Is dental insurance worth the cost?

You need medical insurance, if only to protect against the cost of an accident or illness so expensive that you could be ruined financially. But do you really need dental insurance?
It’s an interesting question, because you can avoid the most likely causes and expenses of dental problems, decay and gum disease, by brushing and flossing your teeth diligently. But some teeth are more prone to problems, and when they have a problem, the costs can mount quickly.

The price of insurance
About 64 percent of Americans have dental insurance. Nearly all of them have coverage through work or a group plan like AARP, Medicaid, Tricare (for military families) and the federal Children’s Health Insurance Program, according to Evelyn Ireland, executive director of the National Association of Dental Plans, in an email interview.
Most dental preferred provider organizations and regular insurance (indemnity) plans have an average deductible of $50 and a maximum yearly benefit of $1,000, Ireland says. Only 2 percent to 4 percent of Americans with dental insurance use up their yearly maximum allowance.
Dental plans offered through a workplace typically are one of three types:

• Indemnity plan: You choose your provider, and your plan pays a percentage of the fees.
• PPO: Preferred provider organization plans have groups of practitioners who agree to reduced fees for patients within the network. Your costs are lower with network dentists. You may see out-of-network dentists, but it’ll cost you more.
• HMO: Health maintenance organizations cut costs by requiring members to use only providers within the network.

Premiums for group dental plans in 2014 (the latest information available) averaged from $19 to $32 a month ($228 to $384 annually), said the NADP.
Is insurance worth it?
The NADP describes these elements of coverage in a typical plan:

• Preventive care: periodic exams, X-rays and, for some age groups, sealants -- 100 percent.
• Basic procedures: office visits, extractions, fillings, root canals (sometimes) and periodontal treatment -- 70 percent to 80 percent.
• Major procedures: crowns, bridges, inlays, dentures and sometimes implants and root canals -- 50 percent or less.

Orthodontics coverage usually can be purchased as a rider, said the NADP. Cosmetic care isn’t covered.
Dental insurance isn’t always worth the cost. It depends on your plan, your needs and the cost of the services available to you.
In deciding if an insurance plan is right for you, weigh:

• The annual premium
• The cost of the dental care you need
• Your policy’s limit on how much it pays out in benefits and whether you can roll over unused benefits from the previous year
• Policy coverage

“While many dental policies focus on preventive measures by offering two annual visits, you’ll really start seeing the savings with more expensive treatments, like root canals and crowns,” according to Angie’s List.
Help from the Affordable Care Act 
The ACA requires providers to offer dental insurance for children younger than 18. “Although the new act does not require dental coverage for adults, most state marketplaces will also offer dental coverage for adults,” said the American Dental Association. Adult dental coverage may be offered as part of a comprehensive health plan or as stand-alone dental insurance. Here’s more about the ACA and dental coverage:

• The ADA tells how to compare and assess dental plans.
• Use this Healthcare.gov plan locator to find ACA dental plans locally and compare costs.

Dental insurance isn’t the only way to cut dental bills. In fact, 36 percent of Americans have no dental insurance. Here are 10 other ways to cut your costs:

1. Self-pay
It may be less expensive to pay out of pocket than buy a plan. Fees vary by dentist’s office and by geographic region. Here are average costs in the U.S. for several common procedures, from the ADA Health Policy Institute’s 2013 Survey of Dental Fees (the latest data available):

• Teeth cleaning (prophylaxis) adult: $85
• White dental filling (one surface, anterior): $149
• Silver filling (one surface, primary or permanent): $125
• Porcelain crown fused to noble metal: $1,003
• Complete series of intra-oral X-rays: $124

2.  Preventive care
In many cases, the best way to save on dentistry is to take excellent care of your teeth and gums, and to teach children healthy dental routines. For example, did you know that fruit juices, carbonated drinks and acidic foods can help wear away your tooth enamel?
The ADA tells you how to brush correctly, how to floss effectively and offers more information on dental health.
Delta Dental, an insurer, has more tips on preventive care.

3. Cut back to one cleaning a year
Several studies have shown that visiting the dentist twice a year doesn’t deliver notable benefits compared with one exam a year. If you don’t have serious dental issues, you can probably get by with one cleaning annually.
But don’t skip that one annual cleaning and exam. It could save you from costly and serious problems.

4. Discount dental plans
Discount plans charge an annual fee in exchange for discounted services from network providers. Before you buy into a plan, look over its list of covered procedures to see if they’re ones you are likely to use.
PolicyGenius, an independent insurance broker, compared five dental insurance and dental discount plans. Costs vary a lot depending on where you live and because the state insurance marketplaces created under the ACA offer different plans. It’s hard to comparison-shop for dental plans: Companies don’t easily share information on costs and coverage until after you’ve subscribed, PolicyGenius found. Even so, “all five plans we looked at delivered better value than paying cash outright.”
A tip: The cheapest dental plans don’t offer much value, but don’t just go with an expensive plan -- do some careful research. “If you know you’re going to be spending some time in the dentist’s chair soon -- and especially if you require an expensive dental procedure immediately -- the right discount plan could save you hundreds of dollars,” PolicyGenius writes.

5. Request 10 percent off
Some dentists will take 10 percent off the cost of a visit or procedure if you pay at the time of the visit. Some offer a discount for cash.
If your dentist doesn’t provide a discount, ask (politely, of course) if he/she could do so. Or shop around for a dentist, gathering recommendations from friends and then phoning those offices to find out if they offer a discount.

