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Without dental insurance, Canadians are three times more likely to skip dental visits due to the cost. With so many dental benefit plans available, each with different coverage and costs, choosing the right one can be overwhelming. But don't worry—understanding the basics can make it easier.
We will break down common dental insurance terms and explore the various types of plans. By the end, you'll be better equipped to make an informed decision about your dental coverage.
Premium: This is what you pay every month for your dental insurance. Think of it like a subscription fee. Even if you don't use dental services, you still pay this amount. Higher premiums often mean lower costs when you go to the dentist.
Deductible: This is the amount you pay out of pocket before your insurance starts to help. If your deductible is $100, you pay that first. After that, your insurance kicks in. Plans with higher deductibles usually have lower premiums.
Co-payment (or Co-pay): Co-pays are fixed amounts you pay for dental services. For example, you might pay $20 for a check-up, and insurance covers the rest. Co-pays help keep visits affordable.
Coinsurance: This is the percentage you share with the insurance company after paying your deductible. If your coinsurance is 20%, you pay 20%, and insurance covers the other 80%. For a $100 dental procedure, you pay $20, and insurance pays $80.
Annual Maximum: This is the most your insurance will pay in a year. If your annual maximum is $1,500, you cover any extra costs once your insurance has paid that amount. A higher yearly maximum can help if you need dental work.
Network: This is a group of dentists that have an agreement with your insurance. Visiting a dentist in your network usually costs less because of pre-negotiated rates. Going outside the network can be more expensive.
Waiting Period: This is the time you must wait after getting your insurance before it starts covering certain services. For example, you might have to wait six months for a filling or a year for a crown. It's important to know the waiting periods for different treatments.
Pre-authorization: This is approval from your insurance company before you get certain dental procedures. It confirms that the treatment is covered and helps avoid unexpected costs. If you don't get pre-authorization, your insurance might not pay for the service.
UCR (Usual, Customary, and Reasonable): This is the amount your insurance will pay for a service based on what is usually charged in your area. You might have to pay the difference if your dentist charges more than the UCR. Knowing the UCR helps you understand potential extra costs.
In Canada, 54.8% of people have dental insurance through their employer, a private plan, or an affinity group.
Let's start with one of the most popular types, the Preferred Provider Organization (PPO) plan.
Preferred Provider Organizations (PPO) are popular and comprise most dental policies. These plans create a network of dentists who agree to offer services at reduced rates. When you visit an in-network dentist, you pay a percentage of the reduced fee, coinsurance, or co-pay, and the insurance covers the rest. This setup keeps your out-of-pocket costs lower.
One key advantage of PPO plans is flexibility. You can choose any dentist, but out-of-network visits may cost more.
Each PPO plan is unique, so checking the specifics with the insurance company is essential. This way, you can ensure the plan fits your needs and offers the best benefits.
Dental Health Maintenance Organizations (HMOs) offer lower-cost coverage focusing on preventive care, like cleanings and x-rays. Members pay a fixed monthly premium and must use in-network dentists to get coverage.
HMO plans have lower premiums and predictable co-payments, making them attractive for those on a budget. However, the network of available dentists is smaller compared to PPO plans, which can limit your choices.
With an HMO plan, you choose a primary care dentist from the network who manages all your dental services. Out-of-network care is typically not covered except in emergencies. Dentists in the network receive a fixed monthly payment per patient and provide certain services at reduced or no cost. This setup helps keep costs down but may require referrals for specialist care.
Discount dental plans are not traditional insurance but offer affordable dental care through discounted rates. Members pay an annual fee to access lower costs from participating dentists without dealing with deductibles, co-payments, or coinsurance.
These plans have lower premiums and involve no reimbursement paperwork. Members simply pay the discounted rates directly to the dentist.
Often offered to individuals and increasingly by employers, discount dental plans like Delta Dental Patient Direct provide a cost-effective alternative for those without dental insurance or for services not covered by traditional plans.
Indemnity plans, also known as fee-for-service plans, offer the most flexibility. You can visit any dentist you choose, and the plan pays a set percentage of the cost for each service. These plans often have higher premiums and out-of-pocket costs, but they provide more freedom in selecting your dentist.
