Many people are confused about the difference between dental insurance and dental payment plans — specifically, which one is worth the money. While many patients resort to insurance, some prefer payment plans. The fact is — they both have pros and cons. Insurance policies can be tricky, whereas payment plans are often full of complicated jargon, so here is an overview of both terms so you can decide which one works better for you.
What are dental insurance and dental payment plans?
Dental insurance is a type of medical insurance, designed to pay a portion of the costs associated with dental work. Don’t miss the keyword here: portion!
Dental payment plans are a type of loan taken out by patients when they can’t afford the treatment or when their insurance doesn’t cover the complete cost of the treatment.
Choosing dental insurance!
When you sign up for insurance, you will come across different plans to choose from, including dental insurance through HMOs, PPOs, and DPOs. Each plan type will have a premium linked to it, which you will pay every month to assure your coverage for the year.
HMOs and DMOs – When signing up for insurance through an HMO or DMO, you will see only an in-network provider
PPOs– Insurance through PPO may go in-network or out-of-network.
The difference in co-pays, coverage, deductibles, and maximums is completely dependent on the plan type you choose. The general breakdown is as:
Preventative: 100% (Includes x-rays, cleanings, and oral exams).
Basic: 80% (Includes fillings, periodontal maintenance/cleanings).
Major: 50% (Includes partials, crowns, fixed dentures, and implants).
Co-pay: This is the percentage or a fixed dollar amount, which is paid upfront at your dental visit. For example, 80/20-insurance pays 80% while you pay 20%.
Yearly Maximum: This amount is covered by your insurance, which usually ranges between $1000-$2000.
Deductibles: This amount is paid out of your pocket before specific coverage kicks in. It is generally $50.
Note: With insurance plans, you get what you pay for. It means if you choose a high-tier plan, you will pay more in premium, but it will have better coverage and may include out-of-network providers too.
In-Network vs Out-of-Network Providers
In-Network: You are given a list of dentists who are contracted by the insurance provider to provide dental services at a fixed rate.
Out-of-Network: You can go to any dentist who is not on the list provided by the insurance provider.
An in-network provider has contracted and set fees. They aren’t paid as much as an out-of-network provider. For example: If you go to an in-network provider for a routine cleaning, and the rate is set at $50 by your insurance provider, the dentist will get paid only $50. Whereas, if you decide to go to an out-of-network provider for a routine checkup, that charges $80 for a routine cleaning, then you might need to pay an additional amount. Why? Because, although the insurance company says they cover this service at 100%, they are accountable to pay only for what they deem “reasonable and customary” based on the amount charged by other dentists in the same geographical area. Therefore, in this case, insurance may end up picking $68, leaving $12 for you to pay to the dentist.
Choosing Dental Payment Plans!
dental patient financing comes into the picture when you are short of money to pay for the expenses of dental work. There are many third-party lenders that offer payment plans, many times at no or low interest. Some dentists also offer in-office payment plans or payment plans to their patients. Selecting the right option to get payment plans for dental work can make a huge difference in how much you end up paying for the procedure. Currently, there are three major dental payment plans options to consider:
a) Third-party lenders
Nowadays, there are tons of businesses competing online to earn your business. All you need to do is find them, perform a credit check, and see if you are eligible for the loan or not. Some lenders offer medical loans for inadequate credit as well while many are looking for borrowers with excellent credit.
The catch: In general, the dental payment plans offered by third-party lenders incur a small interest on the total amount for a short period of time. However, if you don’t pay the loan within the advised timeline, you are in trouble. The rate of interest can go as much as 30% on the balance going forward. So, if your credit score is good, and you can pay the installment easily, go for it.
b) Healthcare Credit Cards
The catch: Similar to third-party loans, if you fail to pay the amount within 12 months, the standard APR can reach as much as 29%. Also, if you have a poor credit history, don’t bother applying.
c) In-house payment plans
Many dentists offer this payment plan option through third-party lenders. Dentists consort with third-party lenders to offer their patients flexible payment options. They may or may not check your credit history; it completely depends upon the dentists. It is an ideal option for patients with less than stellar credit.
The catch: Unlike other payment plan options, it completely depends on the dentist how much interest rate should be charged after a certain period. A dentist can charge as much as 29% and as low as 10%. Good rapport with your dentist works well in this case.
Do you really need either of these two options?
This question is probably on everyone’s mind, although it completely depends upon your hygiene: Do you regularly go for exams, x-rays, and cleaning? Have great hygiene? If the answer is yes, then you are good without insurance because you will be overpaying in premiums when you could have paid $200-$400 cash for the whole year.
However, if your mouth is a hot mess, and you need extractions, crowns, fillings, etc., you definitely need insurance because treatments like these are undoubtedly creeping into the thousands. But, keep in mind that, at best, your insurance will cover $2000 per year. You could use up your insurance for some of the dental work and pay the rest out of your pocket.
In case, you don’t have enough savings or can’t afford the treatment right away, turn to the guaranteed dental financing option. But, make sure that you familiarize yourself with all the dental payment plan options and their terms, so as to avoid paying any payment plan penalties.