After two years of preparing, the national health insurance marketplace is now open for business. Considering all the new choices you will be faced with, you might feel a little overwhelmed. To help, Delta Dental of Arizona put together the five things to consider when making your decision about dental benefits.
1. Not All Networks on the Exchange are Created Equal
Dental benefits are provided through an arrangement with your local dentists. Dental carriers enter into contract with the dentist, who in turn agrees to charge you a certain price. The key to a great network is how your plan contracts with dentists to get you the lowest cost and highest quality of care. Delta Dental of Arizona negotiates a low cost for you with our statewide network of more than 3,100 dentists, and we protect you from balance-billing (the difference between what the plan pays and what the dentist charges). Lower out-of-pocket costs for you mean that your dental benefits stretch further.
But not all networks are created equal. Some dental carriers offer a limited discount from the standard dental office fee. This practice can shift the burden of expense to the patient, which is you the consumer, for costly services such as root canals and crowns. And the discounts offered may be restricted to only a very narrow network of dentists. This means you will not have the same range in choosing a dentist as you would with a robust network.
Make sure your dental insurance offers you the lowest cost…with the most choice.
2. Do the Math
Make sure to understand what payments you are responsible for. In addition to the monthly premiums, there may be cost-sharing arrangements on services. Look for a plan that encourages preventive care by covering 100% of the costs of initial exams, cleanings, X-rays, sealants and fluoride treatments. Secondly, look at deductibles – the amount that you must pay before the insurance company pays for all or a portion of the costs. Deductibles will vary across plans. Lower monthly payment plans will typically have a higher deductible. In addition, there are also out-of-pocket maximums, which means that once you have paid the out-of-pocket maximum, the insurance plan pays 100%.
Keep in mind, if you are purchasing your dental benefits through a medical insurance carrier on the new online insurance marketplace, you need to look carefully at how deductibles and out-of-pocket maximums apply. For example, a deductible for a health plan might be $2,000 compared to a typical deductible for a stand-alone dental plan that ranges from $25 to $100. This means you could pay for a lot of dental costs before the medical plan starts paying 100%. That can be costly for the average family.
3. An Ounce of Prevention
When choosing a dental plan, it is important to review what services the plan covers. While it may seem like all plans are the same, many vary in coverage. Look for an insurance plan that emphasizes preventive and diagnostic care. Many people don’t realize that costly and painful dental problems can be prevented by regular visits to the dentist…even at the earliest of ages. The American Dental Association recommends that children see a dentist by age 1. Dental problems such as cavities are nearly 100% preventable.
4. Getting the Most Value
Each family has a unique situation. It is important to assess dental plans based on your family’s needs. Do you have children who are ready for braces? Might you be heading for a crown or root canal? Are implants or dentures in your future? Or are annual exams, cleanings and X-rays the extent of your dental needs? Make sure you are paying for services you need and getting the best value on those services. It’s not just about cost; it’s about coverage as well. Look for the coverage that works best for you and your family.
5. Who Are You Doing Business With?
You are sure to come across many companies in the online marketplace. Some are big, but many will be small, new businesses. It is important to make sure you’re working with an established company. Review their company profile and make your decision based on the answers to several questions. How long have they been in business? How many years have they been specializing in dental insurance? Are they local or national? There has been a lot of consolidation in the insurance industry. How much experience your dental insurance company has processing and paying dental claims is important. You don’t want to get a notice from another company you are not familiar with that has subcontracted with your insurance company because that means dental insurance is not your insurance company’s main area of expertise. Established dental carriers have the benefit of smooth, accurate operating procedures.
Consider the mission of the company you select. Does the company invest back into the communities it serves or is it interested only about the bottom line and getting shareholders the greatest return? As a tax exempt organization created for the welfare of the community, Delta Dental of Arizona is a locally-based company concerned and active in creating a better and healthier state.
Delta Dental of Arizona is a leading dental benefits company and unlike most carriers, we focus on just one thing — dental insurance. We provide our 775,000 members with local customer service and a robust statewide network of dental providers. And that’s not all – we are also a nonprofit company with a mission to promote optimal oral health in Arizona.
