Dental insurance is designed to pay a portion of the costs associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories:
Indemnity Dental Insurance Plan: This plan allows you to stay with your dentist when he/she does not participate in a dental network. The insurance company pays the dentist a percentage of your services according to the policy you purchased. In addition, plans of this type may include co-payment requirements, waiting periods, stated deductibles, annual limitations, and graduated percentage scales based on the type of procedure and/or length of time you have owned the policy prior to starting your dental work.
Dental Health Managed Organization (DHMO): This plan allows you access to a dentist who has agreed to accept an insurance fee schedule for services as an In-Network Provider. Many DHMO insurance plans have little or no waiting periods, no annual maximum benefit limitations, while covering major dental work near the start of the policy period. Some dental insurance plans offer free semi-annual preventative treatment. Fillings, crowns, implants and dentures may have various limitations.
Participating Provider Network (PPO): Depending on your specific plan, the PPO works similar to a DHMO while using an In-Network facility. However, it allows you to use an Out-of-Network or Non-Participating Provider. Any difference of fees will become the financial responsibility of the patient unless otherwise specified in your dental policy. Some dental insurance plans may have an annual maximum benefit limit that, once exhausted, leave payments for any additional treatments as the patient’s responsibility.
Questions to ask before deciding on what type of dental policy you need:
- What are the plan’s costs, benefits and exclusions?
- Does my dentist participate in a plan?
- Do I think I’ll need major dental work or routine maintenance?
- Will regular exams and cleanings be enough?
- When was my last dentist visit?
- Will I need x-rays or other services?
- How does the cost of paying for dental insurance compare to paying for dental services without insurance?