WSDA Blue Self Insurance Program

It’s OPEN SEASON!

8 IMPORTANT THINGS TO CONSIDER FOR YOUR DENTAL INSURANCE  
Open Season sounds terrifying to many, yielding images of a sportsman in camo for some, but for others, it means it time to review and renew your medical and/or dental benefits options.  Having been in the dental field for almost 29 years, I can tell you with certainty that most people have no idea what they are buying!  The fine print of deductibles, percentages, and exclusions, not to mention comparing cost vs. benefit can make one comatose.

Believe it or not, our dental office can be a huge resource in helping you make a decision.  Here are some important items to consider when making your dental insurance selection: 

1. How much dental work do you usually need during the year?  

If you have a healthy mouth – i.e. – you keep up with routine care and need only an occasional filling or crown – then you MAY be paying more in premiums, deductibles and copayments than you are receiving in benefits.  Your insurance company LOVES you for this!  You’re exactly the patient that increases their profits.

2. Is this the first time you are enrolling in this employer’s plan?

Watch out for wait periods. Many plans have a wait period for non-preventative services. This can be 12 months or longer. You are paying full premium during this wait period, which your insurance company loves as their obligation to your care is minimal during this time.

3. What are the coverage percentages?

As with medical plans, dental plans are also increasing the out-of-pocket costs for enrollees. Patients often will have a copay due for preventative visits that used to be fully covered and other services may be paid at a lesser percentage than in prior years.  These changes increase your out-of-pocket cost, yet the premium has likely also increased.  Pay close attention to these percentages when reviewing plans.

4. What if I have multiple options?

Some employers offer multiple options through one or more insurance companies.  Be sure to compare what your potential out-of-pocket costs may be, not just what your premium will be.  They are offering options for a reason.  The cheapest option likely has less coverage.  In addition, some companies are much easier to contact than others, process claims faster and more accurately, etc.

5. Dual Coverage

Many patients think “the more coverage, the better”, but that’s not generally the case due to coordination of benefits. This simply means that if company #1 pays more than company#2 would have paid, then company#2 doesn’t have to pay anything….although YOU still have to pay the premium. 

 Company#2 will have an obligation to pay under the following circumstances:

a-They allow a higher $$ benefit- in which case they ONLY pay the difference

b-They pay at a higher % - in which case they will ONLY pay the difference

c-Company #1 does not cover the submitted procedure – so then company #2 pays at its normal rate.

The additional benefit is typically quite small, IF company #2 has any obligation at all.  It MAY not be enough to justify a second monthly premium. And… if your secondary coverage uses the same company as coverage #1, they often will NEVER have to pay anything on your claims, since they work from the same contract maximum.    Bottom line, having two dental insurances may not be a good financial decision.

6. Should self-employed or retired patients secure dental insurance?

Many patients think they NEED dental insurance.  In the recent past, it has been difficult to secure individual dental coverage, however more companies are beginning to offer it.  Be aware that most of these plans are quite limited.    There are two basic types:

a) Discount plans:  These are plans that you pay a monthly or annual premium for the right to discounted rates at specific participating dental offices.  The plans will seem incredibly inexpensive.  They are!  BUT….good luck finding a quality office that accepts the plan.  Dentistry is expensive to provide and most cannot work for the discounts that these plans require.

b) Individual plans through major dental carriers:  These are becoming more common, however they are not as comprehensive as their corporate offerings because the enrollment pool is smaller.  They tend to have waiting periods on major services.  Pay attention to the fine print. 

7. Pediatric Healthcare Benefit

The ACA included provisions for pediatric dental care within health plans. MANY patients are not aware of this.  The coverage is limited but DOES cover some basic preventative care, but only for children.  This coverage would be primary for children, with any additional dental coverage providing secondary benefits.  

8. WS Blue Dental Plan – Do You Really Need Dental Insurance Anyway?

If all of this information makes your head spin, or if you have a reasonably healthy mouth and are tired of the insurance red tape, please consider our in-office discount program.  We will essentially self-insure you, providing semi-annual preventive care visits at a huge discount and most other services at a 15% discount.  

Still Confused?  We are West Springfield Dental Arts, and we are here to help you!  Contact us via email at This email address is being protected from spambots. You need JavaScript enabled to view it.  or call 703-451-8332.

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West Springfield Dental Arts
6116 Rolling Road, Suite 316
Springfield, VA, 22152  USA

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