental procedures are covered?

Review the limitations and exclusions of each plan to make sure the procedures you might need are covered. If not, consider the out-of-pocket cost when comparing against a plan that does cover such treatments.

In general, it’s easiest when you can prioritize what matters to you most: affordability, breadth of coverage, or choice of dentist. Knowing this will help you determine the best benefit plan for your needs.

Use our print-friendly Plan Comparison Checklist to compare your options.

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