Insurance & Finances

Choosing dental insurance? What to know about Delta Dental

Name: Central Park West Dentistry
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If you have the opportunity to choose your dental insurance, it can be tempting to just pick the plan with the lowest premium. But your policy can affect which dentists you can see, how much your insurance helps with the cost of care, and how much flexibility you have when treatment is needed. That’s why we encourage people to look closely at their options before selecting a policy.

If you have a choice, look beyond the premium

When you compare dental plans, the monthly premium is only one piece of the puzzle. If your employer offers more than one dental plan, compare them carefully. Here are some things to look at:

What’s the annual maximum? Unlike medical insurance, where an out-of-pocket maximum generally limits what you may have to spend, a dental insurance annual maximum is the opposite. It usually limits what your insurance company will pay toward your care each year. Once your plan reaches that amount, you’re responsible for any costs for the remainder of the benefit year. Compare the annual maximums of the plans available, particularly if you expect to need more than routine preventive care.
What does the plan actually cover? “100% preventive, 80% basic, 50% major” can sound straightforward, but those percentages don’t necessarily tell you exactly what you’ll pay. Look at which procedures fall into each category, whether there are frequency limitations, and if certain care is downgraded.
Are there waiting periods or other limitations? Some plans require you to be enrolled for a certain amount of time before they’ll contribute toward particular services. Others may limit how frequently they’ll cover certain procedures or have exclusions that matter to you. A plan can look generous at first glance but be much less useful if the care you need isn’t eligible when you need it.
Does it include out-of-network benefits? Some PPO plans provide benefits both in and out of network, although they may calculate those benefits differently. Having out-of-network benefits can give you more freedom to choose your provider instead of limiting your search to an insurance company’s directory.
How does my plan determine what it will pay for out-of-network care? This is an important detail to check. Some plans base their out-of-network benefits on what’s known as usual, customary, and reasonable (UCR) fees, which take into account typical charges for dental care in a particular geographic area. Other plans use a set fee schedule that may be significantly lower than the cost of care in Manhattan. In general, plans that base out-of-network benefits on UCR fees tend to contribute more toward care at our office than plans that use a set fee schedule.
What will the plan cost you for the entire year? Don’t compare premiums alone. Look at what you’ll pay in premiums over 12 months, plus the deductible and your expected share of dental care, and weigh that against the plan’s annual maximum and benefits.

You can also tell your HR or benefits team that being able to choose from a wide range of dental providers matters to you.

Why we’re taking a closer look at Delta Dental

We regularly review the insurance plans we participate in so we can keep offering the care, time, and attention we believe everyone deserves. Delta Dental’s contracted reimbursement rates for our participating dentists have not meaningfully increased in many years, even as the cost of providing high-quality dental care has continued to rise. For example, our records show that the contracted Delta reimbursement rate for a routine cleaning remains the same as it was over a decade ago, in 2015. The inflation rate has been approximately 40% during that same period, according to the U.S. Bureau of Labor Statistics.

Currently, only two CPW Dentistry dentists participate with Delta. They’re nearing capacity, so appointments with an in-network Delta provider are not always available to new patients or those who have not previously established care with them. Delta isn’t allowing us to add additional dentists to its Premier network to accommodate more patients. We can help you understand which CPW dentists are available based on your individual insurance plan and scheduling needs.

Having Delta Dental doesn’t mean you can’t see us

This is an important distinction: having Delta Dental doesn’t always mean you need to see a dentist who is contracted with Delta. Many of our Delta Dental patients use their out-of-network benefits to see a non-contracted provider at CPW Dentistry and continue receiving care from the dentist they already know and trust. Exactly how that works depends on your individual plan. Your insurance may contribute differently when you see an out-of-network provider, but that doesn’t always translate into a significant difference in what you pay. For many of our patients, there is little or no change in their out-of-pocket responsibility! Either way, seeing a non-contracted provider doesn’t change the support you receive from us. We still submit your claims and handle all the insurance paperwork for you.

Another option: dental care without insurance

Insurance isn’t the only way to plan and budget for your dental care. For people without insurance, or anyone weighing whether a dental plan is worth it, our Care+ Membership is another option to consider. Care+ is our in-house membership program, designed to make routine preventive care predictable while offering savings on additional treatment. Depending on the membership level you choose, your monthly fee includes two, three, or four cleanings each year, along with fluoride treatments, oral cancer screenings, necessary routine x-rays, check-up exams, and emergency visits. Members also receive 20% off most general restorative treatment and 10% off Invisalign and specialist treatment. Because Care+ is a membership rather than insurance, there are no claims to submit and no annual maximums to worry about. Your care stays between you and your dental team. It can be worth comparing the premiums, coverage, limitations, and provider access of the insurance plans available to you against the cost and benefits of Care+.

Choosing dental insurance? What to know about Delta Dental