If there’s one thing people have against dental coverage, it’s the sheer complexity of the thing! Who wants to deal with the hassles of coverage, the form-filling, the confusion of the whole ordeal? But the reality is that if you have dependents, or if your spouse has to stop work for a procedure, or if your teen is going to get braces, you need to know it all before the bill arrives. Here’s what I would say to a friend who just moved here and who’s looking for a family dentist in Simi Valley.
Talk About the Members First
Many people forget to start with the basics. Figure out who needs to be covered first. You can’t compare an individual to a family of three who lose teeth, get into accidents, and eat an alarming amount of gummy bears! Think about everyone who needs fillings, everyone who needs cleanings twice a year, and everyone who could eventually need orthodontic treatment: that should tell you more than their marketing ever will.
HMO vs. PPO Coverage
Most plans are either HMO-style plans, PPO-style plans, or something else entirely. The bottom line is that an HMO plan will be cheaper per month but offer a smaller network, and a PPO plan will be more expensive but offer flexibility (and possible out-of-network coverage). As with most things, it’s all a matter of priorities.
Research the Dental Office Before Settling
Make sure the dentist’s office that you’re considering is actually on the plan’s network before purchasing a policy. Many people are shocked to find out that their preferred dentist isn’t on the plan at all now that they actually bought it! If you’re not sure which office you want, it’s best to get your shortlist ready, then cross-check their plans. It’s better to get in touch with a local family dentist in Simi Valley and ask them directly than to always rely on the coverage companies’ websites, which are often out-of-date.
Take Advantage of Preventive Care
preventive care is almost always 100% coverage, sometimes with a small deductible (or it’s not considered a deductible). That’s a given. Family Dental Insurance Plans will want you to take advantage of your cleanings, exams, and x-rays, since they’re the best way to catch problems early (and it’s cheaper for the plan to cover a filling than a root canal). Take those cleanings twice a year!
Remember the Annual Maximum
Most dental coverage plans have an annual maximum (or a per-person annual maximum). This means they’ll only pay up to a certain amount per person, which, strangely, hasn’t increased much in the last decade or so while dental work has gotten exponentially more expensive. This can get eaten up quickly if you have to have a crown placed or some fillings. Ask your dentist about spreading work out over two years if you’re going to need major work.
Watch Out for Waiting Periods
It’s not uncommon for dental coverage to have waiting periods (usually between 6 months to a year) for major work like crowns or bridges. Cleanings are usually covered right away, but that’s about it. If you’re considering switching coverage mid-treatment, be sure to ask about waiting periods being waived for new policies.
Kids’ Insurance Requirements Are Usually Different Than Adults
Kids require very different services, from sealants to fluoride treatments and special attention as their jaws grow in. Luckily, most plans take this into account and offer better coverage for children, who are more likely to need orthodontic work and more likely to need preventative treatments. A good kids’ family dentist in Simi Valley will also be adept at working with children who may be quite apprehensive, which is a major bonus as an adult patient is often far more difficult to sedate or calm.
Braces and Orthodontic Coverage Are Often Separate Too
Orthodontic coverage is a strange beast, wherein most plans will only cover up to a certain percentage (like 50%) of treatment up to a lifetime maximum (around 1500-2000), while others don’t cover orthodontic treatment at all! Cosmetic surgery isn’t covered anywhere, so if you’re considering braces for your teen, be sure to ask the orthodontic coverage questions before your consultation, not after!
Ask the Dentist Office About Billing Details
A dental office handles insurance all day long: they should be able to handle billing questions as well. Ask them about filing claims on your behalf, about coverage and out-of-pocket disbursements, and about estimated costs (a good family dentist in Simi Valley should be able to tell you how much you owe them before any treatment). If the receptionist seems fazed by your questions or unprepared to answer them, that’s a sign to look elsewhere.
Do the Math on Monthly Premiums, Deductibles, And Out-of-Pocket Expenses
Compare different plans: some may have a lower premium but require a higher deductible and out-of-pocket expenses, and some plans – like membership clubs – may actually be a steal if you don’t need to use them much. It all depends on how much treatment you expect to get in a year. Do the math with a calculator, and spend ten minutes on it: the longer you wait to decide, the less likely you are to actually do it.
Final Thoughts
Dental insurance can be complicated, but the right knowledge helps you get much better value out of your premium. Make sure to keep track of everyone who needs to be covered, to take advantage of preventive care, to ask around about networks, and to consider your out-of-pocket costs. If you’re looking for a local Family Dentist Simi Valley who can help you choose a plan, Alamo Family Dentistry is always happy to take new patients and give you advice, so give us a call and schedule a visit today!
FAQs
Is dental insurance worth it for a family?
It can be, depending on your needs – if you and your dependents are healthy, it’s often worth it to take advantage of preventive care, since those are nearly 100% covered. Families on a budget sometimes end up with discount plans that require more out-of-pocket expenses but have lower premium rates. You need to do the math for your specific case.
At what age should a child see a dentist?
By their first birthday or when they have their first tooth, whichever comes first. It’s mainly a checkup to assess risk and start the process of becoming comfortable with a dental environment.
Can I get care somewhere else if they’re not on the plan’s network?
It depends on the type of plan you have. A PPO plan usually allows out-of-network care but at a higher out-of-pocket cost, and an HMO-style plan usually does not allow out-of-network care unless it’s an emergency.
My coverage has an annual maximum. What does that mean?
That means once the coverage hits that limit for the year (usually per person), the plan will no longer pay for anything until the next year. You should talk to your dentist about spreading out treatment if possible so some of it falls under the next year’s coverage.
