Getting the Most from Indemnity Dental Insurance

Indemnity dental insurance is a type of insurance that allows you to visit any dentist you choose, without having to worry about finding a network provider.

This freedom of choice comes at a cost, as you'll typically pay a higher premium than you would with a managed care plan.

The good news is that you can usually get reimbursed for a significant portion of your dental expenses, often up to 80% of the cost.

To get the most out of your indemnity dental insurance, it's essential to understand how the reimbursement process works.

Indemnity dental insurance is a type of plan that reimburses you for covered dental expenses, with the reimbursement amount determined by the insurance company's definition of "usual, customary and reasonable" fees.

This type of plan operates without network restrictions, allowing you to choose any dentist you prefer. In fact, indemnity plans have no network restrictions for their members, giving you the freedom to see any dentist you want.

Indemnity plans typically have a monthly premium, a deductible, and a benefit design that outlines what services are covered and what services are not. They also have waiting periods for certain procedures and an annual limit on insurance payments, known as a maximum benefit.

The reimbursement amount is based on the insurance company's definition of "usual, customary and reasonable" fees, which may or may not reflect the actual cost of dental services in your area. If a dentist's charge exceeds the rate, you'll be responsible for paying the difference.

In contrast to PPO and HMO plans, indemnity plans have a higher premium, coinsurance, and deductibles. However, they offer more flexibility in choosing your dentist.

Here's a comparison of indemnity plans with other types of dental coverage plans:

As of now, indemnity plans account for only 6% of dental plans in the United States, down from 38% 20 years ago, according to the American Dental Association.

The premium for indemnity dental insurance can vary, but it's generally around $25-$50 per month, depending on the insurance company and the plan you choose.

This cost is a significant factor to consider when selecting an insurance plan, as it can add up over time.

Your age can also impact the premium, with older individuals typically paying more.

It's worth noting that some insurance companies may offer discounts for certain groups or plans, which can help lower the premium.

Indemnity dental insurance plans offer a range of benefits, but they also come with limitations and co-payment options. You'll typically pay a flat fee for each dental visit, and there's an annual limit on coverage for dental spending.

You can choose your own dentist with an indemnity plan, as there is no network. This means you have the freedom to select the dentist you prefer.

Indemnity plans are considered fee-for-service, and payment is based on the actual cost of the dental procedure. You'll need to pay for services at the time of visit and submit a reimbursement claim to the insurance company.

Some indemnity plans have annual dollar limits, deductibles, and waiting periods, which depend on the type of dental procedure. For example, you might need to wait a certain number of months before the insurance company will pay for a specific service.

Indemnity plans typically cover a range of services, including annual exams, teeth cleanings, X-rays, fillings, and crowns. However, not all services may be covered, and there may be waiting periods or limitations on coverage.

Here are some common services covered by indemnity plans:

A deductible is the amount you must pay out of pocket before your dental insurance kicks in, and it's usually $100 or more. This is the amount you have to pay for services before your insurance company starts paying.

Some dental insurance plans don't have a deductible, which means you pay a copay or coinsurance immediately. Plans without deductibles tend to be more expensive.

Your portion of the bill after paying the deductible is called the "copayment" when it's a fixed dollar amount or "coinsurance" when it's a percentage of the bill.

A deductible is the amount you must pay out of pocket before the dental coverage kicks in. For example, if the deductible on a dental insurance plan is $100, then you have to pay the first $100 for services out of pocket.

Some dental insurance plans do not have any plan deductibles. This means you pay a copay or coinsurance immediately for services like routine dental cleaning and diagnostic X-rays.

Plans without deductibles tend to be more expensive.

Copayment is a fixed dollar amount you pay after meeting your deductible. This amount can vary depending on the level of dental coverage and the specific procedures.

Your copayment can be a significant portion of the final bill, ranging from 20% to 50% of the total cost.

The yearly maximum on a dental policy is the most that the insurance company will pay in a calendar year, typically ranging from $750 to $2,000.

You become responsible for 100% of any remaining charges once you reach the yearly maximum, unless you have a higher coverage plan with no yearly maximum.

