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Choosing The Right Dental Insurance For You!

It will soon be that time of year when many of us are asked to choose a dental insurance plan for next year. You want to make sure you pick the plan that’s best for you--that might not necessarily be the cheapest one offered. Every year, we see people who are surprised that they didn’t get what they thought they were buying. You need to look at what type of work you need to have and what the plan covers to see if it is the right fit for you.


What are the types of plans?

“Traditional” plans allow you to choose any dentist that you want to see. Most also allow you to go to a specialist without any special insurance paperwork. Payment is based on a percentage scale.

PPO or Participating Provider plans prefer that you see a dentist who has contracted with them (the Participating Provider). Payment is based on a percentage scale, but there is a maximum allowable charge for each service. Some PPO plans do allow you to see a dentist who is not on their list but may pay less if you do. Most PPO plans allow you to go directly to a specialist but a few may ask your general dentist to fill out insurance specific paperwork.

DMO/HMO plans require you to choose a dentist from their list and will only pay benefits to that dentist. The dentist you choose is your “gatekeeper” and if any specialist visits are necessary, will need to fill out the appropriate referral form from the insurance company authorizing your treatment. Specialists must also be picked from the limited list provided by the DMO/HMO company.


If you have a specific dentist that you definitely want to see, it’s probably best to ask him or her if he or she participates with the plan you are considering before you choose it. One of the many benefits available for patients of my office is that we will help our patients compare their options so that they can pick one that works best for their needs. We look at past dental history, current dental needs, current plan benefits and cost of the new plan against cost of the treatment needed and the plan’s anticipated portion. Some people with minimal needs might be better off paying out of pocket and banking the difference between the premium and the treatment against the rare time that they’ll need a more expensive treatment.


But if insurance is right for you what other things should you consider when choosing a plan?

Is there a waiting period for certain benefits? More and more we see inexpensive new plans that only provide cleaning/preventive benefits for the first year. That’s great if it’s all you need, but if you purchased it because you have cavities or need a crown and thought it would help you with those expenses, you’ll be disappointed. Think you can wait that year? Maybe--but your dental condition will continue to deteriorate during that time, and you may end up with higher cost treatment needs because you waited.

Are any dental treatments excluded? If you’re looking to get white fillings or dental implants, and the plan you choose doesn’t pay for them, you’re still stuck figuring out how to pay for the treatment you want and need.


As you can hopefully see, the choice of which insurance to get is not as easy as looking at the cost alone. All insurance plans are not created equal.


If you would like to see if we participate with your insurance plan, please give us a call at 440-960-1940. If you're a current patient of mine who is looking at several dental plans, call us at 440-960-1940 if you have questions on which one might be best for you. And remember we’re saving a seat for you!