Dental insurance seems to be coming into its own. The number of people insured got a boost from the Affordable Care Act that defined dental coverage as an “essential benefit” for children, and offered adults the benefit either as part of a health plan or as a separate dental plan. As people are given the chance to make consumer decisions about the coverage they want, some are choosing less expensive medical plans “so that they can use some of their dollars to buy other benefits, such as vision and dental plans,” said Aaron Groffman, president of the independent Ignition Group, which analyzes data and identifies dental industry trends. 

Dentists are also warming up to joining insurer networks. Of the approximately 200,000 active dentists in the U.S.,less than 50,000 were part of the top 15 preferred provider networks in March 2009. But by March 2013, that number rose to more than 70,000, according to Groffman’s data. (For an overview of how dental insurance works, see Should You Bite On Dental Insurance?)

About 53 million full-time workers get dental insurance through their employers. Here we zero in on two plans offered to federal government employers and to those who work for state governments, including Arizona, Oklahoma and Tennessee, among other employers. We take a close look at the Assurant Prepaid and Delta PDO offered by the state of Tennessee. But while the details of other plans may vary, these tips for comparing plans apply to most choices among dental benefits. (You may also want to read How To Choose A Health Care Plan and 4 Important Steps For Choosing Dental Insurance.) 

Consider What Type of Plan is Best for You

As in medical insurance, the choice often comes down to a dental health maintenance organization (HMO or DHMO) or a preferred dental provider organization (PPO or PDO). Assurant calls the offering we analyze here a “prepaid” plan, an alternative term for an HMO that means the dentists are prepaid on a per head (capitation) basis, receiving a basic payment for each patient they see. Assurant offers dental HMOs in 21 states through employers, and also individual HMO plans in 16 states. In this HMO there there are no forms to fill out, and Assurant provides the dollar amounts for all copays, which can ease budgeting.  

Delta sells a variety of PPO or PDO options, a network of dentists under contract to the insurance company to deliver specified services for set fees. A variety of Delta plans are offered by employers and sold through groups such as AARP. PPO networks of dentists are typically larger than those of HMOs. In September, 2014 Delta had the fifth largest network of dental providers. PPOs generally have more expensive premiums, and perhaps larger copays. Delta expresses its benefits as a percentage of Maximum Allowable Charge (MAC), so it's more difficult to calculate the amounts you may be responsible for. The PDO allows you to see any dentist, in or out of network, although copays are considerably larger for out of network dentists. Comparing these two options provides no clear winner, it depends on your circumstances. Here’s how to tell.

First, Check Out Local Dentists

If you can’t find a dentist you like who takes your plan and can give you prompt appointments, dental benefits will do you no good. It’s important to check the plan’s dental directory to find participating dentists at convenient locations. And a good idea to call a few of the dentists you’re considering to find out if their hours suit your needs and the office staff is accommodating. One question to ask: How long will I have to wait for my first appointment? The average wait time for a dental appointment for a new patient has decreased from 10.9 days in 2001 to 5.7 days in 2013, according to the American Dental Association. So if a dentist's office says you have to wait weeks for an appointment, you might want to try another one.

Take Care of Basic Needs 

The great boon of dental insurance is that office visits, including periodic oral evaluations, routine cleanings and x-rays are liberally covered. The idea is to encourage you to get good preventive care so your future dental costs (and the misery involved) will be reduced. This care does not come cheaply. A tooth cleaning appointment that includes dental X-rays and an exam by the dentist, costs an average of $198, according to consumer experiences reported by costhelper.com.

In the Tennessee plans, Assurant Prepaid has no annual deductible, and no charge for x-rays, routine cleaning, and periodic oral evaluations by general dentist. There is a co-pay of $10 for an office visit. Under Delta PDO, if you use an in-network dentist there is no charge for an office visit, oral evaluation and routine cleaning, but you’re responsible for 20% of the cost for X-rays. Both plans charge a copay for amalgam (silver) fillings.

Expect Only Partial Coverage for Emergency Events

Root canal (endodontics) is generally unplanned and can be expensive. Under Assurant PrePaid there is a $250 copay for a root canal by a general dentist and $600 copay for one by a specialist dentist. In the Delta PDO you’re responsible for 50% of the maximum allowable charge. Tooth extraction and removal of impacted teeth also have significant copays, especially if they are done by a specialist dentist.

Plan for Big Ticket Items

Does someone in the family need braces or dentures? Under Delta PPO, orthodontics are covered at 50% of the Maximum Allowable Charge agreed to by participating dentists. Under Assurant Prepaid, it’s 25% off the “participating orthodontics usual fee.” While Delta might seem a better a deal on first glance, consider that there’s a waiting period of 12 months before the benefit kicks in, and that the benefit applies only up to age 19. So if you’re an adult desiring orthodontics, or you need the benefit more quickly, you might be better off taking Assurant Prepaid. A complete set of upper dentures will cost $310 copay plus lab fees at Assurant Pre-Paid, and 50% of maximum allowable charge at Delta PDO 

Remember the Annual Maximum Benefit

Here’s where Assurant Prepaid might offer the best deal for families with large dental needs. There is no annual maximum on the benefits paid and pre-existing conditions are covered. Delta PPO, on the other hand, has $1500 maximum per person per year, and there are some exclusions in the coverage of pre-existing conditions.

And Now to the Premiums

If you get dental insurance through your employer, premiums may be fairly low, because the employer may chip in and negotiate a good deal on costs. Here’s what employees of the state of Tennessee have to pay this year or dental insurance premiums.

Monthly Premium Comparison
Plan Assurant Prepaid Delta PDO
Employee only $9.63 $20.46
Employee + Spouse $17.07 $38.69
Employee + Spouse + Children $23.47 $75.71

 

The Bottom Line

If your goal is healthy teeth, having dental benefits and finding a dentist you like are important steps. Consumers who had dental insurance and those who had a personal dentist were more likely to visit the dentist than those without, according to a recent Ohio Health issues poll. Examine dental plans carefully to make sure you understand the limits of the benefits. Set aside money for both premiums and potentially expensive copayments. If dental insurance is not an option and you need major work, talk to your dentist about arranging a payment plan.♦

 

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