There are many types of family dental insurance, and each may help lower costs provided the terms of the insurance plan actually cover dental services needed. Insurance may be purchased privately, and is still more available than health insurance and less expensive, but it’s often a benefit of working where it tends to cost much less. How much people pay for family dental insurance in the private market is likely to depend on the services and coverage available. The good news is this form of insurance will cover a whole family (usually parents and children) at one price.
Some of the most common types of family dental insurance are structured like health maintenance organizations and preferred provider organizations (HMOs and PPOs). In a dental HMO, each family member has access to a network of provider dentists. They may see only these dentists for dental needs and specialist dentists like orthodontists (if orthodontistry is offered), endodontists, periodontists or others may only be accessed through referral by the main dentist. People in the plan may each have to designate a primary dentist, though each member of the family could have different primary network dentist.
PPO family dental insurance is usually slightly more expensive, both for premiums and for dental costs. It also has a network of dentists, but people can choose to use any dentist and self –refer to specialists, though they will pay more for doing so. It’s worthwhile to use network dentists whenever possible because percentage of redemption for services can drop significantly for out of network dentists. Not only is this the case, but also network providers have agreed to certain prices while out of network providers don’t. Any charges an out of network provider bills that are above customary and standard charges as determined by the insurance company are the responsibility of the customer.
There can be other permutations of family dental insurance that operate in different ways. HMOs and PPOs usually don’t require a lot of paperwork, but some dental plans may ask members to submit claims and get reimbursed for part of the cost. This may mean paying the whole claim upfront if a dentist is unable to wait for payment. Another type of dental plan is a discount plan, which really won’t cover any of the costs but might give people discounts when they visit dentists who participate. This still leaves a lot of dental expenses in the hands of the family.
Types of coverage in family dental insurance are varied. Some plans will cover 100% of certain services like x-rays, simple fillings, and teeth cleanings. There may be a yearly deductible per person and per family that needs to be paid before any coverage takes place. As services get more complicated, dental insurance pays less.
It is not unusual for people to pay at least 50% of complicated tooth extractions, root canals and crowns. Orthodontic services, if even offered, may have a lifetime maximum benefit of about $1000 USD, which in today’s market is only about 15% of the cost of braces, or less. Plans may also have yearly maximum coverage limits and lifetime total maximums, which can be easily exceeded. Those with a plan with a lifetime maximum that may be close to being reached might want to start looking for a new family dental insurance provider.
