It’s around this time of year that everyone begins to think about renewing and comparing their health and dental insurance plans.  It would actually be beneficial to combine both plans together since they are both equally as important in achieving your best overall health.

I know that you’ve consistently heard me stress the importance of seeing your dentist twice a year, but the next question that always arises is, “How will I cover the expense of this preventative care?”  I must preface this next section by reiterating, NOT taking care of your oral health is extremely detrimental and can lead to serious health problems, so it must be made a priority! *See previous Health Alert: The Life-Threatening Diseases Your Dentist Can Identify.

So, let’s talk about DENTAL INSURANCE.

First, discuss with your dentist about feasible payment plans or check online for potentially free or less expensive dental care clinics.  Those on Medicare should be aware that the only coverage available within their Medicare plan is hospital insurance.  Medicare Part A pays only a portion of dental services in the hospital and for emergency or complicated dental procedures.

As well, states are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program (CHIP), but may choose whether to provide dental benefits for adults.

Medicaid also covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.  Dental services for children must minimally include:

  • Relief of pain and infections
  • Restoration of teeth
  • Maintenance of dental health

States have the flexibility to determine what dental benefits are provided to adult Medicaid enrollees.  While most states provide, at the very least, emergency dental services for adults, less than half of the 50 states currently provide comprehensive dental care. There are no minimum requirements for adult dental coverage.  You should still take the initiative and plan on seeing your dentist at least once a year, if you can’t do the suggested two visits.

It does behoove you to look into dental coverage because dental insurance generally follows the “100-80-50” rule, meaning:

  • Your coverage pays 100 percent of preventive and diagnostic services, including: semi-annual check-ups, cleanings, and x-rays.
  • 80 percent paid for necessary medical work, such as fillings and root canals.
  • 50 percent paid toward crowns, bridge work, and other procedures.

Since some plans might not cover the entire 50 percent for emergency operations, or other plans may not have any limits, it is important to choose the plan that best suits your needs (or gives you the most peace of mind).

The following are three types of individual dental insurance: dental maintenance organization (DMO), preferred provider organization (PPO) and indemnity plans. DMO plans restrict coverage to dental professionals within a limited network, while PPO plans allow patients to visit dentists outside the preferred network. Indemnity plans allow the most freedom of the three, as any dentist is available under this option. PPO plans are the most popular of the three because dental professionals within the preferred network often agree to accept lower fees for procedures.  Studies have shown that people with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care and experience greater overall health.

Dental insurance is also important because preventative care is often covered. This leads to saving you money and, if you do need treatment, will cost you less. The Surgeon General reports that 51 million school hours are missed each year because of children’s dental-related illnesses. Amongst adults, more than 164 million work hours are lost each year because of dental problems. Treating these problems before they become too painful or out of control, will save hours of lost work and school time. In case I haven’t stated it enough, the signs and symptoms of more than 120 medical conditions can be detected first by an oral exam of the mouth, teeth and gums, which is why the dentist’s chair is a good place to start if anything out of the ordinary should arise pertaining to your oral health.

Like I always say, “An ounce of prevention is worth a pound of cure.”

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