Dental > 8 Types of Dental Insurance Plans

8 Types of Dental Insurance Plans

woman holding a toothbrush

Dental insurance is a highly sought after benefit by individuals who want oral care protection through insurance. In fact, according to the U.S. Chamber of Commerce, 55% of employees say that health insurance, including vision and dental insurance, is the most important benefit they can receive on top of a good salary.

But let’s face it: Dental insurance options can be overwhelming. From indemnity plans to DMO dental plans, there are many options to choose from. So how do you know which plan is right for you?

The first step is to learn the differences between the various plans. For example, some plans require your dentist to be part of a network, while others limit maximum charges or have set fees for specific services.

Here’s a complete list of the dental insurance plan options and what they might mean to you.

1. Indemnity plans

An indemnity dental plan is a popular insurance option for the following reasons:

  • Most plans accept patients of any age.
  • Routine cleanings can be paid at 100%.
  • X-rays are typically included.
  • Coverage for basic services like fillings, sealants and extractions, as well as major services like crowns, oral surgery and implants.
  • Orthodontia options can be included in some plans.
  • Some plans have no waiting periods for benefits, with coverage beginning as soon as the next day after enrollment.
  • Some benefits and annual maximums can increase at the beginning of the second and third coverage periods - a “thank you” from the insurance company for continuing your policy.

An indemnity plan generally allows patients to choose their own dentists, but some plans are paired with a Preferred Provider Organization (PPO) network. Most plans have a maximum allowance in which the insurance company pays for each procedure, so it’s a good idea to understand what the costs and limitations are before purchasing a plan.

With indemnity plans, your insurance company pays a certain percentage of claims based on the dental procedure. For example, dental cleanings might be covered 100% twice a year because your insurance company counts it as preventive care. But your insurance carrier may only pay 60% of the cost for filling a cavity or 50% for a root canal.

Here's an example of how indemnity plans pay by procedure:

  • Cleanings: Covered, with a maximum of two cleanings per year.
  • Preventive services: Covered
  • X-rays: Covered
  • Extractions: Covered
  • Fluoride treatments: Covered
  • Sealants: Covered up to one time per year
  • Fillings: 60%
  • Root canals: 50%
  • Crowns: 50%

Your insurance company might even reward you in ways like paying a high percentage for the cost of a filling. Perks like these make it extra important to compare plans side by side to see how their benefits differ.

2. Preferred Provider Organizations (PPO)

A Preferred Provider Organization (PPO) plan is a form of indemnity insurance that uses a specific network of dentists to deliver dental services based on the insurance company’s agreement with that respective network.

In a PPO network, the dentist must accept the insurance company's pre-set fee of the plan. But dentists outside of the network may have higher or lower fees than the plan allows, so it’s important to stay in-network to avoid confusion.

You may want to avoid PPO plans in situations where you're shopping for a new plan, but your dentist isn't in network with the plan. That way, you won't have to pay out-of-network pricing or change dentists.

3. Dental Maintenance Organizations (DMO)

A Dental Maintenance Organization (DMO) is a network of dentists and specialists that are paid a fixed amount each month for any patient that has been assigned to that dentist. Think of it as a subscription service: You pay to have access to a specific service.

When you join a DMO, you’re required to see a primary dentist that has been assigned to you and typically only pay a copayment (or nothing at all) for your dental services. But If you have to see a specialist, you'll need to get a referral from your primary dentist to a specialist within the network.

DMO plans have their advantages. For one, they're predictable plans: Dentists must agree to the contracted fees negotiated between the network and the insurance company, so they can’t charge you more money for services. Plus, your out-of-pocket costs are minimized after the monthly premium.

But a limited network and the inability to see the dentist of your choice can be a disadvantage of a DMO.

4. Direct Reimbursement Plan (DRP)

These plans work like health benefit plans.

A DRP is typically self-funded and managed by your employer, which allows you to choose any dentist without being tied to a specific network. With a DRP, you'll get reimbursed for money spent on dental work with no limits.

