Dental Insurance Maryland

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 Everything You Need to Know about Dental Insurance Maryland

Overview

Dental health is essential for proper hygiene as well as beauty. Dental insurance cover makes it possible to have peace of mind despite the possible risks that may affect this important part of the body. Unfortunately, most people in Maryland do not understand the nitty-gritty of this coverage. This guide covers all the basic information about dental insurance in Maryland.

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Dental Insurance versus Dental Benefits

A common assumption is that dental health included in medical insurance. The confusion arises from the phrase “dental benefits” that is found in health insurance policies. The primary difference between the two is that the “benefits” only cover certain risks. Insurance, on the other hand, takes care of all dental needs.

So how does dental insurance work?

What Does it Cover?

Dental insurance in Maryland policies cover all three aspects of dental health. They include preventive care, basic procedures, and oral surgery. Fillings, crowns, root canals and tooth removal are some of the specific services. You can buy coverage for the entire family, yourself or employees at your firm.

Individual policies also cover periodontics such as braces, and prosthodontics that is, bridges and dentures. However, the insurance company might not pay for these within the first year of the policy and at an increased premium

Deductibles

Like most insurance policies, certain dental insurance plans require that the patient pays for a certain amount of the cost before the insurance company pays. It varies from policy to policy and from one organization to another. The amount is called a deductible.

Take, for instance, a policy that has a $200 deductible. If you have to undergo a dental procedure that requires $190, you will cover the cost at your expense. However, if the cost is $500, then you will settle the first $200. Your policy provider will settle the remaining $300 provided it is within the insured amount.

Waiting Period

Most dental insurance plans in Maryland have an average waiting period of 12 months. It is only after the lapse of this period that you can use the policy to settle the cost of your dental issues. Certain policies may, however, offer a waiting period of only 6 months. Major procedures such as x-rays, on the other hand, have a longer duration of up to 2 years.

The timing of the maturity of the dental insurance cover may also vary depending on the type of procedure. Some organizations only pay for two preventive care visits in twelve months or per the calendar year. Other services such as bridges, x-rays, and tooth extraction might be limited to once in two years or even three years.

The restriction on when the insurance can foot your dental bills is the main limitation of dental insurance policies in Maryland and all over the world.

Pre-existing Conditions

The main reason why dental insurance has a strict waiting period and specific intervals between successive payments is to minimize losses. The regulations aim at discouraging people with pre-existing conditions from enrolling for the coverage to take care of ongoing procedures.

Consequently, it might be impossible to find a dental insurance policy in Maryland if you already have a dental problem. Some organizations do not accept applicants with a missing tooth. When they do, they charge higher premiums than usual.

Cosmetic Procedures

Procedures such as teeth whitening, gum contouring, teeth shaping and veneers can significantly improve your facial beauty. Unfortunately, these procedures are not considered a medical necessity. As a result, they are never included among the services covered by a dental insurance policy.

Some, however, cover for braces, but you will pay for a special rider. Plans that do not have a rider have lengthy waiting periods.

Dispute Resolution

Insurance disputes can be costly to all the involved parties. Most dental insurance covers come with a peer review mechanism that handles disputes between the dentists, the patient, and third parties. Such a platform helps solve conflicts amicably without the costly courtroom process. It as well helps at ensuring individual case consideration, fairness and thorough investigation of treatment procedures, records, and results.

Annual Benefit Caps

Insurance companies also control the cost of dental insurance by placing caps on yearly benefits. Besides, the number of allowable procedures within a 12-month period, there are also dollar amount caps. The dollar amount limits might not be an issue if all you need is constant preventive care.

It is essential that you understand these limitations before enrolling for any policy. You can then use it to plan with your dentist on a treatment plan that minimizes out-pocket expenses while maximizing compensation.

Pre-determined Costs

The cost of different Maryland dental insurance policies is, to some extent, pre-determined. The costs vary depending on the type of program. There are four different payment programs that determine how much you pay, when and who you pay.

  • Usual, Customary Reasonable Programs UCR: It allows you to visit the dentist of your choice. However, the plan can only cover a specified percentage of what the dentist charges or a certain “customary” fee limit, whichever is less. There is little regulation in this sort of payment plan and the costs rarely reflect the dentist’s charges.
  • Direct Reimbursement: In this case, you get reimbursed a predetermined percentage of your expenses on dental care, irrespective of the category. It also allows you to seek dental help a preferred dentist
  • Capacitation program: A contracted dentist receives a monthly payment per patient or family that has enrolled on the program. The dentist agrees to offer specific treatments in return. The amount paid to the dentist is almost always less than the insured amount.
  • Table/ schedule allowance programs: It determines the dollar amount that the insurance plan will pay for each of the services lists in the table. You will cover any extra charges out of your pocket.

Find out from your insurer the program that it uses and check if it will meet your dental care needs.

