People have the misconception that dental insurance is a waste of money and time, but that is far from the truth. Dental insurance is definitely worth it. Dental insurance forces you to see your dentist at least once a year, helping you maintain healthy oral hygiene. Your employees will thank you for this since dental insurance is used at least twice a year and feel they benefit, unlike health insurance that we don’t usually use.
When purchasing dental insurance, it’s essential to focus on finding a plan that will suit your employees’ specific dental needs and provide a large dentist’s network to choose from. This is where Cosmo Insurance brokers come in to play; we will ask you an assortment of questions, especially your budget and any dentist you see and would like to continue working with. We will help you find a plan that fits your needs and allows you to see the dentist you love.
When and Why Get Dental Insurance for Your Children?
Getting health insurance when your child is born is a priority, and it should also be as important to have dental insurance.
Cavities can develop quickly even as quickly as teeth appear, so it’s important to get dental insurance as early as possible. Taking your child to a dentist will help ensure your child’s smile is off to a good start. The dentist will provide you with useful information about dental disease prevention, nutrition and dental development. Having dental insurance makes taking care of your teeth more affordable.
What to Look for in Dental Coverage?
Just like health insurance plans, dental coverage varies depending on the plan. As you compare plans, make sure to review what is and/or isn’t covered. Consider your children’s ages and yours and their needs over the next year. Look for a plan that covers all or most of the cost of preventive care; this includes exams, cleanings, and X-rays. Also, make sure the plan covers basic care like fillings and tooth extractions. Most plans cover fluoride treatments and dental sealants for cavity prevention in children but check to make sure they are included.
Health Insurance vs. Dental Insurance
Most people don’t think twice when purchasing for health insurance because they feel with health insurance they are covered for much more. When searching for health insurance, most people focus on the network coverage, not usually for a particular doctor.
Most people will not change dentists unless they move or if the dentist is no longer in business. That’s why we strongly suggest when purchasing dental coverage you should 100% focus on the dentist. If your dentist is not in your network, then that plan will not benefit you and will become a waste of money unless you have out-of-network coverage.
Dental insurance works almost the same as health insurance plans. You pay a specific monthly premium and are entitled to certain benefits, such as regular checkups, cleanings, X-rays and other services that promote general dental health. All plans are different; some will provide broader coverage and others can require more financial contribution on the individual’s part.
In-Network vs. Out-of-Network
It’s imperative to confirm your dentist is part of your insurance carrier. However, just because he/she is a part of the carrier plan doesn’t mean they accept that insurance. Every carrier has several different networks, so you must have your broker search for you, or you can go online and rely on the insurance carrier’s website.
What are UCR & MAC plans?
UCR is an acronym for a Usual, Customary and Reasonable. It refers to the fee guidelines that are used to pay claims. UCR is used for PPO plans when you visit an out-of-network doctor. It’s essential to understand what your plan’s UCR pays because it can affect your out-of-pocket cost.
MAC plan stands for Maximum Allowable Charge and can also be called a PPO fee plan. Under this plan, the reimbursement for services provided by an out-of-network dentist is capped at the MAC. For example, if you visit an out-of-network dentist who charges $150 for a cleaning, covered at 100%, but the MAC is set at $100, the insurance will cover $100, and you will be responsible for the remaining $50.
UCR and the MAC refer to the way your coverage is determined when you visit an out-of-network dentist. If you choose the MAC plan, you are wasting your time because they will pay extremely low fees to the dentist and will leave you paying way more out-of-pocket. However, if you choose the UCR plan the reimbursement fee will be very close or equal/greater to what the dentist will charge. Getting a fantastic out-of-network UCR plan will allow you to choose any dentist. Isn’t that what we all want—the freedom to choose?
It’s very important to talk to your broker to find the right plan and not to waste your money. We have lots of individuals who come to us after they chose their plan telling us they are wasting money and it’s because they didn’t have the right plan. So skip this tedious step of wasting your time. Have your broker go straight to the perfect plan for you.
Lastly, dental insurance is essential for your health; your teeth and gums will thank you for it over and over. Make the most of your smile. It’s the only one you have.
Mark Herschlag is the founder and CEO of Cosmo Insurance Agency, which is based in Ocean County. Cosmo Insurance Agency offers personalized solutions for individuals and businesses looking to obtain health, life, dental, long-term care or disability insurance.
For more information or for a free, no-obligation quote, please call (201) 817-1388 or email