6. Charitable clinics
Look for low-cost or free dental clinics in your community offered by local dentist volunteers.
Find opportunities in your area through America’s Dentists Care Foundation. Another charitable organization with volunteer dental professionals is Dentistry From the Heart, a global nonprofit organization. Or ask your state’s dental association about low-cost care.

7. Dental schools
Dental schools at many colleges and universities around the U.S. often offer free or reduced-cost care. Accredited programs are listed at the ADA website.

8. Federally qualified health centers
Private health centers offering dental services exist in cities and counties across the country. They receive some government funding and charge according to what you can afford. Use the clinic locator at the federal Health Resources and Services Administration website.

9. Consider dental tourism
Dental tourism -- traveling to other countries to get treatment, often at a fraction of the U.S. cost -- is a huge business. Among the top countries that have a thriving dental industry catering to foreigners are Mexico, Thailand, Spain, Turkey, Czech Republic, Costa Rica, Poland, Philippines and Hungary.
“Dental tourism companies and corporate dental chains are increasingly advertising ‘all inclusive’ travel packages that include dental procedures, hotel room reservations, side trips to tourist attractions, and airline tickets to lure international clients,” said an article in the International Journal of Contemporary Dental and Medical Reviews.
Do plenty of research to ensure that you’re getting safe, high-quality care. Some resources:

• The American Dental Association has information and cautions about dentistry outside the U.S.
• OSAP, the Organization for Safety and Asepsis Procedures, tells how to assess infection-control practices in a dentist’s office and gives a checklist for obtaining safe dental care abroad. It cautions:

“The decision to visit another country for dental care should go beyond simply comparing prices or even evaluating the dentists’ expertise. Countries differ in their standards for infection control and safety. The use of fresh gloves, sterile instruments and safe water are not standard practice in all countries. Without these precautions, patients could be infected with diseases such as hepatitis B.”

10. Get out of town
Dentist fees in rural counties typically are lower than in urban areas. Comparison-shop for the procedure you need by phoning offices of ADA member dentists outside your metro area and asking about fees. Here’s how to locate an ADA member dentist.

By: Mariyln Lewis, CBS News
http://www.cbsnews.com/news/is-dental-insurance-worth-the-cost/


If you have questions or would like to schedule an appointment, please contact Omni Dental Group at one of our three office locations listed below:

North Austin on Hymeadow Drive: (512) 250-5012
Central Austin on Jollyville Road: (512) 346-8424
South Austin on William Cannon: (512) 445-5811

Dental Insurance Coverage

Your employer, management, or union has purchased dental insurance coverage from a selection of plans offered by an insurance company or broker. Each insurance company offers many different plans. 

What is covered?
The type of dental benefits that are covered relate to the dollar amount spent on the benefit package. Generally, the more money spent on a plan, the more services are covered. Most dental insurance covers only 50% to 80% of the cost of the treatment. Major services (crowns, bridges, etc.), which are the most expensive dental procedures, are usually only covered at a 50% rate. For example, some dental benefit packages will not cover the fees for porcelain (tooth-colored material) crowns on teeth that are not visible when you talk or smile; they will only pay for a metal crown. Under this type of plan, you must pay the full amount of the cost of the porcelain on those teeth. According to insurance companies, fillings in front teeth have both functional use and cosmetic components. They will pay for the functional part but not the full amount for the cosmetic restorations.

Who is responsible for payment?
The fees charged for dental treatment reflect the many different parts of a particular procedure or procedures. Treatment for your particular needs may or may not fall within the limits set by your particular dental plan. Many dental procedures may not even be listed in your insurance's procedure/payment schedule. If your dental procedure falls into this category, you may not receive any insurance reimbursement for that procedure. You are ultimately responsible for paying the entire fee for an accepted dental treatment, regardless of your insurance coverage.

Choosing Treatment Options
Our goal through your examination, diagnosis, and treatment phases is to provide you with the best possible oral health. We do not allow the insurance company to tell us how to treat you. We recommend to you those treatments that we believe you need and we will discuss alternative plans with you. Whether or not the recommended treatment is a covered dental benefit is between you and your employer and the insurance carrier.

Submitting the Claim
We are happy to help you receive the maximum benefits you are allowed from your dental coverage. In order for us to submit your insurance claim, we will need an insurance form with your portion completed and signed. We deal with dental insurance companies on a daily basis; therefore, we have a great deal of experience submitting these claims to insurance carriers. We take great care in submitting claims properly the first time. 

There are three things we cannot do: 
1) Alter the date of treatment; 
2) Submit a claim for more than the actual fee; 
3) Submit a claim for procedures that have not been performed. 

Because it is not at all uncommon for the insurance carriers to make a mistake, we would prefer to submit the claims ourselves, and then verify proper payment. Insurance carriers may respond to requests for payment of preauthorized treatment in as little as a week or as long as 45 days. Please be patient; we have no control over the post office or the speed with which the insurance carrier processes your claim.

Our office cannot negotiate with your insurance company for reimbursement of dental expenses. Only the purchaser of the plan (your employer) can negotiate better coverage. If you would like better or more coverage, you will need to talk with your plan purchaser about the features you want in your dental plan.

If you have any questions about your dental insurance coverage, please feel free to ask us.