Florida Dental Insurance

Finding a quality Florida dental insurance plan has just become a lot easier. Someone finally woke up and is offering various PPO options for individuals.

The higher end plan allows you to go to any dentist you want and there are no waiting periods for major work. You can get the plan this month and have a crown and a root canal next month.

You can also get a variety of discount card options for a fraction of the cost. These plans use the same national PPO networks

Florida PPO dental plan indemnity option

PPO discount dental plan option (Get 3 months Free)

Type of Florida dental insurance plans

Discount Plans or Table of Scheduled Allowances

Florida dental insurance plans using this form of benefits calculation establish a maximum dollar limit for each covered procedure, regardless of the fee charged by the dentist. If you select a plan that uses this type of table or schedule, ask how often the table is adjusted for inflation or for changes in accepted dental procedures. In these plans, the difference between the allowed charge and the dentist's fee is paid directly by the patient.

Patients should understand that contracted fee reductions listed in some plan allowance schedules can significantly diminish the level and quality of care delivered. Contracted rates are based on the size of the patient population and projections of the amount and type of treatment performed within a given time frame. Since cost control drives this payment approach, your ability to choose your dentist or see a specialist may be limited.

We have also found that there a group of dentists who are the directory of every discount plan. Patients report that the dentist always finds a way to charge for a procedure code that is not listed. Make it clear to the dentist before they start any significant work that you want to be informed of the charges and of any procedure or materials that is not listed in the schedule.

Our recommnendations in this area are to stick with a discount plan that utilizes a national network. We cannot use the network names here but you will know who they are. Go to the following web site to view a variety of these plans. For about $10 a month for an entier family, these plans represent a great value. There is a code at the top of the linked page that will get you another 10% off. PPO Discount Plans

Dental Health Maintenance Organization (DHMO)

This type of Florida dental insurance plan provides comprehensive dental care to enrolled patients through designated provider dentists. A Dental Health Maintenance Organization (DHMO) is a common example of a capitation plan. The dentist is paid on a per capita (per head) basis rather than for actual treatment provided. Participating dentists receive a fixed monthly fee based on the number of patients assigned to the office. In addition to premiums, patient co-payments may be required for each visit.

There are a number of hybrid DHMO plans where routine cleanings and fillings are covered for a small copay but more major work falls into a schedule.

Indemnity Plans

A Florida dental insurance plan of this type pays the dentist on a traditional fee-for-service basis. A monthly premium is paid by the patient and/or the employer to an insurance carrier, which directly reimburses the dentist for the services provided. Insurance companies usually pay between 50 percent and 80 percent of the dentist's fee for covered services; the remaining 20 percent to 50 percent is paid by the patient. These plans often have a pre-determined deductible, a dollar amount which varies from plan to plan, that the patient must pay before the insurance carrier will begin paying for care. Indemnity plans also can limit the amount of services covered within a given year and pay the dentist based on a variety of fee schedules.

Preferred Provider Organization (PPO)

This plan allows a particular group of patients to receive dental care from a defined panel of dentists. The participating dentist agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser. If the patient chooses to see a dentist who is not designated as a "preferred provider," that patient may be required to pay a greater share of the fee-for-service.

Annual Benefits Limitations

To help contain costs, your plan may limit your benefits by number of procedures and/or dollar amount in a given year. In most cases, particularly if you've been getting regular preventive care, these limitations allow for adequate coverage. By knowing in advance what and how much your plan allows, you and your dentist can plan treatment that will minimize your out-of-pocket expenses while maximizing compensation offered by your benefits plan.

Eight Things To Consider When Choosing Your Florida Dental Insurance Plan

What looks like a bargain today may not be a good buy in the long run. While your out-of-pocket costs are, of course, an important part of your decision-making process when choosing a dental plan, they are not the only criteria to use when evaluating your options. Your primary focus should be to determine whether the coverage will satisfy your dental care needs.

Keep in mind that certain types of Florida dental insurance plan coverage can be expensive. Also, the types of plans offered to individuals outside of groups are limited. These limitations might force you into choosing one plan type over another. The following guidelines are somewhat idealized and do not take into consideration these facts.

1. Does the plan give you the freedom to choose your own dentist or are you restricted to a panel of dentists selected by the insurance company? If you have a family dentist with whom you are satisfied, consider the effects changing dentists will have on the quality or quantity of care you receive. Because regular visits to the dentist reduce the likelihood of developing serious dental disease, it's best to have and maintain an established relationship with a dentist you trust.

