If you are like the millions of Americans who don’t have dental insurance provided by an employer, you may wonder why there aren’t more “reasonable” insurance products available in the individual market. There is no shortage of individual dental plans; all medical insurance companies offer them. But after looking more closely many people conclude correctly that it just doesn’t add up. So how come? The devil is in the details.
Let’s look at three major coverage restrictions typical of most PPO dental insurance:
- Coverage limits. Most PPO plans provide a maximum benefit of $1,000 or $1,500 annually.
- Waiting periods. Typical is a one year wait for major services – no coverage provided for services like crowns and root canals in the first year of coverage.
- Limited Provider networks. Dentists must accept a much lower fee for services than their going rate so most don’t participate.
Why the restrictions? Simple…profit. For an insurance company to make a profit in the individual dental market, they must control costs to counter the adverse selection. If the preponderance of enrollees are those with major dental needs, carriers must include restrictions (coverage, timing and access) to limit their financial exposure and to forecast a profit. With premiums ranging from $30-$45 per month, it’s not difficult to calculate cost versus risk (and that’s not factoring in deductibles and copays). Those with healthy teeth requiring only basic needs can fare better by self-insuring.
Many assume that when coming off an employer based dental plan there would be comparable plans available in the individual market. But there is a major difference at work … a greater pool of enrollees. In most group plans companies must enroll a high percentage if not all of their employees to be eligible. So you have premiums from heavy consumers as well as the light consumers to cover claims. This in turn allows for higher limits, reduced waiting periods and greater provider choice.
This is not to say that individual dental insurance is always a bad value. I suggest that people consider coverage under these conditions:
- Your dentist participates in the plan (or you find one you like in the network).
- You have the potential for major services year after year. (i.e., a mouth full of fillings turning to gold crowns with root canals looming).
- Having insurance encourages you to go regularly for check-ups and cleanings.
- It provides peace of mind knowing you‘ll have some help if a major claim comes along.
Some Good News! Delta Dental, the most popular group carrier in the state, now offers dental insurance to individuals. Delta has the largest provider network with 90% of dentists participating and the highest benefit limits available (up to $3,000). For more information about this plan visit our web page: http://www.onlyhealthinsurance.com/dental-plans.html