How Dental Plans Work
What dental insurance plans cover differs from insurance carrier to insurance carrier. Most dental insurance plans cover basic preventive dental care, meaning your dental checkups, cleanings and X-rays. Dental plans may also partially or fully cover many of your basic and necessary restorative dentistry treatments, such as a tooth filling or dental crown. It's important to note that dental plan coverage varies according to the type of plan you have and the type of treatment you need.
Many insurance companies have several types of dental plans for you to choose from. Some examples of dental insurance plans include the following:
Dental Health Maintenance Organization (often referred to as DHMO, DMO or HMO) -- With a DHMO, you must choose among an approved network of dentists in order to receive your benefits. In some cases, the dental insurance company will assign a dentist to you. DHMO dentists are paid per patient rather than per dental treatment, receiving a monthly fee for the number of patients assigned to the office.
Exclusive Provider Organization (EPO) -- Like a DHMO dental plan, you must stay in-network to receive your benefits. But unlike an HMO, the EPO pays dentists for each service rather than pay them on a fee-per-patient scale. It's important to note that if you choose to go to a non-network provider for either of these dental plans, your provider will not cover any of your treatments.
Preferred Provider Organization (PPO) -- With a PPO dental plan, coverage varies depending on whether you choose to go to an in-network or out-of-network doctor. Dentists who practice within the network agree to charge a reduced fee for certain dental procedures, lowering your out-of-pocket expenses. Out-of-network dentists may charge a higher rate, which is passed on to you, the consumer.
Indemnity -- Indemnity dental plans allow you the freedom to go to any dentist but often at a greater expense. While you pay the deductible, indemnity dental plans usually cover only a percentage of the dental treatment fee, leaving you to pay the difference.
No matter what type of dental insurance plan you have, most dentists require payment due at the time of service, whether that is your co-payment, fees for services not considered "reasonable and customary" or a payment in full that is reimbursed by your dental insurance plan. You should discuss your dentist's payment policies prior to your appointment to avoid any unexpected bills. For further details on how your dental plan works, talk to your dental insurance plan company.
It's important to have a long-term plan when it comes to your dental health care. Dentistry can be expensive, especially if you need major work. To help avoid costly dental treatments, be sure to eat a balanced diet, practice good oral hygiene and utilize your dental plan by visiting your dentist twice a year. Remember, most dental plans cover preventive care, so investing in a dental plan may actually save you money in the long run.