Understanding dental Insurances and financing options in New York

How many times have you put off dental treatment because you do not have enough money? How many times have you had to choose cheaper treatment options for the same reason? Yes, dental treatment is in the expensive category, and you should not hesitate to talk about finances with your dentist. For timely and effective treatment there are different dental insurance plans in New York City and they are set up for all types of patients with various needs. 

Important aspects of dental insurances

You can get dental insurance on your own if you are not currently employed or your employer does not provide such benefits. In most cases, the parameters of dental insurance are negotiated separately, and then the most appropriate dental plan is chosen. This includes several parameters, among which the following important aspects can be highlighted:

  1. Maximum. It determines the amount of money that the insurance company is obligated to pay as a benefit for one year. It varies from plan to plan.
  2. Calendar or fiscal year. Most insurances run from January until December, based on the calendar year schedule. If a fiscal year is considered, however, you have to consider the beginning of the plan and the end of the plan.
  3. Amount of premiums. It depends on the plan you choose and can range from $25 to $200 per month. The choice and amount of premiums often depend on a person’s dental conditions and treatment plans. 
  4. Copayments. The insurance plan determines the extent to which dental procedures are covered. For example, dental cleanings and preventive checkups are usually covered by insurance at 100%. As for fillings and other restorative procedures, they are usually covered at 80-70%. Such major treatments as crowns or dental implants usually go at 60-40% of coverage by insurance.

In some cases, if there is a medical indication for dental veneers, the insurance may cover the cost of such treatment. However, if veneers are used for cosmetic purposes, most likely the insurance won’t cover this procedure. 

Some dental plans may also cover cosmetic dental procedures, but one must keep in mind that they are quite expensive and not every New Yorker is willing to put that kind of money into insurance.

The most popular limitations of dental insurance plans 

An insurance plan may also have some aspects (limitations), which in most cases depend on the employer’s generosity. 

  • Annual maximum. This is the maximum amount the insurance company can pay for you within a year. 
  • Procedures that are not covered by dental insurance. These usually include cosmetic procedures (teeth whitening, veneers, and sometimes implants).
  • Downgrading or alternative benefits. Some dental plans may cover the least expensive method of treatment for a particular problem. For example, insurance may cover a cheaper filling instead of a composite filling, or a metal crown instead of a ceramic crown. Most patients do decide to take advantage of the more expensive treatment option, choosing the aesthetic side of the issue. 

There are other limitations to insurance plans, but these are discussed individually when choosing the right dental plan. 

Types of Dental Insurances in New York

Choosing the right dental plan is the way to deal with future problems. If you have dental insurance, you will pay for the procedures much less, and you will be able to take care of your teeth on time. Avoid neglected cases, because then the treatment will not only be more expensive but also time-consuming. 

If you go to a dental clinic in Staten Island, you can find out in advance about the terms of your insurance plan and use this information to make the right decision about dental treatment. This way, you’ll know in advance if and how your dental treatments are covered, what the terms of your dental insurance are, and other terms and conditions. 

Preferred Provider Organization (PPO). This type of plan gives more flexibility to use in and out of network providers without a referral. However, it’s costlier and the premiums are higher. Most dentists accept this type of insurance, so you won’t have any problems choosing a provider. Most diagnostic and preventive procedures are 100% covered, so there shouldn’t be any problems with dental treatments.

Exclusive Provider Organization (EPO) is almost the same as the previous dental plan, except for one nuance. You have to choose a doctor who is a part of the network/program of insurance, otherwise the insurance won’t cover anything. 

DHMO/HMO/Medicaid. Suitable as basic preventive care when there are no obvious dental problems and complex treatments are not needed. However, there are challenges in finding the right provider, as not every doctor works with this type of insurance plan.

Dental care in the United States is not cheap. Even if it is an emergency, not everyone is willing to shell out $200 to $500 for a simple treatment or extraction of a single tooth. Dental insurance can help you save money on dental care and will provide the best conditions for treatments. The important thing is to really choose what’s right for you, based on the condition of your teeth and your plans for dental treatments. And remember, delaying the treatment is not recommended, because the more work the dentist has to do, the more expensive the services will be.