What dental insurance should I choose for Open Enrollment?

What dental insurance should I choose for Open Enrollment

If you have dental insurance or are looking for dental insurance in Winter Park, you know that now is Open Enrollment time! If you get dental insurance through your employer, the plans typically provide options to change or upgrade between October and November each year. The new plan will then take effect in January of 2025.

We are in-network with several dental insurance companies and want to provide some guidance if you want to use dental insurance for your visit. If everything is working great with your insurance, you can keep everything the same. We aren't making any changes on our end. All our insurance relationships remain the same as in prior years.

However, if you want to change your insurance or are provided new options with your current or existing employer, the following information might help!

We can use nearly all dental PPO plans but no dental HMO plans.*

As a reference, here are some of the most popular PPO plans our patients use (but there are many, many more):

• United Healthcare PPO

• Cigna Dental PPO (DPPO)

• Metlife PDP Plus (PPO)

• Aetna Dental PPO

• Delta Dental PPO

• GEHA Standard and High Option Plans

• Guardian PPO (DentalGuard Preferred)

• Principal PPO

• Sunlife PPO

• Mutual of Omaha PPO

 Additionally, here are some example plans that we are NOT able to use:

• Cigna DHMO

• Aetna DHMO

• DeltaCare USA (HMO)

• Sunlife HMO

• Liberty Dental

If you have questions or perhaps you have outstanding treatment that you want to be sure will be covered for next year, please give us a call. We are happy to share our experience working with dental insurance and examine your situation.

What if I have a Medicare Advantage dental plan?

We are in-network with some Medicare Advantage plans and have many, many patients with these plans who are happy with the coverage they provide. In general, the same guidance for these plans applies to employer-provided ones – in that we can use PPO plans but not any HMO plans.

Some of the most popular Medicare Advantage plans that we see here in Winter Park are:

·      United Healthcare Medicare Advantage (multiple types)

·      Aetna Dental Medicare Advantage

·      Humana Medicare Advantage (depends on the specific plan) 

Should I keep my current dental insurance?

If your dental insurance works well for you at the dentists and specialists you visit regularly, it might be best to keep everything the same. If you are looking to switch primarily for lower-cost options or lower premiums, there are a few reasons that you should consider before switching:

• If the cheaper option for dental insurance switches you from a PPO to an HMO, sometimes called "managed care," it will change the dentists you currently have access to. Due to the nature of HMO plans, we cannot use or bill any HMO policies. If you are switching to a lower-cost plan which is showing the same or better benefits, we advise you to read the detailed description and understand what the differences are. Unfortunately, we have had many patients unknowingly switch from their PPO plan to an HMO plan, only to find out their new insurance won't cover the services at their preferred dental offices.

• Some plans (particularly individually purchased plans not through your employer) have a "Waiting Period" before providing benefits on services like fillings, root canals, crowns, etc.… These "Waiting Periods" are often 6-12 months, and if you have already met that time, switching plans may reset your "Waiting Period," leading to a gap in your coverage until that new period is completed. In some situations, staying with your current coverage may be more beneficial.

• You should also consider if you have any planned / ongoing treatment. While this isn't necessarily a "deal breaker," you should be aware of any clauses in the new policy that prevent coverage for pre-existing conditions. The most common would be a "Missing Tooth Exclusion," which does not cover teeth missing before coverage. An example would be if you had a tooth extracted under “Insurance A" but then got an implant restoration to replace that tooth in the next year on "Insurance B." The new "Insurance B" might have a missing tooth exclusion, which would not be covered because it was not the policy originally covering the extraction.

Why should I switch to a new dental insurance?

There are also many good reasons you may want to switch your insurance policy. Here are several common reasons why switching may be a good idea:

• If your policy has insufficient coverage for your planned or needed procedures, you might consider switching to a plan with a higher percentage coverage (like going from 50% to 80% coverage for fillings) or a higher annual maximum (like going from $1000 to $2000 per year).

• If you are considering having some teeth straightening, such as Invisalign treatment with your Winter Park dentist.

• Many dental specialists (such as endodontics, periodontists, or oral surgeons) are considered "Out of Network" for many insurances. If your current insurance doesn’t allow for Out-of-network benefits, you might have difficulty visiting the specialists you prefer. Switching to a new plan that has benefits both In and Out of the network might be beneficial. It is standard for policies to have identical benefits regardless of whether you are visiting an in-network or out-of-network dental provider.

• Your insurance might consider our office Out of Network, but your insurance policy provides benefits regardless. In some unique cases, the insurance policy might provide the benefits but only as a reimbursement check directly to you (the patient/subscriber). This can be inconvenient for patients as this means they are paying the total cost of treatment up-front and being reimbursed later by their insurance. For example, suppose a treatment costs $1000 and is covered by insurance at 80%. In that case, a policy that does not allow payment directly to the dental office means the patient would pay $1,000 to the dental office and then receive a check for $800 in the mail 30-60 days later. Switching to a new policy that allows for payment to the dental office in and out of the network can make things easier for patients.

Conclusion

We hope the information provided helps if you are looking to change your insurance or receive new options with your current or existing employer. If you do not have insurance, we offer a dental membership plan that offers affordable options for you and your family.

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