The word on the street is that many believe dental insurance is a waste of money and time. People have this conception that dental insurance is not worth it because it pays out very little and most dentist don’t accept it. But this is a huge misconception! We get calls from our existing dental clients about how its forces them to see their dentist twice a year and they love it because it helps them maintain positive oral hygiene.

When purchasing dental insurance, focus on finding a plan that takes your dentist or give your broker all the information and he/she will find you a plan that fits all your needs and allows you to see the dentist you love.

The larger the group, the better the rates and more options that will be included. Lately, individual plans have come out competing with business platforms, which is great!

Health Insurance vs. Dental Insurance

Most people don’t think twice when paying for health insurance because they feel with health insurance they are covered for much more, i.e., doctors, specialists, hospitalization, outpatient centers and so forth. When searching for health insurance, must people focus on the network coverage, not usually for a particular doctor.

True! Dental insurance is only used for two doctors: a dentist and an oral surgeon. 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 buying dental coverage you should 100 percent focus on the dentist. If your dentist is not in your network, then that plan will not benefit you and therefore will fit the misconception and 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 therefore are entitled to certain benefits, such as regular checkups, cleanings, X-rays and other services that strives to 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

In-Network…

It’s extremely important 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.

Out-of-Network…

What Are UCR and 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 are used for PPO plans when you visit a doctor that is out-of-network. It’s very important to understand what your plan’s UCR pays because it can affect your out-of-pocket cost.

There are three different types of fee schedules: 90th, 80th and 70 percent. This is how you’ll know how much your dental carrier will reimburse your dentist. For example, if your plan pays up to the 90th percentile, this means that 90 percent of the dentists in a given area charge that fee or less.

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 percent, but the MAC is set at $100, the insurance will cover $100 and you will be responsible for the remaining $50.

Basically, 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 for you so you don’t end up wasting your money. We have lots of individuals who come to us after they chose their plan, saying how 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, and 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.

By Mark Herschlag

For more information or for a free, no-obligation quote, please call (201) 817-1388 or email [email protected].