Understanding Dental Copay Plans: A Consumer Guide

With rising dental costs, choosing an effective plan is more important than ever. Copay plans are designed to make dental care costs predictable and manageable. Offering flexibility and choice, they are an attractive option for employers and individuals. Unlike traditional insurance plans that may involve deductibles and varying charges, copay plans simplify the process by specifying fixed upfront service costs. This guide will help you understand the features, benefits, and how these plans compare to other options like Dental Health Maintenance Organization (DHMO) plans.

What is a copay plan?

With this type of plan, all fees for procedures are listed on a fee schedule, and you will have a flat fee, also known as a copayment, to pay at your dental visit. The contracted dentist has agreed to use the plan’s fee schedule, so there are no surprises regarding costs for each service. And when visiting a non-contracted provider, you will only be responsible for the difference between the contracted amount and the insurance payment.

Features of copay plans

• Fixed copayments: Know costs upfront. Each type of dental service has a predetermined fixed copayment, which means you pay a set amount for services at the time of visit, making financial planning straightforward.
• No deductibles: There are no annual deductibles to meet before coverage starts, which helps keep out-of-pocket costs low from the beginning.
• No waiting periods: Get immediate benefits for all dental procedures without having to wait for a specific period after your plan starts.
• Budget-conscious premiums: Premiums are designed to be affordable, catering to budget-conscious consumers.
• Flexible networks: With Ameritas, you can choose from two networks, DentalSelect Gold or DentalSelect Platinum, depending on the need for broader access to dental care providers.

How copay plans pay

Copay plans operate on a simple principle: visit a contracted provider, and the plan payment is based on a fixed copayment. In other words, when you see a dentist within the network, you only pay the copayment; the plan covers the rest up to the contracted rate. If you choose to see a dentist outside the network, you are responsible for any charges above the discounted plan payment.

Comparing copay to coinsurance plans

Understanding the differences between copay and coinsurance plans is key to selecting the right coverage for your needs. Here’s a concise comparison:

• Payment structure: With a copay dental plan, you pay the set amount for each service according to a predetermined fee schedule, whereas with a coinsurance plan, you pay a percentage of the cost of services after meeting the deductible.
• Coverage for procedures: Copay and coinsurance plans cover most preventive and diagnostic procedures at a $40 copay or 100%, but coinsurance plans have more robust coverage for more expensive Type 2 and Type 3 procedures.
• Network options: Ameritas copay plans feature the DentalSelect Gold or Platinum network. Ameritas coinsurance plans feature the Ameritas Dental Network – these plans offer lower out-of-pocket costs for out-of-network services than copay plans.
• Cost difference: With a copay plan, premiums are generally more affordable, with no deductibles and no maximums.

Comparing copay to competitor DHMO plans

A copay plan is not a DHMO plan and understanding how copay plans stack up against alternatives can help you decide which is best for you.

• No deductibles or annual maximums: Both copay plans and DHMO plans offer the advantage of no deductibles and no annual maximums on benefits.
• Flexibility in provider choice: Unlike DHMOs, which require you to select a primary dentist and need referrals for specialists, copay plans offer more flexibility. You do not need to select a primary dentist and no referrals are needed for specialist care.
• Out-of-network benefits: Copay plans provide out-of-network benefits based on a contracted schedule, which DHMOs do not offer.

Maximize savings with a copay plan

Choosing a copay dental plan means opting for simplicity, affordability, and predictability in managing dental care expenses. With features like fixed copays, no deductibles, and flexible network options, these plans suit anyone looking for straightforward financial planning and immediate coverage. Keep this dental information in mind, as you find the best fit for your needs.