The state of Colorado’s official health care exchange is now open for business! If you plan to purchase insurance through Connect for Colorado, here are 5 things to keep in mind when making decisions on dental coverage.
1. Not All Networks on the Exchange are Created Equal
Dental insurance is delivered through contracts with local dentists. The key is how your plan contracts with dentists to get you the lowest cost and highest quality of care. Delta Dental negotiates a low cost for you with our statewide network of nearly 1,900 PPOSM dentists, and we protect you from balance-billing (the difference between what the plan pays and what the dentist charges). Lower out-of-pocket costs mean that your dental benefits go further.
In contrast, some dental carriers offer only a limited discount from the standard dental office fee, which shifts the burden of expense to the patient for costly services. And the discounts they offer may be restricted to a very narrow network of dentists.
2. Do the Math
Understand what your payment obligations are. In addition to monthly premiums, there may be cost-sharing arrangements on services. Look for a plan that encourages preventive care by covering 100% of the costs of initial exams, cleanings, X-rays, sealants and fluoride treatments. Next, look at deductibles. This is the amount that you must pay before the insurance company pays for all or a portion of the costs. Deductibles vary. Lower-priced premiums typically have higher deductible amounts. There are also out-of-pocket maximums, which means that once you have paid the out-of-pocket maximum, the insurance plan pays 100%.
If you are purchasing your dental benefits through a medical insurance carrier on the new state online insurance marketplace, look carefully at how deductibles and out-of-pocket maximums apply. For example, a deductible for a health plan might be $2,000 compared to a typical deductible for a stand-alone dental plan that ranges from $25 to $100. This means you could pay for a lot of dental costs before the medical plan starts paying 100%. That can be costly for the average family.
3. An Ounce of Prevention
Look for an insurance plan that emphasizes preventive and diagnostic care. Many people don’t realize that costly and painful dental problems can be prevented by regular visits to the dentist…even at the earliest of ages. The American Dental Association recommends that children see a dentist by age 1. Why? Dental problems such as cavities are 100% preventable. Want to learn more? Read Healthy Smiles in Childhood and Beyond.
4. Getting the Most Value
Assess your family’s unique situation. Do you have kids who are ready for braces? Might you be heading for a crown or root canal? Are implants or dentures in your future? Or are annual exams, cleanings and X-rays the extent of your dental needs? Make sure you are paying for services you need and getting the best value on those services. It’s not just about cost; it’s also about coverage that works for you.
5. Who Are You Doing Business With?
Make sure you’re working with an established company. Look at their company profile. How long have they been in business? How many years have they been specializing in dental insurance? Are they local or national? There has been a lot of consolidation in the insurance industry. How much experience your dental insurance company has processing and paying dental claims is important. You don’t want to get a notice from another company you are not familiar with that has subcontracted with your insurance company because that means dental insurance is not your insurance company’s main area of expertise.
While you’re looking at financial stability, do your insurance premiums go to a for-profit or nonprofit company? Do profits and community benefits stay in Colorado? There are several nonprofit organizations in our state that are offering products on the online insurance marketplace including Delta Dental of Colorado, Kaiser Permanente and Rocky Mountain Health Plans.
Do you have any questions? Leave them in the comments.