Unlocking the Key Features of Individual PPO Dental Plans
There are many nuances to the various types of dental plans you can choose. Each has its benefits and limitations.
Dental PPO plans have more extensive dentist networks and allow enrollees to visit any provider in-network without a referral from their primary care dentist. These plans typically have a lower UCR or Table of Allowances fee structure.
Coverage for Preventive Care
Dental insurance is designed to help people avoid expensive and potentially painful procedures. However, not all dental insurance plans are created equal. To ensure you’re selecting the right plan, compare the type of services and treatments covered, the monthly premiums, the deductibles, and annual maximums between plans.
Then, decide if you or your employees have a higher tolerance for cost-sharing and a desire to work with a more extensive network of dentists. If so, a DHMO or dental Preferred Provider Organization (DPPO) may best suit your needs.
DPPOs and DHMOs usually offer comprehensive preventive care coverage, including teeth cleanings, oral exams, specific X-rays, and fluoride treatment. Most of these services are typically covered 100% in-network with and basic restorative procedures such as fillings or extractions are often reimbursed at 80%.
Coverage for Dental Implants
Dental implants are a popular option for replacing missing teeth. Many dental insurance plans offer some coverage for implants, but it’s essential to understand your specific policy’s coverage details before deciding whether or not to get this treatment.
Most individual PPO dental plans have annual maximums and deductibles that limit how much your plan will pay for specific procedures. These limitations can make getting the care you need easier if your implant treatment requires multiple visits or extensive work.
Some individual dental plans also include a Least Expensive Alternative Treatment (LEAT) clause that can prevent an insurer from paying for a more expensive procedure when a less costly treatment is available. This can reduce the amount an insurer will reimburse for your dental implant procedure, mainly if you use in-network providers.
Purchasing separate dental coverage through the Marketplace may help to circumvent these limitations. Dental Associates can help you compare Marketplace health plans and select one that doesn’t require a deductible or annual maximum to get the care you need.
Coverage for Major Treatment
The next step in selecting a dental plan is to consider the types of coverage you’ll need. A good PPO dental insurance plan should offer mid-level or full coverage for preventive care, basic restorative procedures, and some significant treatments.
In addition, the deductible, coinsurance, and maximum annual benefits should also be considered. The cost of a dental plan can vary depending on its deductible, premium, yearly maximums, and network choice.
Some PPO dental insurance plans offer a DPPO (Dental Preferred Provider Organization) network that provides a wide selection of in-network dentists. These dentists have agreed to accept a set fee from the dental insurance provider for certain services. DPPO plans generally have lower cost premiums and out-of-pocket costs.
Other PPO dental insurance plans offer a DHMO (Dental Health Maintenance Organization) network with fewer choices for in-network dentists. These dentists are paid a fixed monthly fee in exchange for providing care at a discounted rate to the plan’s members. DHMOs usually have lower patient costs and no deductible or maximum annual benefits.
Coverage for Orthodontics
Orthodontic treatment, including braces, can be expensive in dental care. For this reason, it is essential to determine whether a plan covers orthodontics and under what conditions. Some plans offer maximum lifetime coverage, while others may include orthodontics in the primary dental coverage.
Most insurance companies have a network of in-network orthodontists that agree to negotiated rates. While you can go to an orthodontist outside the network, your out-of-pocket costs will likely be higher. It would help if you always chose an in-network orthodontist to help reduce your overall dental costs.
Many insurance plans do not include orthodontic coverage, especially supplemental dental policies purchased independently. However, a few insurance providers, such as Renaissance Dental, offer individual plans with orthodontics coverage as an additional feature to the core dental benefits.
Other plans, such as the Dental Health Maintenance Organization (DHMO) and Exclusive Provider Organization (EPO), do not allow for coverage for orthodontics.
Coverage for Orthodontic Treatment
Orthodontic treatment is vital to any comprehensive oral care plan for adults. It can save families a lot of money and reduce the time they spend wearing braces or other appliances. Often, insurance plans that cover orthodontics also have lifetime maximums, so it’s important to carefully review any coverage before enrolling in a plan that includes this type of service.
Thanks to their extensive networks, PPO dental plans — sometimes called DPPOs — offer many dentist choices. These include general dentists and specialists who have agreed to treat patients at negotiated rates, which are generally much lower than they typically charge.
In contrast, DHMO dental insurance plans tend to have more restrictive networks with limited selections for general and specialty dentists. They may also have a deductible and annual limits. Regardless of the plan type, using an in-network dentist is best to get the most cost savings from your coverage. But you want to change your provider. In that case, you can do so without any financial penalty by paying the difference between the insurance company’s payment and the new dentist’s charges.
