There are four distinct types of dental insurance and dental discount plans. The most common insurance plans are fee-for-service plans, where dentists negotiate fees with the insurer to cover a portion or percentage of the costs for major dental procedures.
DPPO Plans- Dental Insurance Preferred Provider Organizations
DPPO plans have no annual maximum limit on the amount of coverage they offer, however, you will be required to pay out of pocket for a percentage of most dental services. The annual maximum may be higher than the insured person’s co-pay. The amount of coverage can also vary between individual and group plans. Employer-provided group plans usually have a lower monthly cost than individual plans.
- Most dental insurance plans support twice-yearly visits, although they may allow for more frequent preventative care. The benefits of one plan can offset the costs of another. If you are planning to see the same dentist twice in a year, you should check your plan’s dollar and service limits. In this way, you can get the best care and work with your dentist to develop a treatment plan that works for you.
- Dental insurance policies often restrict services to those provided by a specific network, so make sure your preferred dentist is in the insurance policy’s network before you purchase the insurance plan. Also be sure to choose a dentist office who will plan your dental services to maximize your insurance benefits. In other words, if you need more dental services than your plan will cover in one year, you might be able to wait until the policy year renews to get certain services that will be covered later.
- Many plans require a waiting period before they will start paying for dental services and you may have to pay out-of-pocket for a full year before the first visit will even be covered.
Your new dental policy may not require a waiting period for specific essential services, and the services with no waiting period should be clearly listed in your policy, and you can sign up at any time! Before you purchase a policy, check with your preferred dentist’s office to see if they are in the network. Also, be sure that you understand the rules and limitations of the plan before you enroll. Do not hesitate to ask questions and be sure the insurance agent is knowledgeable, helpful, and willing to fully explain the policy coverage.
Most policies include a yearly dollar limit for major care, but others are based on lifetime limits. Some policies may only cover dentists within their network, while others will allow out-of-network services with prior authorization. In such cases, you will need to pay out-of-pocket for any dental services over this limit.
DHMO Plans – Dental Health Maintenance Organization
- DHMO plans differ from DPPO plans in that they typically do not have deductibles. Often, they offer the same basic services, but the cost of the services may differ depending on your dentist and your specific insurance policy. DHMO plans might cover major procedures with no deductible, however, the focus of DHMO plans is for preventative care. You should consider your specific dental needs and check the policy coverage carefully long before any major dental work becomes necessary. If you are looking for an individual plan, shop to find an agent who is willing to explain all your options and help you choose a plan that best covers your needs.
- While there are differences between DHMO plans, there are general rules that apply to all of them. These plans are often best for preventative care such as checkups and cleanings. If you may need more major dental work, you should carefully check the services allowed by your DHMO coverage before signing up.
Dental Indemnity Plans
Dental indemnity plans allow the policyholder to see any dental provider. There are no network restrictions. Dental indemnity plans pay a percentage of the cost for a given procedure, which means you will pay more if your dentist charges more for dental services. Since there is no network for an indemnity plan, dentists are not required to limit their fees based on a network contract. Indemnity plans typically have a deductible, an annual benefit maximum, and a waiting period for non-preventive care, just like PPO plans.
Dental Discount Plans
Dental discount plans differ from dental insurance mainly because they do not pay directly for any dental expenses. They do, however, provide discounted prices from participating dentists.
Dental discount plans usually have no deductibles, no waiting periods, and no annual maximums. The discounts can range from 10% to 60%. Typical discount plans cost as little as $100 for individuals and $150 for families annually. If you do not have dental insurance and you need dental services that cannot wait, a discount plan could save you some money on the cost of much-needed immediate dental services. Check with your dentist’s office to see if they participate in any of these plans.
The types of dental insurance available differ widely, but they all have their own limitations and benefits. Most DHMO plans, like PPO plans, have an annual maximum, which is the maximum amount you can spend on dental services in a year. Most DHMO plans work on a coinsurance system, which is a percentage of the total cost of a procedure after the deductible has been paid.
If you need to see a dentist, you should contact your primary health insurance company to find out what options, if any, are available through them before looking for a dental-specific insurance plan, such as Delta Dental, or Cigna.