Dental Benefits Options

Grin and Bear it: Your Options for Dental Benefits

While kinder, gentler technology has taken some of the fear out of a visit to the dentist, access to dental benefits hasn't gotten any easier. But there is hope: Dental benefits can be affordable, even if they aren't provided through your job.

While you might not need to buy a dental plan if you rarely have dental problems, you might want to join a dental plan if you've had a rough dental history or if you know you'll need a lot of dental treatment in the near future even if you must sit out an initial waiting period for certain benefits to kick in.

As for your children, if they qualify for the federal/state Children's Health Insurance Program (CHIP), they might be provided with dental benefits. However, CHIP plans are not required to offer dental treatment; the decision is made on a state-by-state basis.

If you work at a company with more than 500 employees, you're probably among the 175 million Americans who have a dental plan. About 89 percent of large employers offer some type of dental benefit to their workers, according to the National Association of Dental Plans (NADP), based in Dallas. But when you take both large and small employers into account, the number of employers offering dental insurance drops to 54 percent. According to the NADP, about 40 percent of the U.S. workforce still lacks dental benefits.

Dental Insurance vs. Discount Plans

Some consumers are confused by the differences between dental insurance and dental "discount" plans. Dental insurance is true insurance. You pay regular premiums for your coverage and your plan has annual spending caps. It generally covers 100 percent of the cost of preventive services after you meet your deductible.

Dental discount plans are not insurance and they work differently. These are membership-based programs. In exchange for a fee, members get discounts on a variety of dental services, such as fillings, braces, exams, and routine cleanings. Members typically receive about 30 percent off standard out-of-pocket prices. The are akin to "diner's clubs," in which you buy a book of coupons and get a percentage off of your meals at participating restaurants.

With a dental discount plan, you must go to a dentist who has agreed to participate in the plan and offer services at a discounted price say $650 for a crown instead of the standard rate of $750.

Some typical features of these plans:
  • An initial enrollment fee.
  • A monthly fee to the dental-discount company.
  • Discounts on cosmetic procedures that are excluded from most dental insurance plans.
Be aware that dental discounts plans are not regulated by state insurance departments. That doesn't mean these plans aren't legitimate, but you should take precautions when buying a dental discount plan, especially over the Internet, where you have to provide a variety of confidential information.

According to the NADP, these are some questions you should always ask a dental insurance or discount plan:

Are you licensed to offer this plan in this state? True dental insurers must be licensed in your state to sell dental insurance.

Are you registered with the Secretary of State? All legitimate companies operating in a state should have at least filed documents with the Secretary of State in the state where they are operating.

Are you registered with the Better Business Bureau? The BBB maintains a large database of companies, where they operate, contact information, and complaint data.

Where are you located and what is your address of operations? A bogus dental plan is likely to be hesitant to give you this information or will give you an address that is nothing more than a local post office box.

Can you mail me specifics on the plan before I sign up with the plan? Fraudulent plans are more likely to collect your "membership fee" before they will send you any information. All legitimate plans will have marketing materials that they will be more than happy to send you.

Do you have a Web site with more information? Most legitimate dental plan companies have extensive Web sites that outline their plan benefits, approximate costs, and the providers accepting the plan in your area.

Can I get a list of providers on the plan? Avoid any plan that cannot provide you with a list of dentists who accept their plan.

Can I think about it and get back to you next week? Bogus plans use high-pressure techniques to get you to join the day you call.

Is your plan endorsed by or affiliated with a legitimate national organization? According to the NADP, a recent bogus dental plan said it was endorsed by the "United Dental Association." There is no such organization.

Direct Reimbursement Plans

The most recent entrant to the dental benefits market is the direct reimbursement plan. This is a self-funded benefit plan (not insurance) in which an employer pays for dental care with its own funds, rather than paying premiums to an insurance company or having a third party process claims. You, the patient, pay the full amount directly to your dentist, then get a receipt for the services, which you show to your employer. The employer reimburses you for part or all of the dental costs, depending on your specific benefits.

Some features of a direct reimbursement plan:
  • Neither you nor your employer pay monthly premiums.
  • Freedom to choose any dentist.
  • Employer's cost depends on the number of employees and benefit caps.
  • Benefits are usually capped at $500 to $1,500 annually.
Have Your Employer Help

If you aren't happy with these dental plans, or they aren't available in your area, you have another option: Ask your employer to help out. You might think it's impossible, but many insurance companies have devised creative ways for employers to offer dental benefits without reaching into their own wallets. Most dental plans can be offered through what is known as a "voluntary group plan" by your employer. You and your colleagues who want to participate pay all the premiums or fees, not your employer. Your employer merely acts as the conduit through which the plan is offered.

Not only do you get access to a dental plan, but you get it at the lower-cost group rate.