Dental Insurance 101

November 20, 2019
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For many families in our practice, the time for open enrollment regarding your health and dental insurance is upon us! We are thrilled that so many of you call our office to get an idea as to what might make the most sense for your family. We are always here to help and are grateful to you for inviting us into your decision making process! We thought it might be helpful to offer some points to consider when you are considering what your options may be for dental benefits for your family.

What are 'dental benefits'?

Perhaps the place to start with this answer is to help accurately describe WHAT dental insurance actually is. Unlike medical (or life or home or auto…), dental insurance is truly nothing more than a ‘discount plan’ to help offset the cost of dental treatment. It essentially has a maximum payment amount (ranging from $500 - $2,000 depending on how the plan was set up). As you receive treatment, the insurance company may pay out a portion of the cost to help reduce your responsibility, up to the annual maximum amount. We always encourage families to reflect on whether dental insurance is the best approach for their families’ needs – we know there are other options available (e.g., Flex Spending Accounts, Health Savings Accounts, Membership Plans, etc.) and would be happy to discuss those with you.

Do I always have to see a dentist that is 'In Network'?

Happy to report that most insurance plans offer two categories of benefits - In-Network and Out-Of-Network. That means that you can be seen by a dentist that has either decided to contract with the insurance carrier - or has decided not to contract and is termed 'Out-Of-Network'. Again, most plans have benefits available for both categories! It's important to remember that the choice of where you wish to bring your children for care ALWAYS resides with you! We work with many, many, many families that exercise their Out-Of-Network benefits at our practice - and many who have In Network benefits. If you have any questions regarding your plan, please don't hesitate to contact us and we can help you explore your benefits.

Is dental insurance always the best approach?

Not always! Many families are unaware that they may have the option to forgo dental insurance entirely and instead leverage a Flex Spending Account or a Health Savings Account. In addition, there are Membership Plans that are available to you (one of which we will be rolling out in our office so stay tuned!). If you wish to discuss what options may make sense for your family, please don’t hesitate to contact our office! Know that most dental disease is preventable. If your family follows the principles of disease prevention, your children may not need much more than preventative services (i.e., exams, cleanings, fluoride, x-rays, sealants, and diagnostics). If your family is able to embrace these prevention principles, it may not make sense to spend the money on dental insurance – we are happy to help explore other options for your family so please give us a call!

How can I learn more?

The American Dental Association (ADA) offers a series of very short articles on their website that we think you might find helpful as you weigh your options. Here are a few links:

o What's the difference between 'dental insurance' and 'dental benefits'
https://www.mouthhealthy.org/en/dental-care-concerns/insurance-vs-benefits

o Do I need a dental plan?
https://www.mouthhealthy.org/en/dental-care-concerns/do-i-need-a-dental-plan

o In addition, we wanted to share an interesting NPR Podcast/WGBH article - Why Aren't Dental Benefits Typically Included with Health Insurance?
https://www.wgbh.org/news/local-news/2019/11/20/why-arent-dental-benefits-typically-included-with-health-insurance?fbclid=IwAR0iUI50DCYMORWag9RJwDBV7PtJdIjQr2HzDu3YlgVzBy3g4PZbu2xQVzg%E2%80%8B

We hope you find this information helpful! As always, if you have questions or think we can be of help, please don't hesitate to give us a call!

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