What is a Dental Benefit?

Dental insurance is misnamed. Dental benefit is what it should be called. It’s easy to see why. Dental care is typically very predictable, involving primarily dental cleanings and oral cavity examinations. The care provided is usually not catastrophic, like a major medical expense that involves hospitalization. At this time, the Southeastern District Dental Society is not aware of any traditional indemnity insurance plans available for direct purchase by individuals.

The Georgia Dental Association encourages patients to discuss treatment options and accompanying payment options with their dentist of choice. To find a SEDDS/GDA member dentist in your area, click here.

This page offers some brief definitions of insurance terms. For more information about paying for dental care, please visit www.mouthhealthy.org, the consumer web site of the American Dental Association.

What is Indemnity Dental Coverage?

Indemnity coverage places dental procedures into categories. Each category provides coverage at different percentages. After meeting a required deductible, the plan pays either a set percent or the amount of the treatment charge determined by the plan to be customary. Typically, the patient pays any remaining balance. The customary limit may not accurately reflect the standard treatment charge of dentists in an area. This doesn’t mean that dentists overcharge for treatment. A drawback to this type of plan is that it can exclude certain procedures. However, indemnity plans allow patients to see the dentist of their choice.

What is a Preferred Provider Organization?

A PPO is a type of managed care organization which contracts with an insurance company to provide dental care to insured persons at discounted fees. Under a PPO plan, you may be required to choose a dentist from a limited list. If you see a dentist for care who is not in the plan, your benefits may be reduced or eliminated.

What is a Health Maintenance Organization?

An HMO is also a type of managed care organization. Under HMO plans, contracted dentists typically agree to provide specific types of treatment to HMO members at no charge. For some types of treatment, however, patients must pay a co-payment. Charges for other types of treatment may not be covered. Some patients may experience difficulty scheduling timely appointments if contracted dentists are busy, or if a plan's contracted dentists are not close by a patient.

Financing Dental Care in a Dental Office

A dental office may offer patients financing options for proposed dental treatment. Financing may involve the use of a credit card a patient may apply for within the dental office. If you are offered this option, make sure you understand what your monthly payment requirements will be before you decide on this option.

Typically there are two types of financing offers: No Interest and Low Interest. “No Interest” payment plans are more commonly offered by special health care credit cards. They typically give you a short time period to pay your balance (perhaps six to eighteen months). With these plans you must pay at least the monthly minimum and pay off the balance in the time offered. If you don’t interest charges will be added. “Low Interest” payment plans are typically longer term, sometimes up to five years. Payments are divided into equal monthly payments and should be paid off every month.

Make sure you understand how credit finance plans work before you decide on a specific plan. Only finance what you can afford, pay on time, and make sure you read, fully understand, and keep copies of anything you are asked to sign. Take the time to understand your options and obligations and you can improve your financial as well as your oral health.