2. Who controls treatment decisions--you and your dentist or the dental plan? Many plans require dentists to follow treatment plans that rely on a Least Expensive Alternative Treatment (LEAT) approach. If there are multiple treatment options for a specific condition, the plan will pay for the less expensive treatment option. If you choose a treatment option that may better suit your individual needs and your long-term oral health, you will be responsible for paying the difference in costs. It's important to know who makes the treatment decisions under your plan. These cost control measures may have an impact on the quality of care you'll receive.

3. Does the plan cover diagnostic, preventive and emergency services? If so, to what extent? Most dental plans provide coverage for selected diagnostic services, preventive care and emergency treatment that are basic for maintaining good oral health. But the extent or frequency of the services covered by some plans may be limited. Depending upon your individual oral health needs, you may be required to pay the dentist directly for a portion of this basic care. Find out how much treatment is allowed in any given year without cost to you, and how much you will have to pay for yourself.

Every Florida dental insurance plan is different. It's your responsibility to be informed about what your specific plan will cover. As a basis of comparison, the following services should be covered in full, with no deductible or patient co-payment:

- Initial Oral Examination--once per dentist

- Recall Examinations--twice per year

- Complete x-ray survey--once every three years

- Cavity-detecting bite-wing x-rays--once per year

- Prophylaxis or teeth cleaning--twice per year

- Topical Fluoride treatment--twice per year

- Sealants--for those under age 18

4. What routine corrective treatment is covered by the dental plan? What share of the costs will be yours? While preventive care lessens the risk of serious dental disease, additional treatment may be required to ensure optimal health. A broad range of treatment can be defined as routine. Most plans cover 70 percent to 80 percent of such treatment. Patients are responsible for the remaining costs. Examples of routine care include:

Restorative care - amalgam and composite resin fillings and stainless steel crowns on primary teeth

Endodontics - treatment of root canals and removal of tooth nerves

Oral Surgery - tooth removal (not including bony impaction) and minor surgical procedures such as tissue biopsy and drainage of minor oral infections.

Periodontics - treatment of uncomplicated periodontal disease including scaling, root planning and management of acute infections or lesions

Prosthodontics--repair and/or relining or reseating of existing dentures and bridges.

Understand what routine dental care is covered by the plan, and what percentage of the costs will come our of your pocket.

5. What major dental care is covered by the plan? What percentage of these costs will you be required to pay? Since dental benefits encourage you to get preventive care, which often eliminates the need for major dental work, most plans are not generous when it comes to paying for major dental work, most plans cover less than 50 percent of the cost of major treatment. Most Florida dental insurance plans limit the benefits--both in number of procedures and dollar amount--that are covered in a given year. Be aware of these restrictions when choosing your plan and as you and your dentist develop treatment best suited for you. Major dental care includes:

Restorative care--gold restorations and individual crowns

Oral Surgery--removal of impacted teeth and complex oral surgery procedures.

Periodontics--treatment of complicated periodontal disease requiring surgery involving bones, underlying tissues or bone grafts.

Orthodontics--treatment including retainers, braces and/or diagnostic materials.

Dental Implants--either surgical placement or restoration

Prosthodontics--fixed bridges, partial dentures and removable or fixed dentures.

6. Will the plan allow referrals to specialists? Will my dentist and I be able to choose the specialist? Some plans limit referrals to specialists. Your dentist may be required to refer you to a limited selection of specialists who have contracted with the plan's third party. You also may be required to get permission from the plan administrator before being referred to a specialist. If you choose a plan with these limitations, make sure qualified specialists are available in your area. Look for a plan with a broad selection of different types of specialists. If you have children, you may prefer a plan that allows a pediatric dentist to be your child's primary care dentist. Since specialized treatment is generally more costly than routine care, some plans discourage the use of specialists. While many general practitioners are qualified to perform some specialized services, complex procedures often require the skills of a dentist with special training. Discuss the options with your dentist before deciding who is best qualified to deliver treatment.

7. Can you see the dentist when you need to, and schedule appointment times convenient for you? Dentists participating in closed panel or capitation plans may have select hours to see plan patients. They may schedule appointments for these patients on given days, or at specified hours of the day, restricting your access. Some dentist's fees for seeing you on weekends or during emergencies are high than those the plan allows. You may be required to pay additional costs yourself. If you select these types of plans, have a clear understanding of your dentist's policies as well as the plan's dentist-to-patient ratio. It's the best way to ensure your access to care is not unduly restricted and that you are not surprised by higher fees the plan does not cover.

8. Will the Florida dental insurance plan provide benefits to patients who may also be covered by another dental plan? It is not unusual to be eligible for dual benefits. You may be covered under your company's plan as well as under that of your spouse's employer. In analyzing your options, make sure to look for a plan that allows coordination of benefits.

You should be entitled to either 100 percent coverage or some form of premium credit. By coordinating benefits, you can eliminate being penalized or denied coverage when the two plans have conflicting exclusions.