Introduction to Dental Insurance Plans

The primary goal of any type of insurance plan is to protect people from financial hardships when the need arises: whether related to auto, life, health or dental problems, there is a common element in all these types of insurances.

In this article we discuss dental insurances, which protect insured individuals from unexpected dental problems, as well as offer additional services. According to American Dental Association (ADA) less than half of the population of the United States is covered by a dental insurance plan – these people mostly gain this benefit through their employer.

Similar to medical health care plans, dental insurance plans can be categorized into PPO and HMO plans. There is one big and important difference in HMO and PPO dental plans and HMO and PPO health plans which affect the way dental care providers view their patients. Put concisely, participating dentists are paid differently in HMO and PPO plans.

  • In PPO dental plans, in exchange for patient referrals from the insurance providers, dentists agree to offer lower rates to these patients. That being said, the dentists are fully paid for their services.
  • In HMO dental plans, dentists receive a predefined salary every month. This means that the less time the dentist spends on HMO patients, the more profitable this arrangement is. Clearly this has the potential of patients receiving less than ideal care: shorter visits, quicker treatments, and longer waiting times. It doesn’t have to be this way, but the potential exists.

HMO Dental Plans
HMO Dental plans are very similar to their medical counterparts and are also called Capitation Dental Insurance Plans. In this type of plan the insured person pays a monthly premium, and gets dental treatments from a given list of dental care providers when he requires them. Using a dentist that does not belong to the network will not be covered by the dental plan.

HMO dental plans cover a yearly dental exam and necessary X-rays, as well as periodical cleanings, generally for free. In addition, they partially cover more advanced dental procedures such as crowns, bridges and dentures – the rest of the cost is covered by the insured individual himself.

An additional important point is that HMO dental providers cannot turn patients away.

PPO Dental Plans
PPO Dental plans are very similar to their medical counterparts as well. These plans also offer a network of dental providers, and the insured individual is encouraged to use dentists from the list. The advantage to these plans is that the dentists offer cheaper rates for patients coming from the plan. The insured individual also has the option of going to an out of network dentist, but then he will be charged with more expensive bills (at times even significantly more) or receive fewer benefits – these can make a real difference.

The advantage of PPO plans is that that they enable the insured person to see any dentist he wants, but using a dentist that is in-network offers cheaper treatments. Furthermore, as stated before, PPO dentists are known for giving better service because of the way they are paid. An additional advantage is significantly lesser bureaucracy: normally the dentist is able to fill all the paperwork for the patient.

That being said, PPO dental plans usually require the patient to pay a deductible, normally around $50 (though some don’t require any deducible), and additionally PPO dental providers, unlike HMO dental providers, have the right to turn some patients away. Furthermore, PPO plans also tend to be fairly restrictive and offer maximum yearly coverage (often as low as $1,000, which barely covers the cost of one crown). At times there’s also a ‘life limit’, meaning, an amount in which the coverage stops afterward.

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