Dental Insurance Basics
To start, there are two basic types of dental plans: DPPOs (dental preferred provider organization) and DMOs (dental managed organizations). Here is a general summary of each plan type.
DPPO allows you to go to any dentist you want. If you use a network dentist, your bill will be less. Procedures are grouped into coverage levels: preventive, basic, and major. Some policies have orthodontic coverage too (braces). Typically, you pay a percentage of the cost for each level.
· Preventive - exam, cleaning, and x-rays.
· Basic - fillings and simple extractions
· Major - periodontics, crowns, root canals, bridges, oral surgery, implants, etc.
There is often an annual deductible ($25 - $50) that applies to services other than preventive. Then the amount of the bill you pay is based on the coverage level. There is an annual maximum amount that the insurance company will pay for services.
A typical plan is 100/80/50, $50 deductible waived on preventive, $1500 max. This means that the insurance company pays 100% of preventive services with no deductible, 80% of basic and 50% of major services after you pay a $50 annual deductible. The maximum amount the insurance company will pay of your bills $1500.
NOTE: there waiting periods or reduced coverage levels for basic and major services for a period of time on most policies. Preventive services are covered right away. Make sure to read your plan information thoroughly so you know what you are buying.
DMO plans are sometimes called discount plans. With this type of plan the costs are listed in your policy so you know exactly how much each procedure your dentist can perform will cost. What makes a DMO attractive is not having any waiting periods or annual limits on your benefits. If you need five fillings, two crowns and a root canal, you can get those done the first day you are covered. You just pay the fixed cost for each service.
In summary, know what your benefits are BEFORE you buy. Read your benefits book. Make sure you use a network dentist to get the best pricing even if not required. Ask your dentist if they are in your plan’s network, not if they take your insurance. If they are not in your network, find a dentist that is or you will likely pay more for your dental services. If you do not understand something, call customer service, they are there to help.