Momentum - Business to Business Online Magazine April 2017 | Page 21

By: Shari Ferguson, J Macpherson Financial Services, LLC
Dental care has been shown to have a direct effect on a human (and animal’s) well-being. It is important to have teeth
and gums checked for diseases early before they have a chance to get into the blood stream and affect the heart or other
organs. Toothaches can also affect what we eat as it is harder to eat those raw veggies if your teeth hurt.
How Affordable Care Act Affected Dental Insurance
The Affordable Care Act (aka “Obamacare”) legislation addressed the need to add dental care for those under the age
of 18. If you purchased a health insurance plan that is ACA-compliant, you automatically enrolled in dental insurance for
children under 18 even if you have no children. It is part of the premium you are paying for your health insurance plan. Be
sure to check your plan or call your agent to see what coverage you may already have for your children with your health
plan.
But, what if you are not under 18 or you have children that are older than 18? Then, you will need to purchase a dental
insurance plan separately from your health insurance. You can purchase this as an add-on product and pay for it at the
same time as your health insurance, or you can purchase from an entirely different company. So, what types of dental
insurance plans are available?
Dental Indemnity Plans
Dental Indemnity Plans are not dental insurance. They are plans which specify how much you will pay for specific treatments
that you may need. You know before the procedure is done exactly how much you will be paying. The Dental Indemnity
Plans usually require you to go to specific dentists or facilities which have agreed to accept the procedure prices. Some
of these plans are offered by facilities with multiple locations and your plan is accepted at all of those locations. The
advantage of the indemnity plan is that you know exactly how much each procedure costs. However, there may be a
procedure that you will need that will not be covered on the plan, such as orthodontics, or implants. Be sure to know
what restrictions are on the plan.
Dental Insurance – HMO Plans
Dental Insurance HMO plans work basically the same as Health Insurance HMO plans. You must go to the dentists and
facilities that are on the plan, and the insurance covers the cost with little or no copay on your part. These plans will specify
which procedures are never covered. Procedures which may or may not be covered include things like orthodontics,
dentures, or implants. They will also specify how many times during a year that they will cover cleanings, x-rays, etc. The
policy will most likely have an annual maximum limit of coverage (see below).
Dental Insurance – PPO Plans
Dental insurance PPO plans will allow you to go to any dentist or facility that agrees to take your insurance. Unlike health
insurance policies, most, if not all, dental polices have a maximum limit of coverage. In a given year, they will only cover a
specific dollar amount of claims. It is important to look at this limit before you make your purchase. If you do not use all
of the coverage, the amount you did not use will not be rolled into the limit for next year. So, it’s called “use it or lose it”.
It is also important that you understand any restrictions that may be on the policy for certain procedures. For example, it
may require you to wait 6 months or a year before the policy will cover a specific procedure. This prevents someone for
purchasing a policy for just one expensive procedure and then dropping it again.
As with the HMO plans, there may be certain items which will not be covered. Be sure and check on orthodontics,
dentures, implants, etc if you feel that you will need these procedures during the time you have the policy. Also, you most
likely will have a full
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