Dental Plans

Dental Plans Attending to the state of your dental health is one of the most important parts of attending to your overall health. Your oral health directly affects the state of your physical health, so ensuring that your teeth are healthy is essential to maintaining optimum health overall. However, just as you have to pay for other types of medical care, so do you have to pay for dental care. If you’re like most of us, you don’t always have all the money available to pay for your dental care upfront. Fortunately, there’s plenty of types of dental plans available to assist you with covering the cost of your dental care.

Types of Dental Plans
There’s numerous types of dental plans available to dental patients. Moreover, dental plans are offered by a variety of insurance companies. The type of dental plan that is best for you depends upon numerous factors, though, such as the insurance company that you choose to get insurance from, your specific dental health needs, where you’re located and so on. Generally, though, there are four different classifications of dental plans.

Dental PPO Plans
PPO is the acronym for Preferred Provider Organization. Basically, PPO plans are those that utilize a network provider system, which means that in order for your insurance company to cover the cost of your dental care, you must receive the care from a dentist who is in your provider’s preferred network. This doesn’t mean that your insurance company won’t pay anything if you choose to go to a dental provider outside its preferred network. However, the insurance company likely won’t pay as much towards covering the cost of your dental care as it would have if you had went to a preferred in-network dentist. Part of the reason for this is because PPOs have made special deals and negotiations with their in-network dentists so that they don’t have to pay as much towards the cost of dental services, which, in turn, means that you won’t have to pay as much for dental services either.

Usually, PPO plans require you to make a co-payment on the cost of your dental services. For instance, when you go to one of your PPO’s in-network dental providers, you might be expected to make a small co-payment of 20 percent towards the cost of the dental services while the insurance provider will pay the remaining 80 percent of the cost. How much your co-payment is depends upon your specific type of insurance as well as the types of dental services that you plan on undergoing. For instance, some insurance companies will require you to pay a higher percentage of costs when you choose to undergo reconstructive or cosmetic dental services than they do for you to undergo basic dental procedures. Additionally, you’re usually required to pay an annual deductible for PPO plans, and there’s also usually a cap on the amount of coverage you can receive for the coverage period.

Dental HMO Plans
Dental HMO or PPO HMO stands for Health Maintenance Organization, and dental HMO plans are the ones that require you to choose one dentist or dental office to receive all your dental treatment from before you can set up a dental plan. Also referred to as prepaid plans, HMO plans don’t require you to pay a percentage of the cost for your dental services. Instead, you’ll always have to pay a fixed amount as the co-payment for your dental treatment. Most of the time, if you have an HMO plan, preventative and diagnostic dental services don’t require any type of co-payment. Instead, the full cost of the service is covered under your dental plan.

While HMO plans can be one of the most affordable types of dental plan options, they do come with their drawbacks. Not only are you locked into getting dental treatment from the predetermined dentist or dental office, but if you do, for whatever reason (perhaps you can’t get in to see your dentist when you need to), choose to go to another dentist or dental office, then your insurance company likely won’t cover any of the cost for your dental care.

Fee-for-Service Plans
Fee-for-service plans, also referred to as indemnity dental plans and individual dental plans, are those dental plans that typically offer the patient the most flexibility on the dentist that he or she wants to visit. Whereas PPOs and HMOs require patients to go to a certain dentist or a certain group of dentists in order for the insurance company to pay, these types of dental plans don’t have a list of preferred or required dentists. Instead, you can go to any dentist that you choose, any time that you choose.

The downfall with fee-for-service plans is that they generally do not negotiate any discounts on the dentist’s normal fee. Instead, you will have to pay the dentist’s normal costs for his or her dental services. Similar to PPOs, though, you’ll have to pay a percentage for certain types of dental services, and then your insurance company will pay the rest. However, whereas PPOs won’t pay until you’ve made your co-payment, with fee-for-service dental plans, the insurance company pays the entire cost of the dental services and then sends you a bill to collect your portion of what’s owed for the services. While fee-for-service plans certainly have their benefits, they also have their drawbacks as well. They tend to have the highest premium rates, and there are still deductibles and co-payments required that are similar to those required of PPO plans.

Discount Dental Plans
Discount dental plans are not a type of dental insurance. Instead, they are merely dental plans that are specifically designed to offer dental services at a discounted rates to those patients who wouldn’t be able to afford dental services otherwise because they can’t afford a PPO, HMO or fee-for-service dental plan. Also referred to as reduced fee-for-service plans, these dental plans offered a discounted rate off the cost of services for dentists who choose to participate in the plan. In order to get a reduced fee-for-service plan, you must pay an annual or monthly charge, which obviously usually isn’t as expensive as the monthly or annual charge for the aforementioned types of insurance.

Because there’s generally no deductibles or co-payments required for this type of dental plan, there’s relatively little to no paperwork needed to get this type of plan. Instead, patients who want to participate in a reduced fee-for-service dental plan must merely visit a participating dentist in order to receive the reduced fee off dental services. Also, with this type of plan, the patient is required to pay the dentist directly.

Dental Financing Plans
Alternatively, there are also dental financing plans. Similar to how you can enter into a payment plan with a creditor when you purchase an automobile or large household appliance, so can you open up a line of credit with a credit provider to obtain dental financing. An example of one such provider is CareCredit. However, some dentists will also allow you to set up a payment plan directly with their office for dental services rendered, although many won’t. Whether or not a dentist accepts dental financing options like CareCredit or offers their own in-house financing payment plans depends upon the specific dentist or dental office you wish to go to. However, these can be attractive options for people who want to get a certain type of dental treatment done when they don’t have any insurance or when their insurance doesn’t cover the type of dental procedure that they want to get done.

Deciding Which Type of Dental Plan Is Right For You
Determining which type of dental plan is right for you depends upon numerous factors. Of course, the cost of the dental plan must be taken into consideration as well as whether or not the dentist or dental office that you want to visit is within the required network to be compatible with your dental plan. You’ll also want to consider whether you’ll need any dental treatment from dental specialists since some types of dental plans will cover treatment from specialists while others don’t. Lastly, you’ll also want to consider the location where you plan on getting dental services since some dental plans might not have many, if any, dentists near you from whom you can get dental treatment and them still pay for your treatment.

References:
National Association of Dental Plans. “What are the different types of dental plans?” Retrieved on December 5, 2016, from http://www.nadp.org/Dental_Benefits_Basics/Dental_BB_2.aspx.

National Association of Dental Plans
12700 Park Central Ave.
Suite 400
Dallas, TX 75251
1-800-226-5428
http://www.nadp.org

American Dental Association. “Dental benefit plan models.” Retrieved on February 6, 2017, from http://www.ada.org/en/public-programs/dental-benefit-information-for-employers/dental-plan-benefit-models.

American Dental Association
211 East Chicago Avenue
Chicago, IL 60611
312-440-2500
https://www.ada.org

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