Types of Dental Plans

Like with health insurance plans, there are many different options when it comes to dental insurance.

When it comes to dental health, everyone has their own unique needs. Knowing how to compare the choices available to you can help you find the best and most affordable coverage. For instance, say you prefer to continue going to your current doctor. If he or she is not in the insurance provider’s network, you may want to consider choosing a plan that covers out-of-network doctors.

Some plans offer the most basic coverage, covering only the simplest procedures. If you expect to need more complex dental or orthodontic work done in the next year, these plans may not be the best option. You also need to take fees, copays and deductibles into consideration.

In general, your options for dental coverage include preferred provider organizations (PPOs), dental indemnity plans, health maintenance organizations (HMOs) and even dental savings plans. Learn more about these options below.  

PPO Dental Insurance

This is one of the most popular dental plans, since PPOs typically offer the most flexibility for enrollees. Those who elect this option can choose from a wide range of doctors and specialists, and often have better access to any specialized services they need.

Like other plans, PPOs create a network of contracted dentists for you to choose from. When you choose from within this network, you gain access to special rates for different dental services.

In addition, you also have the option to choose a doctor that is outside of the network for your care. This means if you like the dentist you already have, you can continue to visit his or her office using your dental insurance plan. However, choosing an out-of-network doctor means you may pay higher fees and copays than if you chose a doctor from the established network.

In-network doctors are contractually obligated to offer specific coverage and rates, whereas those outside the network can set their own costs. If you are considering keeping your out-of-network doctor, make sure to ask about these fees to find out if they are lower or higher than in-network fees. That way, you can ensure that you are choosing the best option for you.

It is important to note that the price for this coverage flexibility is higher monthly insurance premiums. That is why many PPOs are offered through employers, who may cover some of these costs on your behalf.

Another downside to this option is the red tape and paperwork. Once you meet your deductible, PPOs often require you to submit multiple claims forms to receive any reimbursement for your treatment. It may also take longer to receive these reimbursement funds than with other dental plans.

HMO Dental Insurance

HMOs are typically the cheapest insurance option, because they are more restrictive than other plans. Similar to PPOs, these plans provide coverage for a network of contracted dentists that you can choose from.

These dentists are required to offer pre-determined rates for different services, depending on the insurance provider. This is another common option offered by employers, though it is possible to enroll in an HMO on your own as well.

However, one of the main downsides to HMOs is the coverage restriction. When you sign up for an HMO plan, you must choose a dentist from the network provided. This chosen dentist is responsible for issuing referrals any time you need to see a specialist.

If at any time you choose to visit an out-of-network doctor, the insurance will not cover your expenses. This means you are required to pay out-of-pocket for your visit and any services performed.

Another downside is the high volume of patients on HMO plans. Dentists may be more likely to rush through a visit in order to see all of their patients. Moreover, the process to get a referral can be a long and complex process for HMO enrollees.

When deciding if an HMO plan is right for you, consider your needs. If you do not mind choosing an in-network doctor and do not require specialist care often, this insurance option can help you save in the long run.

Dental Indemnity Insurance

Dental indemnity plans are more unstructured than HMOs and PPOs. This is a fee-for-service plan, which means you pay the doctor for any care you receive and seek reimbursement later. Rather than working with the insurance providers to establish fees for different services, dentists set their own costs.

As a result, you are expected to pay any difference that is over the insurer’s coverage limits. Unfortunately, reimbursement can take a while with this type of plan, especially if you submit the wrong claims forms.

Like with PPOs, dental indemnity plans allow you to choose which doctors and specialists you see, without needing any referrals. You are also not required to stick to one dentist with this option. A

As a result of this freedom, you can expect higher deductibles and premiums than with other options. Note that dental indemnity plans are the most beneficial for families or groups, rather than single individuals.

Alternative Dental Coverage

Though HMOs, PPOs and dental indemnity insurance plans are the most common, there are other options available as well. The following are a few examples of alternative dental coverage:

  • Direct Reimbursement Plan: This insurance option is self-funded, meaning you pay for your treatments and submit a reimbursement later on. However, you only pay for the treatment you receive, with no monthly premiums involved. This typically operates on a tiered reimbursement system, which varies based on the employer and plan structure.
  • Point of Service (POS) Plan: POS plans combine features of both the PPO and HMO options. You must choose an in-network doctor, but you can visit those outside the network as well. If your in-network dentist issues a referral for an out-of-network specialist, this visit is covered by the plan.
  • Dental Savings Plan: Unlike dental insurance, these plans operate more like discount programs. Rather than receiving coverage for different procedures, you pay out-of-pocket and gain access to significant discounts offered by dentists around the country.