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Dental Plans vs. Dental Insurance - What's The Difference?

Dental plans and dental insurance are dental coverage options that offer affordable dental healthcare for everyone from individuals to large business groups, so they can enjoy the benefits of a beautiful, healthy smile. With all the different options available, it can be confusing to decide which dental coverage type to go with. Some charge a high monthly premium and offer limited dental services, while others offer an affordable monthly fee to pre-selected dental group networks. This is where the selection process becomes important. A consumer must educate themselves on the differences between dental plans and dental insurance in order to choose the best dental coverage for their dental care needs.

Dental Insurance

There are three main types of dental insurance available. HMO dental programs require patients to choose an oral health care professional that is contracted within their dental group provider network. If you are referred to a specialist outside of their network those costs may not be covered by your insurance, resulting in high out-of-pocket expenses for you to pay. HMO dental programs have limitations on preventative oral health care visits and maximum allowance coverage. These programs are less expensive than PPO programs, but quality care and the complex paperwork involved with referrals and claims often becomes an issue.

For a higher monthly premium, PPO insurance programs allow patients to choose from a wider network base of dental professionals. (However, like HMO plans, PPOs require a large amount of paperwork involved in order for you to see the savings.) This leaves patients with the entire bill until everything is completed and accepted by the PPO provider.

Dental indemnity insurance works on a per service basis. The patient sees the oral care professional they want and pays them directly. Then, they need to fill out claim forms and submit them to their insurance provider.

A majority of indemnity providers base their pay on a standard fee guide (Usual, Customary, and Reasonable or UCR). This means they set up a maximum amount that they will pay for each procedure. If you have a cleaning that costs $200 and the dental professional says their fee guide states it only costs $60, the $140 difference the dentist charges will come out of your pocket. This combined with the high monthly and annual fees and long wait times for reimbursement can make indemnity insurance expensive.

These three insurance plans may also have special clauses in their coverage that limits what they will cover. Like medical insurance, many of these coverage plans will not cover anything that existed before you signed your contract. This means replacing a tooth that had been pulled previously or even treating things such as tooth decay or broken dental work such as bridges will not be treated.

Dental Plans

The first thing you will notice about dental plans is the significantly lower annual or monthly membership cost. This form of dental health care coverage charges an annual fee equivalent and often less than a monthly insurance premium. These plans, in some cases, can also be used with existing insurance coverage to further lower your overall dental costs.

The benefits it gives you are significant discounts on dental services provided by its group of dentists and oral care professionals. These plans often save you between 10% and 60% on most dental care services. One main reason you receive significant savings as a member is because the group of dentists have agreed upon providing quality dental care at reduced fees. They get paid directly and bypass dealing with claim forms, waiting periods, and certain limitations and exclusions. The savings is instant on both sides with no maximums and restrictions to treatments you can receive.

Unlike insurance coverage, anyone is eligible for the plan. There are no set requirements or exclusions in order to sign up for the plan. Another difference is that dental plans do not require you to wait one to three months in order to qualify for the full benefits. In fact, most plans take no more than a couple of business days for an application to process and become effective. With some plans, the only restriction is that you must visit a dentist inside of their network group.

Dental plans and dental insurance might appear the same at first, but the differences will be noticed in your smile and your wallet. Be sure to consider both options to ensure you and your family get the care they need at a price you can afford before making the final decision.

About Southwest Dental Plan

Southwest Dental Plan is a leading dental program in the state of Arizona delivering high-quality, affordable dental health care to individuals, families, seniors and small businesses. To learn more about becoming a member of Southwest Dental Plan, visit www.southwestdentalplan.com or call 480-619-5790.