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Florida Health Insurance |
Florida Dental Insurance
Finding a Florida dental insurance plan that will pay for all of your expensive dental work, is an exercise in futility. You need $3,000 worth of dental work and you want to find a company that will accept your twenty dollar monthly payment and cover all of your expenses. Keep dreaming.
The fact is, Florida dental insurance usually takes the form of a discounted fee for service plan. Meaning that each procedure is offered on a discount basis. But you still pay up front for these services.
Types of Florida Dental Insurance Plans
Dental Discount Plans
A discount plan is simply that - a discounted rate for sevices. You go to a dentis in the network and you only pay the discounted network fee. Some of these plans offer free cleanings, x-rays and exams.
The plans have schedules which the primary dentist uses to base his or her fees. Specialist that are in the network, typically offer 20-25% discounts. They are not held to a schedule.
If you use a network provider, these plans can be an excellent value and save you a lot of money. They are relatively inexpensive. Use the following link to find a discount plan in your area.
For
discount dental PPO plans click here now.
Dental
Health Maintenance Organization (DHMO)
This type of Florida dental insurance plan provides comprehensive
dental care to enrolled patients through designated provider dentists.
A Dental Health Maintenance Organization (DHMO) is a common example of
a capitation plan. The dentist is paid on a per capita (per head) basis
rather than for actual treatment provided. Participating dentists receive
a fixed monthly fee based on the number of patients assigned to the office.
In addition to premiums, patient co-payments may be required for each
visit.
I am
not a big fan of dental HMO plans and we have had clients tell us that
they were forced wait an unreasonable amount of time for appointments.
I do not offer these plans any more.
Preferred Provider
Organization (PPO)
This plan allows a particular group of patients to receive dental care from a defined panel of dentists. The participating dentist agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser. If the patient chooses to see a dentist who is not designated as a "preferred provider," that patient may be required to pay a greater share of the fee-for-service.
Pure PPO plans for individuals are not generally available. Sometimes, this type of plan can be purchased along with one of our health insurance plans.
Combo Preferred Provider Organization (PPO) & Indemnity Plans
This is the type of plan pays you or the dentist a fixed amount based on the procedure being performed. At the same time, it imposes a PPO schedule that provides a discount on all services. The discounts are reasonable but not so low as to make the dentist want to sacrifice quality. With the discount and the payment from the plan, we find that most usual services are paid for and very expensive services like root canal/crown are paid at about 50%.
If you would like to see a plan like this, click on this Florida Dental PPO Link.
A better value and a similar plan that uses a co-pay for most procedures can be found at this link - Florida Dental Co-Pay Plan. This co-pay plan does not have any annual limits.
Annual
Benefits Limitations
To help contain costs, your plan may limit your benefits
by number of procedures and/or dollar amount in a given year. In most
cases, particularly if you've been getting regular preventive care, these
limitations allow for adequate coverage. By knowing in advance what and
how much your plan allows, you and your dentist can plan treatment that
will minimize your out-of-pocket expenses while maximizing compensation
offered by your benefits plan.
Eight
Things To Consider When Choosing Your Florida Dental Insurance Plan
What looks like a bargain today may not be a good buy in the long run.
While your out-of-pocket costs are, of course, an important part of your
decision-making process when choosing a dental plan, they are not the
only criteria to use when evaluating your options. Your primary focus
should be to determine whether the coverage will satisfy your dental care
needs.
Keep in mind that certain types of Florida dental insurance plan
coverage can be expensive. Also, the types of plans offered to individuals
outside of groups are limited. These limitations might force you into
choosing one plan type over another. The following guidelines are somewhat
idealized and do not take into consideration these facts.
1. Does the plan give you the freedom to choose your own dentist or are
you restricted to a panel of dentists selected by the insurance company?
If you have a family dentist with whom you are satisfied, consider the
effects changing dentists will have on the quality or quantity of care
you receive. Because regular visits to the dentist reduce the likelihood
of developing serious dental disease, it's best to have and maintain an
established relationship with a dentist you trust.
On the
other hand, if your dentist refuses to either participate in any plan
you can buy or offer a cash discount, they have become too greedy and
you should strongly consider dumping them.
