Dental
8 Types of Dental Insurance Plans
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: CoveredX-rays: CoveredExtractions: CoveredFluoride treatments: CoveredSealants: Covered up to one time per yearFillings: 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 plansDental 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 plansTable 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.