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Types of Dental Insurance Plans

Dental insurance plans can be classified into three main categories; PPO, HMO, and dental indemnity. Here is an outline of each of the following plans:

  • Preferred Provider Organizations (PPO) Insurance Plans

The plan is provided by a dental insurance carrier that has a network of dentists who have signed contracts with it. The dentists in the network provide dental care to patients who have subscribed to the plan at a subsidized price. However, the patient can still opt for a dentist who is not on the network.

The flexibility of choosing a specialist of choice makes it the most popular dental insurance plan in Maryland. However, choosing a dentist out of the network raises the premium rates significantly.

 Another limitation of this plan is in its direct reimbursement payment plan. First, filling the claim is tedious. Secondly, the patient has to settle the dental care bill and then wait for reimbursement. Additional, the plan only covers a specific percentage of the fee. Such can be an inconvenience in the event of a costly dental emergency service.

  • Health Maintenance Organizations (HMO) Dental Insurance Plans

It is the cheapest dental insurance plan of the three. Like the PPO, dentists in this plan have contact with the insurance provider. They provide services to the insured members at a pre-determined rate. It is a feasible option when one needs to ensure many people at a reduced cost. Consequently, it is the most preferred by companies who seek to offer dental insurance to their employees.

In spite of its low premiums, HMO insurance plans have several limitations. Its primary disadvantage is the lack of flexibility. Unlike the PPO plans, there is no reimbursement to patients who seek treatment from a dentist who is not in the network. All patients choose a preferred dentist from a list provided by the insurance firm.

The second limitation of dental HMOs is the lack of specialized attention to patients. Dentists in the network are to meet a targeted number of patients within a specified period. As a result, some of them hurry through dental appointment to hit the mark. The arrangement adversely affects the quality of service offered by a dentist in an HMO network. Even more, the plan has a tiresome referral and claim procedures.

  • Dental Indemnity Insurance Plans

It is the most expensive of the three. Fortunately, it comes with a lot of flexibility as a patient can choose their own dentist and even change them without a referral. It also has high annual benefit limits. Individuals avoid this plan in spite of its high flexibility because of the high premiums. It is a favorite choice for companies or group insurance.

Most plans in this category pay through a direct reimbursement program. A patient settles the fee and then files a claim form. Like the other insurance claims, these may take longer to process. Additionally, it has a dollar amount limit on the amount payable. Any extra charges will be covered by the insured group or company.

Referral Dental Plan

It is not a standalone dental insurance policy.  Most carriers offer it a bonus plan to its members. A patient gets a discount for every successful referral to the network or dentist. The plan does not earn money with which one can use to pay for a service. The patient only pays less during the next dental care visit.

Factors to Consider When Choosing a Dental Plan

It is time to choose a dental insurance plan, but where do you start? Let’s condense what you have learned so far to explain the factors to consider when choosing a dental policy in Maryland

Location

Location is important as dentists within a network will charge less if the patient is located in the neighborhood. Choose for insurance plans in which the specialists in the network reside or operate in Maryland.

Who Is to Be Insured?

Do you need a dental insurance policy for an individual, family or employees? PPOs and HMO are proper insurance plans for individuals. If you need insurance for a group of workers, the HMO and indemnity insurance plans will do.

Pre-determined Cost

Do you want a plan that requires you to pay for your dental care charges and then wait for months to get reimbursed? Check out the different programs used by different carriers and go for the one that is most appropriate for you.

Need for Flexibility

Do you have a favorite dentist who unfortunately does not belong to any network? If yes, then choose an option that allows you to consult specialists outside the network. It might cost more, but it will be worth it. Otherwise, opt for the restrictive HMO plan.

Pre-existing Dental Issues

? It is important to understand your unique dental care needs in order to choose a plan correctly. For example, if you will need a brace in a year’s time, it will not be wise to select a policy that only allows for braces after two years.

The Expertise of the Dentist

You do not want a quack tampering with your dental formula. Ensure the dentists in the pre-approved list are qualified and properly regulated. Insist on seeing their qualifications.

Costs Covered and the Distribution

Does the plan cover preventive as well as emergency services, and by how much? Most dental insurance plans follow the 100-80-20 rule. That is, they cover 100 percent of the costs of preventive care, 80 percent of basic procedure and 20 percent of the cost of major dental services. Understand these specifics before buying a policy.

Timing

Ensure the duration it takes for you to be eligible for various dental care services are properly stipulated. Then figure out if they are convenient for you.

Premium Rates

Premium rates of most dental insurance policies in Maryland are not fixed. Search for a company that offers suitable coverage at a reasonable price. Do a little haggling as it always works.

Conclusion

Taking insurance for your personal dental health or that of your employees can save you from a financial catastrophe in the times of an emergency. This guide has outlined most of the information about this policy that you need to understand. Visit a firm that offers dental insurance in Maryland close to you for more information.

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