All employers work differently, though. So one employer may reimburse you after submitting a copy of your paid invoice, while others may pay the dentist directly to help ease your out-of-pocket responsibility.

Benefits in this type of plan include:

  • No monthly premium in many cases.
  • No deductibles.
  • No waiting periods.
  • No pre-authorization required.
  • Choose any dentist with no network limitations.

5. Point of Service plans (POS)

A point-of-service dental plan can be loosely defined as a “half DMO/half PPO” plan.

Like a DMO, you can select an in-network dentist to be your primary dental care provider. But like a PPO, you can go outside of the network for other dental services, but you’d have to pay the full cost (unless the primary care dentist has made a referral to an out-of-network dentist or specialist). Then, in most cases, the plan will pay for the services.

6. Dental discount plans

Dental discount plans can be a great option for individuals who want to save money on their dental bills, but don’t want to pay for dental insurance.

As the name suggests, dental discount plans are not insurance plans. Instead, a company sells its discount plan via contract with a network of dentists and specialists. The dentists then agree to discount their dental fees by a certain percentage.

When the patient goes to a dentist in the discount network, they pay the predetermined rate and don’t have to file any dental claims. There are also no waiting periods or deductibles.

7. Exclusive Provider Organizations (EPO)

Like a DMO, exclusive provider organization plans require you to only see participating dentists within a set network of providers. There are no out-of-network benefits, so you’re responsible for the entire retail cost of your dental services if you don’t use a contracted provider within the EPO plan.

8. Table or Schedule of Allowances plans

Table plans are indemnity plans that pay a fixed dollar amount (or a percentage) for qualifying procedures, regardless of the total cost. This type of plan bases its pricing on a specific schedule based on the amount you’re charged for dental services.

The table lists the maximum amount that the plan will pay for individual procedures, which means you’re required to pay for any difference between that amount and the amoun your dentist charges for the service. If you see an out-of-network dentist, there is no limit to the amount the dentist may charge.

What dental plan is right for you?

Take the time to shop around and compare dental plan benefits, plan pricing, and dentists to choose from.

If you arm yourself with a better understanding of these plans, you can confidently purchase the best type of dental insurance - whether you need a long-term dental plan or short-term dental insurance option to fill gaps in coverage.

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Girl using her hand to shield her mouth from her dentist

