The world of dental insurance is very complicated and confusing. There are literally thousands of different plans available in the United States today. Most people have dental insurance benefits provided by their employers. Others do not and choose to buy it for themselves.
Much like medical insurance, dental insurance comes in a few different general types. These differences determine not only your out-of-pocket costs, but also where you can go for dental care.
PPO stands for Preferred Provider Organization and, like a medical PPO plan, includes a network of “preferred providers” who are contracted with the insurance carrier to provide dental care at a specific cost.
A PPO plan allows you to choose which dentist you would like to perform your dental care and does not require you to see a dentist who is in their network of providers. PPO plans provide some flexibility for patients who like to make their own decisions. You are not restricted to a certain dental office or even a list of offices.
Selecting a dental office that is in the insurance carrier’s network of preferred providers does give you a financial advantage because the in-network dentists are restricted to a set of fees they are allowed to charge patients for various procedures.
With a PPO plan, you can choose a dentist who is not in your insurance company’s network. You just might have to pay slightly higher fees to an out-of-network dentist.
DMO stands for Dental Maintenance Organization and is similar to HMO medical insurance plans. A DMO provides the advantage of being a lower cost solution to dental insurance.
With a DMO dental insurance plan, you do NOT get to choose which dental office to go to for dental care. The dental insurance company assigns you to a specific dental office for all of your dental needs. If you want to have a say in which dentist you go to, a DMO plan is not the right selection for you.
Typically, the benefits provided by a DMO plan are limited to the most basic dental procedures. There are also certain restrictions such as how many times you can go to the dentist in a time period.
A newer option that has arisen in recent years is a dental discount plan. This type of plan differs from typical dental insurance in that they do not pay the dental office for portions of your incurred fees. They simply negotiate contracts with dentists to provide lower fees for those people who buy their discount plan. The lower fees apply to certain procedures only; it is not a blanket discount across the board for any dental work.
It can be challenging to find dental offices currently accepting these discount plans, as they are relatively new and gaining in popularity.
A typical discount plan may charge you several hundred dollars a year and allow you to see a contracted dentist for two free professional teeth cleanings, one free set of dental x-rays, and two dental examinations each year. Some also provide a percentage discount on dental treatment, like a 25% discount on dental fillings or crowns. Each plan is slightly different.
Typically, you will receive the best benefits and the most flexibility with a PPO type plan. Unfortunately, this is also the most expensive and most difficult to obtain (usually only large employers provide group PPO plans).
It is important to understand your specific level of risk for various dental problems when selecting a dental insurance provider. If you are very high risk for gum disease and/or cavities and will need a lot of dental treatment, you need a plan that provides a lot of benefits. On the other hand, if you have never had a cavity in your life, and your professional teeth cleanings are always a piece of cake, you do not need an extensive dental insurance plan. You can choose one with minimal benefits.
That is a great question, and the answer is all across the board.
In general, traditional dental insurance plans pay for different categories of dental work at different percentages. A typical dental plan will pay for 100% of the fees for diagnostic and preventive dentistry at an in-network dental office twice each year. Preventive dentistry includes things like professional teeth cleanings, and diagnostic includes exams and dental x-rays.
Dental insurance plans pay for other categories of dental work like fillings and crowns at a different percentage. Your plan may pay for 80% of the fee for a filling to fix a cavity and 50% of the fee for a dental crown. There are LOTS of little details when it comes to dental insurance benefits.
Most dental insurance plans have a yearly maximum amount of money they will pay for your dental work. Once your dental costs pass that maximum, you are responsible for paying for the rest. If you do NOT use your dental insurance each year, you are actually wasting those benefits because they do not carry over from year to year. Use those benefits or lose them!
We are here to help! We have dental insurance experts with years of experience at each Premier Dental of Ohio location. If you cannot decipher what type of benefits you have and are not sure how to use them, let us help you.
Call your nearest Premier Dental of Ohio location today to see what type of dental benefits your insurance provides. We will help you take advantage of them by getting the dental care you need.