Dental insurance is becoming more popular as people realize that the costs involved in caring for their teeth and gums continue to rise. And many doctors are now emphasizing the need to keep your mouth and teeth clean and healthy to prevent heart disease and other serious illnesses. Dental insurance typically covers basic dental procedures that are necessary for good oral health, such as tooth exams, cleaning procedures, filling, fluoride treatment, and tooth extraction.
Currently, there are 3 main types of dental insurance that clients can choose from. PPO (Preferred Provider Organization) dental plans select network participating dentists as “preferred providers.” This means that the dentist accepts a discounted flat rate as payment in full rather than billing at their usual rate for patients, reducing costs for the insurance company.
When a patient visits a PPO dentist, they generally pay a certain percentage of the reduced fee (called coinsurance) and the plan pays the rest. PPOs generally require patients to meet a deductible and be capped on the maximum annual amount of coverage that insurance will pay for. Patients participating in PPO plans can also visit dentists who are not part of the PPO network, but the insurance plan will only pay a small portion of the fees in that case.
Dental Health Maintenance Organization (DHMO) plans, also known as prepaid plans, require the patient to choose a specific dentist or dental center to coordinate all oral health needs. If the patient needs to see a specialist, they will need a referral from their primary care dentist and may also need to obtain prior authorization.
Unlike a PPO, a typical DHMO-type plan has no deductibles or maximums. Instead, the patient pays a fixed dollar amount (“copayment”). for the treatment they receive. Diagnostic and preventive services often have no copay, making these plans very affordable. However, generally, if a patient visits a dentist who is not part of the DHMO network, the patient may be responsible for the entire bill.
Indemnity or traditional plans, also known as fee-for-service, generally offer clients the best choice of dentists. Like PPO plans, if a patient visits a network dentist, the patient pays a certain percentage for each service (called coinsurance) and the plan pays the rest. And like PPO plans, indemnity plans generally require the patient to meet a deductible and have a maximum annual amount of coverage. The difference between a fee-for-service plan and a PPO is that a fee-for-service dentist generally does not offer the discounted rate that a PPO dentist offers, which means that patients can pay more for their dental care.
Besides dental insurance, another way to save money on dental costs is through discount dental plans or reduced fee-for-service plans. These plans charge a monthly or annual fee that allows participants to obtain dental services at a discounted rate from participating dentists. Unlike insurance plans, there are generally no paperwork, annual limits, or deductibles with a dental discount plan, but patients must visit a participating dentist to receive the discount.