5 Things To Do If Your Child Is Scared of The Dentist

Kids can be scared of new or unfamiliar things: the dark, thunderstorms, or that monster under the bed. And if you're a parent, then you likely know that your child can be just as scared when going to the dentist. In fact, researchers have found that 20% of school-age children have a serious fear of the dentist, which can come from a number of environmental or emotional causes. And it can be nerve-wracking for you as a parent. What's causing your child's fear of the dentist? Kids can be afraid of the dentist for any number of reasons. Some children pick up on a family member's fear, while others might hear stories about painful visits to the dentist. Common causes for dental fear in children include: Fear of medical professionals Fear of medical instruments or doctors’ offices Avoidance of stressful situations Emotional sensitivity or hyperactivity Painful history of dental visits The good news is: There are ways to make trips to the dentist easy on your little one (and you). So here are five simple tips and tricks to help your kids overcome their fear of the dentist. 1. Inform and communicate Believe it or not, helping your child to get over his or her fear of the dentist starts with you. Start by talking to your child about why it's important to have healthy teeth and gums, and how the dentist plays an important role in oral health. Then you can work his or her upcoming dentist appointment into the conversation. It's key not to spring the appointment on your child: That can only worsen his or her anxiety. Try to explain to your child what he or she can expect at the appointment and answer any questions along the way. Just be sure to limit the amount of details you give about the dentist: Stick to short, simple answers while avoiding words like "pain" or "hurt." Another good technique is to bring your child to watch one of your dentist appointments. If you smile and remain calm before and during your appointment, you'll show your child that the dentist isn't a scary person. But if you’re the type that gets nervous before a dentist appointment, try to control your anxiety around your children. Kids are intuitive - they can easily pick up on your nerves, and it might negatively affect their perception of the dentist. 2. Role play When in doubt, act it out: Setting up a pretend dentist office and role playing with your kids is one way to help them understand what to expect at the dentist. You can pretend to be the dentist while checking their teeth and talking about healthy teeth and gums. You can even explain how certain tools work. For example, you can talk about how the tooth polisher keeps teeth nice and clean. Again, just be sure to limit any potentially "scary" details or noises when playing dentist. You can also watch YouTube videos about the dentist with your child. Seeing his or her favorite Sesame Street or Daniel Tiger characters taking a trip to the dentist might further calm any qualms your child is having. 3. Use relaxation techniques Relaxation techniques are a great way to help your child settle down before a dentist appointment. Try doing deep breathing exercises together. Or, have your child play with a calming toy like a bubble wand, which encourages him or her to breathe deeply. 4. Distract them with toys or games Like a bubble wand, small entertaining toys can serve as beneficial distractions before (or sometimes during) your child's dentist appointment. Just be sure to ask the dentist for permission for your child to bring a toy or game to the dentist chair. Some dentists will allow it, while others may not. A skilled pediatric dentist may also be able to distract your child with fun conversation that will keep his or her mind off of what's happening in the chair. But if these options don’t work, you can come up with a game to keep their attention: Ask them to count the tiles on the ceiling or play a game of "I spy." 5. Use positive reinforcement Kids benefit greatly from positive reinforcement for good behavior. Applaud your child for his or her good behavior and bravery during the appointment. Then, you can reward your child with things like small stickers, toys or good behavior tokens. But a word of caution: Don't promise any rewards or treats to your child before appointment. This type of bribery can increase your child's fear. Keep the rewards a surprise. Other alternatives If your child is still fearful of the dentist after you've tried these tips, talk to your child's dentist about alternative options. A dentist might be able to safely sedate your child via nitrous oxide or laughing gas to ease anxiety and pain caused by dental procedures. You can also explore therapy for your child. There are plenty of skilled pediatric therapists who can help your child manage his or her fears of situations like visiting the dentist. Start dental care early Good oral habits and regular visits to the dentist are key to your child's overall health. It's recommended to get your children into the dentist by age 1 or when their first tooth appears. Your child's dentist might even teach you a thing or two about dental health tips for your child. For example, some parents don't realize that children can get cavities in their baby teeth from certain feeding methods, or that tooth decay is the most common chronic disease for children in the United States, even though it's highly preventable. Avoid "scary" dental costs by shopping for dental insurance Like dental insurance plans for adults, children can get dental insurance coverage to help curb any "scary" dental costs to you. Children’s teeth grow quickly, so it may be wise to invest in a dental care insurance plan now before bigger dental problems arise. Most dental insurance policies will offer coverage for three different categories of oral health: Preventive dental care includes diagnostic and preventive services like regular oral exams, teeth cleaning, and x-rays. It may also include fluoride treatments and sealants (plastic tooth covering to prevent decay). In many cases, dental plans include 100% of the cost of preventive care. Basic dental care includes office visits, extractions, fillings, periodontal treatment (gum disease), and root canals. Major dental care covers crowns, bridges, dentures, and inlays. (Note: Some dental insurance plans include root canals under "major" dental care, while others categorize them as "basic.") In general: Know that not all dental insurance plans are the same. Some insurance companies have smaller discounts on dental services, while others cover the full cost of preventive visits and higher percentages of the cost for other care. It's always best to be a smart consumer and shop around and compare dental insurance plans that best fit you and your family. Make sure you're getting the best care at the best price possible before you schedule your next dentist appointment for your child.

