At Southwest Oral Surgery in Glendale, we get questions every day about dental insurance. We know that insurance can often be confusing – it may even seem to be deliberately designed that way!
We also know that informed patients take better charge of their health and have an easier time making decisions, so we’d like to take a few minutes to discuss some of the ins and outs of dental insurance and, hopefully, answer some of your most common questions.
Do you currently have medical benefits through your employer? It may be worth inquiring with your HR department to find out if dental coverage is included and what the coverage includes. With healthcare and dental costs rising so quickly, many employers are looking for ways to shrink their costs, and limiting or eliminating dental coverage is often one of the first protections to be cut.
Also, ask if your company offers a dental spending account. Similar to a medical FSA, this is a special type of account that grows through pre-tax paycheck deposits throughout the year and can be used to help cover patient portions of deductible costs or other unexpected dental expenses. There are monetary limits on these accounts for annual contributions, and it is important to note that any money not spent by the end of the year is then forfeited. If you are planning on using one of these accounts, it is best to look ahead and consider your upcoming procedural needs.
If you are self-employed or are otherwise ineligible for employer benefits, you can shop around for dental insurance plans with your current medical insurer. It’s important to note that dental coverage is not required for adults under the Affordable Care Act (although it is required for children). According to the health insurance marketplace website www.healthcare.gov, you can purchase dental insurance as part of a health plan through the Marketplace or choose a stand-alone dental plan.
There are many different kinds of dental insurance coverage, which can lead to confusion and frustration for the consumer. The best way to minimize those problems is to educate yourself as a consumer about your particular plan. Are you looking for provider options? Or is cost the more important factor for your needs?
Two of the most common plans include the PPO, or Preferred Provider Organization, and the HMO, or Health Maintenance Organization. They differ in a few important ways, so it is best to read your policy offer carefully to make sure it will fit your needs.
PPO– A PPO is typically comprised of network providers that offer services at a discounted rate to patients on the plan. It is possible to choose a provider outside of the network, but be aware this can change your responsibility for the patient portion of the copay.
HMO– With an HMO, patients are usually required to only use providers from within the network. All financial responsibility for care from providers outside the approved network is the sole responsibility of the patient.
Whichever plan you end up choosing, make sure to carefully review any copay requirements, deductible limits, and plan coverage caps (both annual and lifetime) to make sure the plan adequately meets your needs. It is common for there to be a limit to the number of extractions, x-rays, cleanings, or crowns annually; likewise, there are often lifetime orthodontic or oral implant coverage limitations.
In addition, it is important to make note of any waiting periods required between the time of plan purchase and the procedure needed. This means that it may not be possible to purchase insurance and then immediately seek care.
You know best what your needs are, so ask questions to make sure you feel comfortable with your coverage and your share of the financial responsibility.
If you don’t have dental insurance, we can still help you. Call Southwest Oral Surgery at (623) 792-5794 to discuss your financial options. We work with many insurance plans, and we also accept major credit cards and Care Credit, a popular financing option.