February 12, 2005

9:29 PM

What's the difference between a dental plan and dental insurance? My employer doesn't provide any dental insurance, and I don't know which I want or why. Oh, if it matters, I'm in PA
posted by filmgeek to (3 comments total)

From my understanding, "dental plans" don't make payments directly to the dentists like insurance does. If you have a plan, you pay the dentist yourself, but at a pre-negotiated discount in accordance with the plan. The dental plans provide discounts at certain dentists for certain services. There are no claims involved. Kinda like an HMO.
posted by coolsara at 11:43 PM on February 12, 2005

Most plans (like this one) have a well-defined fee schedule so you can determine how much you're likely to save based oh the work you expect you might need. You also want to see if your dentist is 'in plan', instead of dealing with a wild card.
posted by nj_subgenius at 7:13 AM on February 13, 2005

coolsara kind-of has it (though an HMO is type of insurance, and "dental plans" are not.)

So, let's say you go to the dentist and need a crown.

A) You have no insurance, or coverage of any kind: you pay $1,000 out of pocket.

B) You have a "dental plan": You go to an in-network dentist, and pay $700 out-of-pocket. (The plan has negotiated a discount for it's members, but they don't pay any of the costs) If you go out of network, you pay full price like in scenario A.

C) You have dental insurance: You go to an in-network dentist, he charges $700 (the negotiated discount) you pay, for example, a $50 copay and 20% of the remainder, so $180, and your insurance pays the rest. (Or, if you go out of network, the insurance will pay 80% of reasonable and customary charges, and you pay the rest, but regardless, your insurance actually pays for part of the procedure)

Obviously, these numbers are all made up.
posted by antimony at 1:49 PM on February 13, 2005