Dental care is an important part of a healthy lifestyle - but because dental coverage is not a part of standard health care insurance, it’s something that can often get forgotten until it’s too late. The rising cost of good dental care means that insurance might be just what you need to ensure your teeth remain healthy and well cared-for throughout your life.

In the United States, there are a large number of Americans who are without dental insurance. Dental insurance is often the key to obtaining professional dental care. Without it, many are unable to afford a trip to the dentist. If you are currently without dental insurance, whether your employer does not offer it or if you are unemployed, you may want to consider obtaining your own dental insurance plan.

Before you can go out and purchase a dental insurance plan, there are a number of different factors that you should consider. Where you live is one of those factors. Where you live may have an impact on the dental insurance companies in which you are able to do business with. For instance, if you live in or around the New York city area, you will want to consider doing business with a New York city dental insurance company. A New York city dental insurance company is defined as a company that either operates out of the area or services it.

Types of dental insurance plans

There are several basic types of dental insurance plans offering a range of cover from the most basic dental care plans to complete all encompassing dental insurance plans.

Basic dental care plans aren’t effectively an insurance but rather a ‘club’ that enables you to obtain discounted dental care from participating dentists. The level of discount is largely dependant on the monthly fee you pay but unlike dental insurance there is no limit to the amount of discounted treatment you can receive. One thing to check with dental care plans is the amount of local dental coverage (if any!). You can join a dental care plan for just a few dollars a month.

Indemnity Insurance Plans

Indemnity Insurance Plans are a type of dental insurance whereby you pay the insurance company a fixed monthly fee who, in turn, will reimburse your dentist for services rendered. However, the dental insurance company doesn’t normally cover the whole cost with the policy holder be liable for 20 – 50% of the total cost. If you take out an indemnity plan you need to check the level of deductibles and the maximum amount the insurance policy will pay out in any given year. Also find out the length of any probationary period during which the dental insurance company won’t pay out and whether you are able to use your own dentist. Expect to pay around $14 to $26 per month.

Direct reimbursement plans

One of the increasingly popular dental insurances is the direct reimbursement plans which are self funded by employer’s rather them paying dental insurance premiums. As a general rule the person receiving the dental care will pay the fee in full and reclaim all or part of the cost (depending on what level of cover their particular employer provides) from their employer. Annual benefits of this dental insurance option are usually capped with the capped level varying quite significantly from one employer to another

Capitation dental insurance plans (HMO’s)

A Capitation dental insurance plans (HMO’s) is the agreement with a dentist who has signed up to provide dental treatment for the enrolled members of the dental plan. Usually, the dentist is paid a fixed amount on monthly basis for a dental plan of the participants chosen to provide the dental treatment. In like manner, it is the responsibility of the dentist to provide all the needed dental treatment for the individuals during the negotiated period.

As the dentist is paid the same amount, it does not matter how much treatment they provide for the members of this plan. The dentist may make an entrée to the dental treatment to be complicated. Finally, since the capitation dental graph would utilize a “closed panel” of dentists, one should evaluate the remedies that are available for those who require a dental treatment, when they are out of the area serviced by the dental plan. The cost of HMO insurance plans are generally targeted at preventative and emergency care and can vary from patient to patient following an initial examination.

Preferred Provider Organization (PPO)

Managed care plans, or Preferred Provider Organization (PPO) programs are schemes where the patient is at a liberty to choose the dentist from a network. The fees payable for the services rendered by the dentist will be discounted by the PPO. However, if the dentist is not among those preferred, it results in much higher deductibles and larger co-payments from the patient. Though it is less expensive compared to indemnity plans, it may require one to change dentists due to a limitation in the panel of participating dentists. Expect to pay up to about $25 per month.

UCR (Usual, Customary & Reasonable) indemnity dental insurance plans

UCR (Usual, Customary & Reasonable) indemnity dental insurance plans have a database which contains average prices for each dental procedure you might undergo. These dental plans base their payment calculation on either the insurance company’s proprietary “usual, reasonable, customary” fee (a “UCR” fee) or else the dentist’s fee, whichever is less. As an example:

Let’s say that your dental policy states that the insurance company will pay for 80% of the cost of your dental fillings. Now imagine that Dr. Example has determined that you need a dental filling placed and then performs the treatment. The bill comes to $100.

When the dental claim is submitted to the insurance company they will compare Dr. Example’s fee to their “UCR” fee for that same type of filling. If their UCR data associates a fee of $120 for the type of filling you have received then the insurance company will (quite happily) pay 80% of the cost of your $100 filling which comes out to $80. You would then need to pay Dr. Example $20 so to settle the remainder of your bill.

If, as an example of the converse, the dental insurance company evaluates their UCR data and finds that it associates a fee of just $90 for the type of filling Dr. Example has placed, then the insurance company will (to your disappointment) make a payment of only 80% of $90. This comes out to $72. You would then need to pay Dr. Example $28 to settle your bill.

It seems like a rigged win-win situation for the dental insurance company. Maybe it is. Maybe it isn’t. Insurance companies would like you to believe that the UCR fee they associate with each dental procedure accurately encompasses the fees charged by the majority of dentists in a given area. The unspoken implication here being that if your dentist charges more than the dental insurance company’s UCR fee then the dentist is charging too much, or at least more than most dentists.For those of you who are lucky enough to have dental care included as an employee benefit through a reimbursement plan the cost to you will depend on the level of dental insurance your employer provides. Such alternatives to dental insurance can cover 100% of your dental cost but it does vary from employer to employer and there is usually an annual limit to the amount you can claim.