Because there are so many dental insurance plans to choose from, it is important to know the differences between them in order to decide which plan will work best for you. While some plans demand that you choose your services through a network provider, other plans may allow you to choose whichever dentist you like.
Other plans may also limit the amount of money you can spend on services. Many plans will also set a fee for certain services. Dental care options include preferred provider organizations, health maintenance organizations, dental indemnity insurance plans and more. If you are looking for an alternative to dental insurance, you may want to explore a dental savings plan. Finding the right dental plan involves looking at the pros and cons of each type. For more information about the differences between these plans and how they would benefit you, refer to the sections below.
PPO Insurance Plans
A preferred provider organization, also known as a PPO, is the most popular dental insurance option. They are traditionally flexible in giving members the choice of dentists and dental specialists. These plans are known to offer better services with fewer limitations than health maintenance organizations. The downside to these plans is the premiums associated with coverage. Preferred provider organizations have premiums that are usually more costly than other plans. PPO dental insurance plans are commonly used by businesses that offer them to their employees, but you can still sign up for one if you are not tied to group insurance.
Dental PPOs are care organizations that provide you with a network of contracted dentists. If you are a PPO member, then you will receive special rates on dental care and services. If you select a primary dentist or a specialist from the network, then your rates will usually be lower. While choosing a dentist within the network will give you lower rates, you still have the option of using a dentist outside of the network. Under a PPO plan, dentists within the network must abide by the rules set forth in the contract. Typically, the dentists must keep their prices within the maximum allowable range that is stated in the plan. If you decide to go with an out-of-network dental care provider, then they are not held to the same standard. These dentists can have fees that are lower or higher than your plan states, which may cost you more or help you save on dental costs.
Although preferred provider organization dental plans are flexible, there are a few limitations. Along with PPO dental premiums being higher than other dental plans, this dental insurance requires you to fill out several claims forms. As an insured member, you also can expect your reimbursements to take longer than with other plans. If you are insured with a PPO plan, then you will also have to pay your deductible before you can receive any reimbursement for services. This plan may also require you to pay your dentist copayments. Though this type of plan has downsides, it can be a good choice if you want the freedom to choose your own dentist.
HMO Insurance Plans
Dental health maintenance organizations, also referred to as dental HMOs, are typically a lot cheaper than dental PPO insurance plans and dental indemnity plans. Like PPOs, HMOs have a network of contracted dentists. However, these dentists offer services to members at predetermined rates. Another similarity to preferred provider organizations is that health maintenance organization plans are also commonly used by businesses for their employees. Although this is the case, you can still purchase a plan for yourself.
Unlike PPOs, the premium for a health maintenance insurance plan is typically quite low. However, HMOs are known to have strict limitations for their members. It is important to note that if you decide to see a dentist that is not a part of the network, then you will not be reimbursed for the money you paid out of pocket and you may have to negotiate your medical bill. If you choose to be a part of this insurance plan, then you must choose a primary dentist from a pre-approved list. Your primary dentist is the only person who can give you a referral to another dental specialist.
If you are insured under a dental HMO, then it is likely that your dentist will not be able to spend a lot of time with you. Under these plans, dentists must meet with a number of patients, so rushing is common. Complaints about drawn-out referral procedures are also common with these types of plans. While there are certain downfalls to using a dental HMO, it is still a practical option for dental insurance because of the low cost of plans.
Dental Indemnity Plans
Dental indemnity insurance plans, also known as fee-for-service insurance plans, require that you pay your dentist directly in order to receive the service you want. After you pay for the service, you will be reimbursed. In order to be reimbursed, you must submit the correct claims forms. Unfortunately, with indemnity plans, there are usually long wait times to be reimbursed by the insurance carrier. If the dentist’s fee is greater than what the plan allows, then you will be responsible for paying the difference. With a dental indemnity plan, you do have the option of choosing your dentist, changing your dentist or seeing a dentist without having a referral.
While you do have more freedom with this plan, it is not ideal if you are looking for insurance just to cover you personally. These plans are most common amongst groups needing insurance. Because of the high premiums, annual deductibles and long claims procedures, you may want to look for another type of plan if you are a single individual.
Other Insurance Plans
The aforementioned plans are just three of the most common insurance plans, but there are other options that are available including dental saving plans. For example, a direct reimbursement plan provides benefits that are based on dollars spent. This type of plan is self-funded. With this plan, you can pay your dentist directly and then give the insurance company a copy of the receipt. This will act as proof of your service or procedure. Depending on the plan you have, the insurer will either reimburse you or pay a percentage of the total costs.
There are also point of service plans. These plans request that you use an in-network dental care specialist to receive more benefits. Although in-network dentists are preferred, you can also receive services provided by out-of-network dentists with these plans.