Individual dental insurance can be purchased as a managed-care option – a dental health maintenance organization (DHMO) or dental preferred provider organization (DPPO) or dental indemnity insurance, also known as traditional fee-for-service insurance. If given the three options, plan buyers generally make a choice based on such factors as access to particular providers, price of their premiums, types of services covered and annual maximums paid.
Dental Health Maintenance Organization (DHMO)
Under the DHMO option, you can expect the lowest monthly premiums but no annual maximums and usually no deductibles. However, the policyholder is restricted to dentists within a network and you would have to choose one dentist to be your primary care-giver. If you are unhappy with the dentist you choose, it can be changed. Dental Health Maintenance Organization policyholders can expect a schedule of co-payments for services, making it easy for you to predict your out-of-pocket costs.
Dental Preferred Provider Organization (DPPO)
Under the Dental Preferred Provider Organization option, premiums are higher and there is an annual maximum, usually between $1,000 to $2000, that the carrier will pay for services. The policyholder is again incentivized to use a network of providers and can pay more to go out of network. Dental Preferred Provider Organization policyholders can expect to see the amount paid by their carrier represented as a percentage of the procedure cost. Typical plans pay 100 percent of preventive services (routine exams and cleaning), about 50 percent of basic services (such as fillings), and 50 percent of major expenses (such as root canals, crowns, bridges, dentures and sometimes implants).
Dental Indemnity Insurance
Those who choose dental indemnity insurance usually do so for the complete freedom of choice of providers, but that freedom comes at a cost. Indemnity insurance – or traditional fee-for-service insurance usually has the highest premiums and an annual maximum payment from the carrier as in the PPO plans.
If you’re thinking of enrolling in dental insurance because you know you’ll need expensive work soon, it’s likely already too late as pretty much all dental insurance plans (particularly PPO plans) have waiting periods for pre-existing conditions.
Dental Discount Plans
Dental discount plans are conspicuously different from dental insurance. In fact, the first thing buyers need to be aware of is that dental discount plans are not dental insurance. You receive a designated discount off the dentist’s rates, depending on the plan chosen and services rendered. With a dental discount plan, you can only receive discounts from providers within a plan’s network – similar to the managed-care dental plans mentioned earlier.
Discount plans do offer attractive features, which may explain why they are widely available for consumers. In most cases, there are no deductibles, coinsurance, waiting periods, annual maximums and insurance claim forms. (You simply pay and the dentist provides a discount at the time of the procedure.)
The cost of a dental discount plan is also typically lower – and comparable to a dental HMO. One issue to research before purchasing one of these plans is whether the plan does have a waiting period. (You certainly don’t want to learn while sitting in the dentist’s chair that the root canal you need isn’t covered for another six months.) Also check for a pre-existing condition clause.
Other Tips With Your Dental Coverage
If you already have a dentist you like, make sure he or she accepts whatever plan you are considering.
If you don’t have a dentist, be a savvy consumer and ask prospective dental offices to provide a summary of fees for exams, bitewings x-rays, cleanings and other procedures you may need.
Also ask about the discounts they offer to discount plan holders, as discounts can make prices for the same service vary greatly from dentist to dentist.
As always, do your homework on the Web. It’s an obvious source of plan information and an online dental quote is a great way to predict costs and choose a plan accordingly.
If you do talk to an agent, be sure to ask plenty of questions to ensure that you get the best dental plan for your needs and budget.
Here are links that I send my clients that have an interest in dental and vision coverage.
Humana has some of the best values I could find. They offer both PPO and HMO plan options. On their HMO plan, you have to choose a dentist from their list but can change later if you are unhappy with that doctor. There are no annual limits with HMO plans. The PPO plan only has discounts for major services.
There is also a vision plan option.
For true Individual PPO and indemnity plans look at the three links below.
Always check with your dental office of preference, if you have one, to see which plans they are aligned with. Waiting periods and annual limits will apply.
SecureDentalOne (has an option with no waiting periods)
Dental for Everyone (has 2 vision plan options).
DISCOUNT DENTAL PLANS:
Annual policies at the link below can be less expensive but cleanings are usually not covered, just discounted. Prices are excellent, there’s no waiting periods, deductibles or annual limits. Discounts on major problems have been anywhere from 30-40%.