Posted January 13, 2014
Most Americans like to compare several options before making decisions, especially when considering insurance benefits. When reviewing dental plans, the components may look the same on the surface, but in reality each one is designed differently. Consider the following guidelines about how to compare dental plans for adults. For information about pediatric dental under the Affordable Care Act, read What are Pediatric Essential Health Benefits?
Identify Dental Plan Differences
Review the following categories and ask the questions listed to recognize the differences in plan designs:
- Deductibles and maximums – If the plan has a deductible, when does it apply and what is the amount? Is there a maximum amount that can be charged per family? What is the annual benefit maximum available per year? If orthodontia is included, what is the lifetime benefit?
- Coinsurance and copayments – What is the coverage in and out of network? For Participating Provider Organization (PPO) network plans, know what percent the plan pays by procedure category, typically stated as Preventive/Type 1, Basic/Type 2 or Major/Type 3.
- Frequency limitations – How often can each type of X-ray be taken? How many cleanings are permitted per year? How many years are allowed between crown replacements? For example, one dental carrier may approve replacement of crowns every five years, while another may extend the limit to 10 years.
- Location of procedures – In which category do common procedures fall? Carriers can move procedures, such as X-rays, endodontics (root canals), periodontics (gum disease treatment) or oral surgery, into different categories of coverage that offer different benefit levels. It is crucial to know whether these procedures are classified as Preventive, Basic or Major, as this is likely to impact rates and out-of-pocket costs.
- Waiting periods and participation – What procedures require a waiting period before new subscribers can access benefits? How much time is required before these services can be accessed?
- Network access – If the plan design includes a PPO dental network, are there enough contracted providers to serve subscribers in your market? Ask how the carrier defines access points, providers and locations.
- Extra benefit services – Does the plan cover dental implants? What about composite fillings in molars? Are adults eligible for orthodontia coverage? Some plans also offer carryover maximums and dental coverage with vision, hearing or prescription benefits. Know what extra incentives are built into the plans that increase value.
Evaluate Dental Choices
Take time to analyze dental options to find the plan that will best meet anticipated individual or family oral health needs throughout the year.
To learn more about dental benefits and the Affordable Care Act, visit www.ameritasgroup.com/reform.