6 Ways To Lower Your Dental Costs

Do you avoid going to the dentist because you’re worried about dental costs? If so, you’re not alone. One recent survey found that 22.9% of adults didn’t plan to see a dentist in the next year, with 40% of them saying it was because of their cost concerns. Unfortunately, avoiding the dentist isn’t the best way to save money on dental care. It actually may make your dental bills higher. Here are six effective ways to keep your dental costs down. 1. Keep your oral hygiene in check Regularly brushing and flossing your teeth doesn’t just keep your breath smelling fresh. A good, consistent oral hygiene routine can also help you prevent dental problems like cavities and gum disease. For starters, it's recommended to brush your teeth twice a day with a soft-bristled toothbrush and fluoride toothpaste. Proper brushing takes about two minutes, so don’t rush it. Make sure you brush the inside, outside and chewing surface of each tooth. Many people don't floss their teeth daily even though it's a vital part of your oral health. Flossing helps you clean between your teeth and under your gum line, so don't skip it. If you have trouble using regular floss, your dentist may recommend using an interdental cleaner. 2. Protect your teeth from costly damage Fixing chipped, broken or cracked teeth can be expensive to fix. Fortunately, these costly injuries can often be prevented with some simple precautions: Avoid chewing on hard objects that could damage your teeth: Ice, hard candy, and popcorn kernels are just a few examples. Wear a well-fitting mouthguard if you play contact sports like hockey or football. 3. Don’t skip regular dental checkups Dentists generally recommend two checkups each year. But it can be tempting to skip these routine appointments, especially when you’re trying to keep dental costs down. The American Dental association says that the average dental exam costs $44.10, and adults pay another $82.08 for a dental cleaning. But these costs are well worth it: Your dentist may notice dental issues that you can't see or feel and treat them early on - whether it's finding a small cavity that hasn't become a nuisance quite yet, or spotting the early stages of gum disease. When dental problems are treated early, they tend to be easier — and less expensive — to fix. 4. Talk to your dentist about costs and payment options Talk to your dentist if you’re concerned about the costs of your dental treatment. Your dentist might have suggestions that could help lower your dental bill. For example, you can ask about completing a dental procedure in phases if you need extensive treatment. In some cases, it may be possible to break the treatment down into a few stages, which might lower your upfront cost and allow you more time to budget for the rest of the treatment. If your dentist recommends a treatment that is out of your price range, ask if there are any alternatives. Your dentist may be able to present multiple treatment options. Choosing a more affordable treatment option may help you budget for dental care. 5. Explore alternative options Prices can vary significantly from one dentist to another, even in the same area. You may be able to save money if you shop around, so get estimates from several dentists in your area. If you're financially strained, you can also look into a dental school clinic. The procedure fees are generally less expensive because dental students, rather than dentists, provide supervised dental treatments to patients. 6. Consider buying dental insurance Whether you need a long-term dental plan or a temporary dental insurance option, dental insurance provides coverage for a variety of dental treatments to help you keep your out-of-pocket costs down while keeping your teeth healthy. Dental insurance typically covers: Preventive treatments such as routine checkups and cleanings Basic procedures such as fillings, extractions, and root canals Major procedures such as crowns or bridges Though about 66.67% of Americans get dental insurance as a benefit through their jobs, you can still get an affordable dental insurance plan if you're unemployed, in between jobs or your employer doesn't offer it. But before you start shopping around for a dental plan, it’s important to understand your options. Dental preferred provider organizations (PPOs) Dental preferred provider organizations (PPOs) are the most common type of dental insurance, representing 82% of dental policies. These plans provide a network of dentists who are contracted to provide reduced-cost services to eligible patients. Dental PPO plans will generally cover the full cost of preventive care, but you may need to pay coinsurance for other types of services. For example, some plans may cover 80% of the cost of fillings, leaving you responsible for the other 20%. If you reach your plan’s annual maximum benefit, you’ll need to pay for the full cost of any additional treatments. If you sign up for a PPO, you have the freedom to see dentists that aren’t in the network. But their fees may be higher than the fees you'd see at in-network dentists. Dental health maintenance organizations (DMOs) Dental health maintenance organizations (DMOs) only make up 8% of all dental policies, so they’re not as common as PPOs. This type of plan provides a network of dentists for you to choose from. Dentists are pre-paid monthly for each patient assigned to them. So when you visit your dentist, he or she will provide the plan's contracted services at no cost or at a reduced cost, making it easier for you to budget for routine dental care. Since your primary dentist has been prepaid for your care, you won’t usually get any coverage if you decide to get treatment somewhere else. However, some DMOs offer reduced coverage for out-of-network dentists. Dental indemnity plans Dental indemnity plans, also known as traditional dental insurance, aren’t as common as they used to be because they tend to be more expensive than DMOs and PPOs. Still, they may be a good option for some people. With indemnity plans, you'll generally pay upfront for dental services and then submit a claim to your insurance company. If the service is covered, the plan will reimburse a percentage of the cost of your treatment. But unlike DMOs and PPOs, these plans don’t provide a network of dentists. This means you’re free to get treatment from any licensed dentist, which can be a major selling point for some people. Don’t be tempted to do nothing Avoiding the dentist and not buying dental insurance may be the most affordable option for you in the short term, but doing nothing may end up costing you a lot more in the long run. For example, cavities may not hurt when they're small, so you may feel like you don’t need to go to the dentist. But untreated cavities only get bigger over time, causing symptoms like tooth sensitivity, toothaches, and other problems as they grow. If you leave a cavity untreated, your dentist might recommend a crown to fix the issue. But a single porcelain crown costs an average of $1,026 - much more than the cost of the filling to treat the cavity when it was smaller. Compare dental insurance plans If you’re looking for affordable long-term or short-term dental insurance options, you don't have to go too far: You can compare plans through our site. Just enter your date of birth, gender and location to find and compare dental plans online. If you find a plan that fits your needs and budget, you can apply online - which won't take big bite out of your time or wallet.