A typical waiting period for fillings or crowns is six months, while braces or wisdom tooth removal can have a waiting period of up to two years.

Some dental services may be subject to a waiting period, during which time dental coverage does not apply, and you'll need to pay out-of-pocket for those services.

The yearly maximum is the most that the insurance company will pay in a calendar year, typically ranging from $750 to $2,000.

Generally, the more expensive the policy, the higher the yearly maximum will be. This means that if you have a more affordable policy, you may reach your yearly maximum sooner.

Once you reach the yearly maximum, you become responsible for 100% of any remaining charges unless you have a higher coverage plan with no yearly maximum.

The typical range for maximum benefits is from $1,000 to $1,500.

Waiting periods can be a real pain, but it's essential to understand how they work. Some dental services are subject to a waiting period, which means dental coverage won't apply during that time.

A typical waiting period can be six months for fillings or crowns, or up to two years for braces or wisdom tooth removal.

The length of the waiting period varies depending on the dental procedure, but six months for basic services is a common timeframe. This means you'll have to pay out of pocket for those procedures during the waiting period.

Once the waiting period is over, dental insurance will apply, and you'll be covered for those services.

Dental insurance companies often break down dental procedures into three coverage types: Preventive, Basic or Restorative, and Major. The coverage percentages and waiting periods for these types vary by insurance carrier.

Preventive services usually have little to no waiting period, but Basic or Restorative services may have a waiting period of up to six months for procedures like fillings or crowns. Major services, such as braces or wisdom tooth removal, can have a waiting period of up to two years.

The type of dental insurance plan you choose can also impact the waiting periods and coverage percentages. For example, Dental Maintenance Organization (DMO) plans have lower premiums with no deductibles and coverage restricted to in-network dentists.

Here's a breakdown of the four basic types of dental coverage plans and their characteristics:

Keep in mind that these are general guidelines and the specifics of your plan may vary. It's essential to review your policy documents to understand the waiting periods and coverage percentages for your particular plan.

When considering an indemnity dental insurance plan, it's essential to understand the network and dentist choice options. Typically, network dentists agree to accept predetermined discounted fees for their services, which can be 15-35% below out-of-network doctors.

You should check whether your dentist is part of the network to take advantage of these discounted fees. Some plans require you to go to a participating dentist, while others allow you to choose your own dentist.

To make an informed decision, find out how much more expensive it will be to visit an out-of-network dentist. Some plans pay the same benefits to any doctor, but you'll be responsible for the balance.

Let's break down the network aspect of dental insurance plans. Typically, network dentists agree to accept predetermined discounted fees for their services, which can be 15-35% below out-of-network doctors.

You might be required to visit a participating dentist, but some plans allow you to choose your own doctor. It's essential to check your plan's specifics.

Some dental plans don't have a network at all, meaning you can visit any doctor you prefer, but you'll be responsible for the balance after insurance pays its benefits.

Here's a rough idea of what you can expect in terms of fees and network participation:

Keep in mind that some plans have varying levels of network participation, so it's crucial to review your plan's details to understand what's covered and what's not.

Having the freedom to choose your dentist is a crucial aspect of an indemnity dental plan. This is because dentists, like any other professionals, vary in their quality and talent. Low-quality dental work can result in the need for later repair or necessitate further dental work.

Dentists who don't meet the highest standards can allow significant dental issues to remain undetected, which can have serious consequences for your oral health.

The quality of your dentist can affect the outcome of your dental care.

When choosing a dentist, it's essential to consider their network with your insurance provider. If your dentist is in-network, you'll likely save money on your out-of-pocket expenses.

In-network dentists have negotiated rates with your insurance provider, which means they'll charge you a lower UCR fee. For example, if your procedure costs $90, your insurance provider may have a UCR of $60, leaving you with a $30 out-of-pocket expense.

If your dentist is not in-network, you may be responsible for paying the full UCR fee. However, some insurance plans offer out-of-network coverage, but this may come with higher out-of-pocket expenses.

To find an in-network dentist, check your insurance provider's website or call their customer service. You can also ask your friends, family, or coworkers for recommendations.

Here are some key things to consider when choosing a dentist: