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Dental Insurance Information
PPO Dental Plan
Indemnity Dental Plan
HMO Dental Insurance
PPO Dental Plan (Most popular Plan)
Preferred provider organization (PPO) plans are an ideal way to receive the coverage you need without sacrificing your oral health. You can sign up right away if you don’t have access to dental coverage, and the premiums are affordable.
What is PPO Dental Insurance?
PPO plans afford you the flexibility to receive dental treatment from an extensive network of providers at a reasonable cost — and you will not have to choose a primary care dentist.
In most instances, you’ll be assessed a percentage of the bill at the time services are rendered, which is also called coinsurance. The good news is, the provider of dental care agree to a negotiated, contracted rate for services that are much lower than it would be if you didn’t have coverage, so the cost savings will be passed on to you.
You can also retain dental services from a provider outside of the network, but your out-of-pocket costs will be higher.
Types of Dental Coverage
Coverage extends to preventive care, basic procedures and major procedures. Most common dental insurance providers abide by the 100/80/50 co-insurance rule:
- Preventive care, like checkups, diagnostic services, cleanings, exams and X-rays, are 100% covered.
- Basic procedures, including medically necessary services like extractions, fillings and periodontal work, are covered at 80%.
- Major procedures, including bridges, crowns, dentures, emergency surgeries, implants and root canals, are 50% covered.
Not all plans offer coverage at the 100/80/50 co-insurance levels, though. You may be covered at a lower rate, which equates to higher out-of-pocket costs. Good idea to consult with the provider you enroll with to confirm.
Average Cost of PPO Dental Insurance
As you shop for PPO dental insurance, there are TWO types of expenses you should be mindful of — premiums and out-of-pocket costs.
- Premium, is the amount you pay each month to keep your plan active. The premiums cost per plan design, depending on coverage levels, deductibles and annual plan maximums.
- Out-of-pocket costs include:
- Coinsurance, or your portion of the dental fees. If 80:20 coinsurance applies to the service you’re receiving and the total bill is $1,000, you will be responsible pay $200 of the bill and the insurance provider will pay the remaining $800.
- Copayments, or the amount you pay before receiving treatment, are fixed and only apply to select services.
- Deductibles, or the amount you pay before your services start, assuming your coverage is not payable at 100%.
Be mindful of the annual maximum. Any fees billed for services exceeding this amount will be your sole responsibility.
Several dental insurance companies offer PPO dental plans, which could make picking the right plan for an individual or for a company somewhat challenging, so please… if your not an expert in understanding the “in’s and out’s” of Dental Insurance, please contact us today!
PPO Dental Plan information to understand before purchasing your dental plan that satisfies your service and economic wants and needs:
Consider a dental provider with flexible plan options which will to satisfy your life style within your budget.
Does the PPO plan offer coverage for preexisting conditions, or are the services excluded? Read the fine print or inquire before you enroll. The best dental insurance providers feature plans with very few exclusions, which could save you money in the long run.
It’s frustrating to purchase dental coverage only to find out a lengthy waiting period applies before you can receive services. Do yourself a favor and avoid plans with pesky waiting periods, particularly if you need basic or major procedures sooner than later.
Look for providers that do not cutback on coverage in exchange for cost savings.
Does the provider feature steep deductibles, copayments and coinsurance? Unless the premiums are low and help offset the costs you will incur, it’s probably best to shop elsewhere.
The reputation of the dental insurance provider should be another significant factor in the evaluation process. You want a provider that prides itself on exceptional customer service, affordability and rapid claims processing, just to name a few.
Indemnity Dental Plan
A dental indemnity plan, also known as “traditional” insurance, allows consumers to choose from the largest pool of dentists. Individuals with this type of dental insurance are free to visit any dentist, unlike those with managed care plans. These types of plans come in two main types. One type is called “fee for service” and one is called “managed care.” Subscribers pay their dentist’s bill in full and then submit a claim for reimbursement to the carrier.
Indemnity Plans Overview: What is indemnity dental coverage?
With a dental indemnity plan, you have the freedom to visit any dentist. Those who subscribe to this type of plan (members or patients) must pay for work in full and then submit a claim to the carrier to be repaid. In other words, the providers of indemnity dental insurance (also known as “carriers”) make payments for work only after they receive and review the dentist’s bill. The payments may be made to the plan member or to the dentist.
Thus, those with indemnity plans pay more out of pocket than subscribers to some other types of dental plans. On the other hand, compared to managed care plans, those with indemnity plans have a broader choice of dentists with whom to work.
Indemnity Dental Plan Challenges:
- With this type of plan, you must pay for services in full and send a claim form to the carrier to be repaid.
- The plan pays for work only after the carrier receives and reviews the bill. This means that patients pay more out of pocket.
- What is “usual” or “reasonable” is set by your dentist. The amount deemed “customary” is set by the plan. These two numbers do not always match.
- If the dentist’s full charge and the amount paid by insurance are not the same, you will need to pay the difference.
- These plans require a deductible and have a waiting period before the plan will pay for certain types of work.
Indemnity Dental Plan Strengths:
- This type of plan lets you choose a dentist from a larger pool than managed care plans.
- These plans usually cover a large part of your bill.
- You may complete a pre-claim before you have major work done so you will know up front how much the plan will pay.
HMO Dental Insurance
A dental health maintenance organization or DHMO is a type of “managed care.” With this type of coverage, a network of highly qualified dentists provides comprehensive and affordable care for individuals or families. Consumers choose a dentist from the network, and they pay a low monthly premium to receive services at either no cost or a reduced price (some services may require a copayment). The participating dentists receive fixed monthly fees.
HMO Dental Overview:
What is a dental health maintenance organization?
- A dental health maintenance organization (DHMO) is a structured type of dental plan. With these plans, the plan’s approved dentists provide broad and affordable care for a low monthly premium. Most of the work is done at no cost or for a reduced price. In addition, you may need to make a copayment for some types of work.
How HMO Dental Plans Work?
- With a DHMO plan, you will need to choose a primary dentist to work with. You must also let the plan provider or carrier know if you want to change your dentist. There are no waiting periods, calendar year maximums, deductibles, or claim forms when you have a DHMO plan.
The HMO plan, which is also called a “capitation plan,” is most often the least costly type of dental plan you can buy. Not that dentists need it, but DHMO plans do give them even more reason to help keep you well. When you stay well, they can avoid doing more free work.
HMO Dental Plans:
Many people look to a DHMO plan when they need work to be done in the next month that they can’t put off until the waiting period on their PPO or Indemnity plan can be met. Also, with a DHMO, it is easy for you to know the cost of work you need to have done before you go in for care. This is because DHMO services have copays. The cost of the work is not paid through coinsurance.
Other than office visits, exams, x-rays, and cleanings, the work you have done through a DHMO most often requires a copay for services. As a rule, work that is not spelled out in the plan’s summary of benefits is not covered.
If you think you may want to buy a DHMO plan, it is a good idea to be alert to some key details. For instance, those who get a DHMO plan should look at the average time people on the plan have to wait between their dental visits. Also, ask about the size of the patient pool for the DHMO plan and try to learn how many dentists serve that pool.
If you know you will need to have a special type of work done, it is also good to learn how many dental specialists take part in the plan. Your main dentist can refer you to a dental specialist, and you will get a discount for the work they do.
Lastly, get to know all of the plan’s rules about emergency dental care for when you travel or are away from home.
- Other than office visits, exams, x-rays, and cleanings, most work usually requires a copay
- Most often, plans do not cover treatments that are not spelled out in the plan’s summary of benefits
- You will have to wait a set time between dental visits
- The size of the patient pool for the DHMO plan and the number of dentists who service that pool could impact ease of use
- For work to be covered, you have to choose a primary care dentist
For more information please call: 800-624-8976
- DHMOs are good for those who need work done in the next month but who cannot wait for another plan waiting period to be met
- You will know the cost of work up front
- Provides broad and affordable care from a set group of dentists
- Dentists provide work at either no cost or a lower price
- Dentists have an added incentive to keep you well
- Most often the least costly of dental plans
- There are no waiting periods, calendar year maximums, deductibles, or claim forms
- Your main dentist can refer you to a dental specialist, and you will get a discount for their work