Dental Emergency Without Insurance? Here's What To Know

After a long Saturday of errands and chores, you're excited to have a relaxing night curled up on the couch with your spouse. And now that the kids are in bed, it's time to find a new show to binge watch. You've decided on a show - and naturally, you reach for that bag of popcorn. But before you know it: You're grimacing in pain after your first few bites. You fear that you've cracked a tooth and might need a dentist. But wait: It's a Saturday night. These scenarios happen all too often. Just like medical emergencies, dental emergencies can happen anytime, anywhere, and can become very costly if you don't have dental insurance. But first: What, exactly, constitutes a dental emergency? Defining a dental emergency It's easy to tell the difference between a slightly sprained ankle and a severely broken bone: One needs some ice and support, while the other needs a trip to the ER and potential surgery. But how do you know if your teeth simply need some bonding or if you should be calling an emergency dentist? Colgate defines a dental emergency as mouth trauma that can result in gum lacerations and bleeding, a fractured or dislodged tooth, or the need for immediate medical attention. Pain is the first sign to look for in a dental emergency. Tooth or gum injuries can result in damaged nerves and blood vessels, an infection can follow shortly after. Untreated infections can spread to the head and neck resulting in serious, sometimes life-threatening, problems. When dental emergencies happen, you need to be familiar with the types and severity of common emergencies. Types of dental problems Dental emergencies come in different forms with varying degrees of seriousness. Here's a summary of six common dental emergencies - each defined by AAFP - as well as their signs, symptoms, and treatments. Abscess: A localized bacterial infection of a tooth. Pain and swelling are telltale signs of an abscess. Treatment options include a root canal or tooth extraction. Cellulitis: Occurs when a bacterial infection spreads to a tooth’s surrounding soft tissues. The affected area will be swollen and painful. Left untreated, the infection can spread to the head, neck, and lymph nodes. The patient will probably need a round of antibiotics and a root canal or tooth extraction. Pericoronitis: Occurs when the soft tissues surrounding the crown of a partially erupted tooth becomes inflamed. This typically occurs with wisdom teeth. Food debris and bacterial plaque can become trapped under the gum flap of the tooth, causing inflammation. Besides the swollen gum flap, other symptoms include pain, tenderness, and a bad taste in your mouth caused by pus oozing from beneath the gum flap. Hot, salty mouthwash paired with antibiotics might help alleviate this problem. Tooth fracture: More commonly referred to as a broken tooth, these types of fractures are solely limited to the enamel and a small amount of dentin, while other fractures will extend to the crown, root, or both. Fractures with "exposed pulp" are quite painful and should be treated quickly. Tooth luxation: Luxations mean the tooth has become dislodged from the ligaments and tissues that hold it in place. A dentist should diagnose the severity of the luxation while determining the course of treatment, which can involve a root canal in some cases. Tooth avulsion: Arguably the most serious dental emergency, a tooth avulsion is the loss of a tooth. Be careful not to touch or attempt to clean the tooth’s root. Instead, seek immediate dental care for a tooth avulsion. Costs of dental emergencies The costs can certainly make you reach deep into your wallet, especially if you don’t have dental insurance. As examples: Root canal costs depend on which tooth the procedure is being performed on: A front tooth will cost between $700 and $900, while a bicuspid