Dental care is important to maintaining your health and appearance. For many the cost of preventive dental care keeps them away from the dentist and in danger of facing much more serious, and expensive, dental care in the future. The fact is that most biannual checkups are usually very reasonable, less than $100 each while special dental care can be costly. Even so, both biannual visits and unexpected treatments can add up quickly, especially if you have children. For many people the solution is to have a dental plan. But how do you choose a plan? If you have a plan, what does it really cover?

The basic intent behind having a dental plan is to help individuals by paying a portion of their dental care. Since most dental plans are through an employer, it is usually best to start with your plan provider if you have any questions. However, there is some information common to all plans that may be helpful.

Who Decides the Treatment?

Any decisions about treatment are to be made by you and your dentist. If you are an adult, no third party provider (insurance company) can deny you treatment. However, depending on your dental plan not all treatment may be covered. If you are weighing several treatment options, you may want to see which ones are covered by your dental plan in addition to your dentist's recommendation.

How Payments are Made

Dental plans can vary greatly as to treatments and payments covered. While not mandatory in every state, some states require employers to offer more than one dental plan so that employees can choose which is best for their situation. If you are in a position to choose between several plans, it is best to understand the various styles of coverage.

The most common form of payment is the "Direct Reimbursement" program. Under this program the dental plan reimburses the patient directly for a portion, usually a percentage, of the dental expenses incurred. This type of coverage typically covers most treatments and allows patients to choose whichever dentist they want.

The next type of payment is called "Usual, Customary, and Reasonable". These payment plans also allow patients to see whomever they want and pay a percentage of the dental costs. The difference is that this plan limits the payments to "reasonable" or "customary" fees. The downside to these plans is that what is deemed "reasonable" and "customary" can vary widely from plan to plan.

A "Table of Allowances" plan lists the amount a dental plan will pay for any procedure listed. The dental plan will pay no more than is listed. Since there is often a difference between the Table of Allowances and the actual cost of the treatment, the patient often has some out-of-pocket expenses with this type of payment plan.

PPOs (Preferred Provider Organization) are plans that have contracted with dentists to lower their fees in return for being selected for the plan. A patient must choose a dentist participating in the dental plan to receive coverage for treatment.

The final type of payment plan, "Capitation", contracts with the dentist to pay a fixed amount per patient or family. In return the dentist provides specific treatments such as cleanings or fillings. There is usually no charge to the patient for the specific treatments. However, there may be co-payments required for any other types of treatment.