Dental Savings Accounts allow you to set aside pre-tax money for dental expenses. This can help reduce your taxable income while saving for dental care. DSAs are often paired with high-deductible insurance plans and can be an excellent way to manage dental costs.
Managed fee-for-service plans combine elements of indemnity and managed care. You can see any dentist, but the plan negotiates fees with providers to keep costs down. This can offer a balance between flexibility and cost savings.
When evaluating dental insurance plans, many factors play into what makes a dental insurance plan great. We want the best for you, so let’s take a look at what you should look for when shopping around:
Check what range of services are covered under the plan. Look for plans that cover preventive care like routine cleanings and check-ups and more extensive dental procedures like fillings, crowns, and root canals. Some plans also cover orthodontics and cosmetic procedures. Make sure the plan meets your specific dental needs.
Review the plan's dentist network. Ensure there are dentists in your area and that you have a good selection. If you have a preferred dentist, check if they are in the network. Using in-network dentists usually lowers your out-of-pocket costs.
Consider how much flexibility you need. A PPO or indemnity plan might be better if you want the freedom to see any dentist. An HMO might be a good choice if you're okay with a smaller network for lower costs. Flexibility also includes the ability to see specialists without a referral.
Some plans have waiting periods for certain procedures, meaning you must wait a specified time before coverage kicks in. Check the waiting periods for services you might need soon, and choose a plan with shorter or no waiting periods if necessary.
Read the fine print to understand what needs to be covered by the plan. Some plans exclude specific procedures or limit the number of visits or dental treatments per year. Knowing these exclusions can help you avoid surprises and make a more informed decision.
Good customer service is essential for resolving issues quickly and effectively. Check reviews and ratings for the insurance company's customer service. Getting help when needed can make a big difference in your overall satisfaction with the plan.
Comparing dental insurance plans may seem daunting at first but don’t worry! It’s easier than it looks, let’s jump in to the steps you’ll need to take:
Identify Your Needs: List your dental care needs, such as routine check-ups, fillings, crowns, or orthodontics. Focus on plans that cover these services.
Research Plan Options: Look into different types of dental plans, such as PPOs, HMOs, indemnity plans, and discount plans. Understand the pros and cons of each type.
Compare Coverage: Check what services each plan covers. Ensure they include preventive care, significant procedures, and additional benefits.
Evaluate Costs: Look at the total cost of each plan, including:
- Monthly premiums
- Deductibles
- Co-payments
- Coinsurance
- Annual maximums
Add these up to see which plan fits your budget. Remember that a lower premium might mean higher out-of-pocket costs when you need care.
Check the Network: Review each plan's dentist network. Ensure there are dentists near you and that your preferred dentist is on-network.
Consider Flexibility: Decide how much flexibility you need. PPOs and indemnity plans offer more choices, while HMOs usually have lower costs but limited networks.
Look at Waiting Periods: Compare waiting periods for different procedures. Choose a plan with shorter waiting times if you need immediate care.
Review Exclusions and Limitations: Understand what each plan excludes and any coverage limits. Choose a plan with fewer restrictions that affect you.
Read Reviews and Ask for Recommendations: Check online reviews and ask your friends, family, or dentist for recommendations. Real-life experiences can help guide your choice.
For those looking for an easy and efficient way to secure dental insurance, PolicyMe offers a great solution. PolicyMe is a Canadian digital life insurance platform designed to make financial protection for families simple and affordable.
We make getting a quote and applying for health and dental insurance easy. You can get a quote in just 30 seconds and complete your application in 5 minutes.
You can apply online, either with the help of a phone advisor or on your own, making it a convenient option for securing the dental coverage you need.
There's a plan for everyone, every budget, and every need.
- When choosing a dental insurance plan, key factors include coverage, network, flexibility, waiting periods, exclusions, and customer service.
- Various dental insurance plans, such as PPOs, HMOs, and discount plans, offer different levels of coverage and costs.
- Discount dental plans and indemnity plans provide alternatives for those seeking lower premiums or more freedom in choosing dentists.