can range between $800 and $950. Molars will run from $1,000 to $1,200. Dental crown costs depend on the material the crown is made of: Porcelain crowns cost between $1,200 and $1,500, while metal crowns cost between $1,200 and $1,400. Porcelain fused to metal crowns run slightly less, costing between $1,000 and $1,150. Affordable and practical payment option tips If you don't have dental insurance, here are five options for funding dental emergencies: 1. Dental savings plan A dental savings plan is not dental insurance, but can come in handy in emergency situations. Once you sign up for the plan, you gain access to a pool of participating dentists in your area. Plan members pay an annual fee that typically falls in the $100 to $200 range, and you can receive services typically within a few days of signing up. Each participating dentist offers their services at discounted rates that range from 10% to 60%. The rates are determined by a fee schedule that details the cost associated with a specific procedure. 2. Dental payment plans Financing is another option if you don’t have the immediate funds to pay for a dental emergency. Some dentists offer financing plans to their uninsured patients who might need expensive procedures. The plans tend to be no-fee financing, which simply means that you don’t pay interest. Dental payment plans allow patients to afford cosmetic procedures or those stemming from a pre-existing condition. 3. Government assistance Government resources such as Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) may be available to those who qualify. Medicare dental coverage doesn’t typically cover dental procedures, so it's wise to shop around for Medicare Advantage and supplemental plans. Medicaid provides medical benefits, including some dental benefits, to those who qualify. People age 21 and over are eligible for emergency dental services only, while those under age 21 qualify for more extensive dental coverage. The CHIP program offers medical coverage and some dental services to children up to age 19 who don’t have insurance. The specific dental services offered vary per state. 4. Emergency room visits Visiting a hospital emergency room is a temporary option for an extreme dental emergency. The ER doctors probably won’t be able to fix the dental issue, but they'll be able to treat secondary symptoms like pain or bleeding. This option will only hold you over until you can see an emergency dentist. The cost for treating those medical issues should be picked up by your health insurance though. 5. Options for lesser emergencies If your dental emergency doesn’t require immediate attention, you can try options like seeking out local dental schools, dental charities, and free dental clinics. These options may provide some dental services at a low cost or for free in some cases. Injury and accident prevention While you can’t prevent all accidents from happening, you can take some precautions to limit your risk. Mouth Healthy has three basic tips to keep your teeth intact: Wear a mouthguard when playing a sport. It only takes seconds to pop a mouthguard in, which will protect your teeth and tongue from serious injuries. Watch what you chew. Despite the temptation, don’t chew on ice cubes, popcorn kernels, and hard candy. All three can easily crack a tooth. Your teeth are for chewing, not cutting. Leave cutting to a good pair of scissors. Explore dental insurance options Though we covered some options of what to do when you have a dental emergency with no insurance, the best way to protect yourself is to just get dental insurance if you can afford it. Don't let dental emergencies chomp away at your finances: Find and compare affordable dental insurance plans in your area - whether you're looking for a long-term dental plan or temporary dental insurance option.

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