Insurance can be tricky. How do you choose a plan that works for you? Luckily, we have valuable information to help you understand the best dental insurance options for you.
READY, SET, HIKE!
For some, it is time consider which dental plan to choose for 2016. Take it from one who works with a plethora of insurance companies on a day-to-day basis: insurance can be difficult to decipher.
Here are some tips that can help you select the right plan, keeping in mind that all insurance plans have a multitude of options. Be sure to familiarize yourself with the plans available to you and don’t hesitate to contact us with any questions. We are always happy to help.
PPO vs. DMO
When selecting a dental plan, it is important to understand the difference between PPO and DMO plans. PPO plans give you the freedom to see any doctor (in or out of their network). In many instances, the coverage is typically not dramatically different to go in our out of network. A PPO plan gives you more control of your dental care. Our qualified team can research your plan to determine what is best for you.
DMO plans are much more restrictive. While they usually look better on paper, the reality is, there are a very limited number of providers to choose from. It is a low cost dental maintenance plan where you must select the provider of your choice. This provider is contracted with the DMO carrier to serve you at a discounted rate. The plan typically covers amalgam fillings vs. white composite fillings and has the healthcare provider use a less precious metal for crowns.
If you or your family could benefit from orthodontic treatment, we can check to see if your plan covers this service. Many insurance plans may offer this coverage for adults as well. Orthodontic coverage is typically limited to a lifetime maximum.
IMPLANTS AND OCCLUSAL GUARDS
Believe it or not, coverage for implants is hit or miss. There are guidelines most insurance companies follow to determine if they will cover these items. The best way to find out coverage for these items is to have our office call about your specific benefit. The standard of care is to have dental implants placed when you are missing one or more teeth; it is unfortunate most insurance companies do not cover this procedure. Long term dental implants are the best option vs. bridgework.
BEWARE OF STATE DENTAL PLANS
The state of New Jersey offers many different plans. Some of these include the Blue Cross Blue Shield Young Grins Program and NJ Family Healthcare. These plans are offered through The Affordable Care Act, allowing families to get coverage at lower rates. Sadly, these plans are similar to a DMO plans and are quite restrictive. Additionally, the Blue Cross Blue Shield Young Grins Program only offers coverage for dependent children.
Watch out for certain exclusions your employer may select. The offense can decide to throw a surprise your way by allowing cleanings every 6 months to the day (vs the preferred plan option of two cleanings per plan year which allows you to visit your dentist when it works best for your schedule). Another insurance offensive move that your employer may select is to switch up the benefit year in January to July.
Insurance companies are constantly changing every year. As such, be sure to pay close attention to the literature that you are given about your dental insurance options. Call Seidner Dentistry should you need coaching on the dental plan that is best for you.
Doing so will keep your defense strong against any financial surprises. If you have existing treatment that has yet to be performed, be sure to contact us to find out how much insurance money you have left to utilize. At the end of the fourth quarter, if you don’t use up your maximum, you lose it! Move the chains your way, and score a touchdown by making sure you see the dentist before the year is over. Kick off the new year happy and healthy!
By Cristina Medina