Understande How Your Dental Insurance Works in Sherman Oaks, Los Angeles, CA
At Riverside Dental, we understand that dental insurance can be a tricky thing to navigate. Evaluating dental plans and considering deductibles,
benefits, which treatments are covered, and the mountain of other information insurance companies provide can be a headache in and of itself.
We want every Sherman Oaks resident to have the power to control their own health, so here's a simplified guide to the basics of dental health insurance.
As always, if you have a question, don't be afraid to give us a call at (818) 784-5889!
Dental Insurance
Dental insurance is an excellent investment that helps Sherman Oaks residents ensure a lifetime of healthy smiles. However, in order to get the best
value from your dental insurance, there are a few things you need to know. Here are the answers to the most common questions we hear at Riverside Dental.
What is Dental Insurance?
Having dental insurance means that an insurance provider will pay for a percentage of the dental care that you need every year. Plans vary in terms
of how much they cost, how much they cover, and which dentists are included. If you would like to know if Dr. Bhumika Kathiriya are included in your provider network,
please give us a call to find out today.
Dental Insurance Models
Dental Preferred Provider Organization (DPPO or PPO): 82 percent of today's dental policies are PPOs. In this model, the insurer creates a network of providers for patients to choose from. Dentists in the network get more patients, but take a discount from their normal fees. Patients are free to see dentists outside the network, but usually at higher out-of-pocket costs. PPOs cover all in-network preventative care, but have co-payments for restorative work. For example, the PPO might only pay 70 percent of the cost of the patient's filling.
Dental Health Maintenance Organization (DHMO of HMO):: 8 percent of today's dental policies are HMOs. These plans utilize a network of providers, and patients are usually required to pick a primary provider and stay in network to get the full benefit of their plan. Dentists are paid based on the number of patients on the HMO. This is often referred to a capitated payment model.
Dental Indemnity Insurance: 6 percent of today's dental policies are indemnity plans. This is a traditional dental insurance which, in the past, had significant market share. With indemnity, there are no provider networks and the dentist gets paid his or her usual fees. Indemnity insurance has shrunk in popularity because the plans are more expensive than a PPO and HMO. These plans have deductibles and co-payments similar to PPOs.
Discount Dental Plans: 4 percent of dental benefits are discount plans. Discount Dental Plans are not insurance but rather plans where dentists agree to see enrollees at discounted fees. The patient pays the dentist the discount plan fees directly.
Medicaid and CHIP: All states cover dental for Medicaid and CHIP children under the age of 21, while adult dental benefits vary widely by state. Medicaid and CHIP are typically managed by the state.
Tricare: This program, which is for those actively serving in the U.S. military and their families, looks and feels just like a commercial PPO. Beginning mid-2017, all of these benefits will be administered by United Concordia.
What do Dental Insurance Plans Cover?
Insurance carriers cover dental procedures in three fundamental categories: preventative (examinations, routine cleanings, x-rays, etc.);
basic/restorative (cavity fillings, tooth extractions, etc.); and major (crowns, bridges, surgical extractions, dental implants, etc.).
The classification of procedures into categories varies according to each insurance carrier, but most dental insurance plans have "100-80-50" coverage,
which means routine cleanings, checkups, and diagnostic care are paid for in full; 80 percent of the cost of fillings, root canals, and other basic
procedures are covered; and 50 percent of the cost of dental implants and other major procedures are covered. Cosmetic dental procedures, such as
whitening treatments, are not usually covered.
What are premiums, deductibles, copayments, and maximums?
Premiums: These are the basic yearly or monthly cost of your dental insurance. Premiums do not include copayments or deductibles.
Deductibles: For each plan, there is an annual amount that you must pay prior to insurance coverage of expenses. After your deductible is met,
your insurance plan will cover a percentage of the cost of your dental care.
Copayments: Per visit payments of a flat rate or a percentage of the total procedure cost.
Plan maximums: Most plans include a maximum dollar amount that will be paid for your dental expenses per year. You are financially responsible for any
amount exceeding your plan maximum.
When do benefits renew?
Benefits are usually calculated yearly and renew on the 1st of January but renewal dates may vary. It is important to know that unused coverage does not carry over to the
next year. If you have specific questions about your dental insurance, you can contact your insurance provider directly or give us a call at (818) 784-5889.
We are always happy to answer any questions that help keep Sherman Oaks smiles beautiful and healthy!
