Dental Insurance Plans at a Glance
With cleanings twice a year, X-rays and other routine care, dental costs can add up in a year — and that’s before adding the cost of possible emergency care. Dental insurance is a good way to bring your out-of-pocket costs down so you can access the care you need without breaking the bank. Check out the main types of dental insurance plans to see which type of coverage fits your needs.
Dental Health Maintenance Organizations (DHMO)
DHMO or dental insurance DMO plans prepay contracted dentists a certain amount for each DHMO patient. The dentists then provide specific services for a set fee or no fee, depending on the plan and service. Premiums are typically lower on an HMO dental plan than a PPO plan, but patients are limited in their choice of dentist. If they choose to see a dentist not contracted through the plan, then they are typically responsible for the entire bill. One dentist or practice provides all the patient’s dental care. If a specialist is necessary, the patient must first get a referral from the dentist and authorization from the insurance company.
Dental Preferred Provider Organizations (PPO)
With a dental PPO plan, the insurance company contracts a large network of dentists to provide services at set fees. This allows patients to take advantage of lower prices for services. PPO plans typically have a larger network than DHMO plans, making it easy to maximize savings. Patients are free to visit any dentist they choose, but visiting an out-of-network dentist could result in paying higher fees for services.
Indemnity plays are also known as traditional dental plans or fee-for-service plans. These plans usually offer the largest network and the most choices of dentists. With this type of plan, the insurance company pays a percentage of the services performed, and the patient is responsible for the rest. The percentage varies, depending on the insurance plan and the services performed. These plans are often the most expensive, but they offer the greatest flexibility and the most coverage.
Direct Reimbursement Plans
Direct Reimbursement plans aren’t actually dental insurance, but they provide a way for people to get money back on their dental care expenses. Patients can choose any dentist and are responsible for paying the dentist directly. They submit receipts to the plan administrator and receive reimbursement for all or a portion of the services. This is a self-funded plan, and patients are responsible for all the upfront costs in most cases.
Discount dental plans are also not dental insurance. Instead, the company selling the plans contracts a network of dentists who agree to discount their fees. Patients pay a set amount to access the discount plan and are responsible for paying for treatment at the discounted rates. There are no dental insurance forms to file or paperwork complete. Patients simply pay to gain access to lower cost dental care. In some cases, those who don’t have dental insurance can work out similar types of payment plans with their preferred dentists without paying for an actual discount plan.