Understanding dental insurance plans will help you determine what coverage you may or may not have. Each dental insurance policy is unique, so it’s important to discuss coverage details with your insurance provider and/or dentist prior to receiving services.
Four Types of Dental Insurance Plans
There are several types of dental insurance plans, but here are the four most common types:
Usual, Customary, and Reasonable, or “UCR” Programs – These types of plans allow a patient to go to the dentist of their choice, but there are limits set on each type of service, which the plan determines to be reasonable. These fees may not reflect the actual fees that your particular dentist charges.
Direct Reimbursement Programs – These plans reimburse a patient for a predetermined percentage of the total amount spent their total dental care costs, regardless of what type of treatment they receive. This type of plan also allows for flexibility in care and for the dentist you choose.
Capitation Programs – This style of plan will pay a contracted dentist a regular, fixed amount in exchange for an agreement to perform services for enrolled members (usually without additional charge to the patient other than copayment, if any.)
Schedule Allowance or Table Programs – Patients enrolled in this kind of program will receive a list of covered services along with a predetermined dollar amount that is covered. If the dentist’s usual fees are higher, the difference will typically be billed to the patient.
For many, understanding dental insurance plans can be very confusing. If you need help with your dental insurance plan benefits, refer to your employer, an insurance representative, or your dentist for a more detailed explanation.