About 156 million Americans have dental coverage, estimates Evelyn Ireland, executive director of the National Association of Dental Plans, a Dallas-based trade organization whose members include providers of managed-care and other dental plans.
Of that total, roughly 90 million have traditional indemnity plans; 60 million have managed-care plans; and 6 million operate on a referral system, going to dentists who have agreed to offer special rates, Ireland says. Referral systems, however, are not insurance plans.
People who work for large companies are most likely to have dental coverage. About 90 percent of employers with 500 or more employees offer dental benefits. Across the board, about 50 percent of companies offer dental coverage, Ireland says. The self-employed are the least likely to be covered.
Despite the growth of dental plans, many companies do not consider dental benefits as crucial as medical coverage. When companies look at what to offer employees, "Dental plans are at the bottom of the pile," says Ray Werntz, president of the Consumer Health Education Council, a Washington, D.C. organization formed by the Employee Benefits Research Institute (EBRI). Since individual dental plans are not particularly profitable for providers, few are offered.
Human-resource experts say that dental plans are more predictable in terms of expenses than medical plans. The average dental claim, according to Ireland, is just $150. Medical plans, not surprisingly, are still viewed as more crucial for employees. When a budget crunch hits a company, employers often decrease dental-plan benefits before they touch medical benefits.
How to Decipher the Plans
If you're faced with making a decision about a dental plan, it pays to educate yourself first. Start by finding out which type of plan your employer is offering, suggests James Marshall, director of the Council on Dental Benefit Programs for the American Dental Association.
Fee-for-service plans include direct-reimbursement plans, which are plans funded by individual companies. They typically reimburse employees according to money spent, not treatment type. Patients can choose any dentist.
Another fee-for-service option is an indemnity plan, in which specific payments are provided for specific services, regardless of actual charges.
Other dental plans are managed-care plans -- either preferred provider organizations (PPOs) or dental health maintenance organizations (DHMOs). PPOs allow employees to pick a dentist from a network of providers who have agreed to offer discount fees. With a DHMO, individuals see contracted dentists for services.
Some employers offer referral plans, giving workers the names of dentists who have agreed to provide care at discounted rates, but this does not qualify as true dental insurance.
What to Look for
While nearly everyone in a dental plan is covered for preventive and restorative work such as fillings, only about 70 percent of those with dental plans have orthodontia covered, according to EBRI.
How do you decide which plan is for you? "Look at the percent covered, (along with) what's covered and what's not," suggests Werntz. Determine if the plan provides for early intervention to ward off more extensive problems later, he adds.
If you have young children or teenagers, preventive care is especially important and an orthodontia benefit is ideal. If you're middle-aged, check whether the plan lets you see a periodontist (gum specialist), since gum disease becomes more common with age.
If you are offered a network plan, call the plan's customer-service number and ask how the dentists are selected, Ireland suggests. Following are some other questions worth asking:
- Did the dentists meet minimum criteria?
- If so, what were the criteria?
- Are there restrictions on changing dentists?
- Is there a formal complaint process?
- How are emergencies handled?
Premiums vary, from about $10 a month for a single person to $71 for a family, says Ireland, with managed-care plans being less expensive. Employers typically pay some or all of an employee's premium.