2. Who controls treatment decisions--you and your dentist or the dental
plan? Many plans require dentists to follow treatment plans that rely
on a Least Expensive Alternative Treatment (LEAT) approach. If there are
multiple treatment options for a specific condition, the plan will pay
for the less expensive treatment option. If you choose a treatment option
that may better suit your individual needs and your long-term oral health,
you will be responsible for paying the difference in costs. It's important
to know who makes the treatment decisions under your plan. These cost
control measures may have an impact on the quality of care you'll receive.
3. Does the plan cover diagnostic, preventive and emergency services?
If so, to what extent? Most dental plans provide coverage for selected
diagnostic services, preventive care and emergency treatment that are
basic for maintaining good oral health. But the extent or frequency of
the services covered by some plans may be limited. Depending upon your
individual oral health needs, you may be required to pay the dentist directly
for a portion of this basic care. Find out how much treatment is allowed
in any given year without cost to you, and how much you will have to pay
for yourself.
Every Florida dental insurance plan is different. It's your responsibility
to be informed about what your specific plan will cover. As a basis of
comparison, the following services should be covered in full, with no
deductible or patient co-payment:
- Initial Oral Examination--once per dentist
- Recall Examinations--twice per year
- Complete x-ray survey--once every three years
- Cavity-detecting bite-wing x-rays--once per year
- Prophylaxis or teeth cleaning--twice per year
- Topical Fluoride treatment--twice per year
- Sealants--for
those under age 18
4. What routine corrective treatment is covered by the dental plan? What
share of the costs will be yours? While preventive care lessens the risk
of serious dental disease, additional treatment may be required to ensure
optimal health. A broad range of treatment can be defined as routine.
Most plans cover a portion of such treatment. Patients are responsible
for the remaining costs. Examples of routine care include:
Restorative care - amalgam and composite resin fillings and stainless
steel crowns on primary teeth
Endodontics - treatment of root canals and removal of tooth nerves
Oral Surgery - tooth removal (not including bony impaction) and minor surgical procedures such as tissue biopsy and drainage of minor oral infections.
Periodontics - treatment of uncomplicated periodontal disease including scaling, root planning and management of acute infections or lesions
Prosthodontics--repair
and/or relining or reseating of existing dentures and bridges.
Understand what routine dental care is covered by the plan, and what percentage
of the costs will come our of your pocket.
5. What major dental care is covered by the plan? What percentage of these
costs will you be required to pay? Since dental benefits encourage you
to get preventive care, which often eliminates the need for major dental
work, most plans are not generous when it comes to paying for major dental
work, most plans cover less than 50 percent of the cost of major treatment.
Most Florida dental insurance plans limit the benefits--both in number
of procedures and dollar amount--that are covered in a given year. Be
aware of these restrictions when choosing your plan and as you and your
dentist develop treatment best suited for you. Major dental care includes:
Restorative care--gold restorations and individual crowns
Oral Surgery--removal of impacted teeth and complex oral surgery procedures.
Periodontics--treatment of complicated periodontal disease requiring surgery involving bones, underlying tissues or bone grafts.
Orthodontics--treatment including retainers, braces and/or diagnostic materials.
Dental Implants--either surgical placement or restoration
Prosthodontics--fixed
bridges, partial dentures and removable or fixed dentures.
6. Will the plan allow referrals to specialists? Will my dentist and I
be able to choose the specialist? Some plans limit referrals to specialists.
Your dentist may be required to refer you to a limited selection of specialists
who have contracted with the plan's third party. You also may be required
to get permission from the plan administrator before being referred to
a specialist. If you choose a plan with these limitations, make sure qualified
specialists are available in your area. Look for a plan with a broad selection
of different types of specialists.
7. Can you see the dentist when you need to, and schedule appointment
times convenient for you? Dentists participating in closed panel or capitation
plans may have select hours to see plan patients. They may schedule appointments
for these patients on given days, or at specified hours of the day, restricting
your access. Some dentist's fees for seeing you on weekends or during
emergencies are high than those the plan allows. You may be required to
pay additional costs yourself. If you select these types of plans, have
a clear understanding of your dentist's policies as well as the plan's
dentist-to-patient ratio. It's the best way to ensure your access to care
is not unduly restricted and that you are not surprised by higher fees
the plan does not cover.
8. Will the Florida dental insurance plan provide benefits to patients
who may also be covered by another dental plan? It is not unusual to be
eligible for dual benefits. You may be covered under your company's plan
as well as under that of your spouse's employer. In analyzing your options,
make sure to look for a plan that allows coordination of benefits.
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