Dental Insurance

Preferred Provider Organizations (PPOs)
  • PPOs are a form of managed care in which there is a preapproved list of dentists from which the policyholder must select.
  • Dentists on this list have agreed to pre-set fees, and these savings are passed on to the insured person.
  • There is usually no deductible.
  • The insured person has the option to visit an out-of-network dentist but at a higher cost.
  • A variation of the PPO is the EPO, or Exclusive Provider Organization. With an EPO, the policyholder must use a listed provider or the plan will not cover the treatment.
Dental Health Maintenance Organizations (HMOs)
  • Dental HMOs often operate as capitation plans, under which dentists are paid based on the number of plan members, rather than the services performed.
  • The dentists usually provide preventive and basic services at no charge, while some major services may require a patient copayment.
  • HMOs are often criticized because the structure of a capitation plan means a dentist's profits increase as the amount of treatment he or she provides decreases, giving rise to concerns about whether the treatment provided is always in the patient's best interest.
Indemnity Plans
  • Indemnity plans are what most people consider to be traditional dental insurance.
  • The insured person selects his or her dentist, and benefits are paid based on a percentage of the usual, customary, and reasonable (UCR) fees.
  • These plans typically pay 100 percent for preventive care, 80 percent for restorative services, and 50 percent for major services.
  • If the dentist's charges exceed the UCR fees set by the insurance company, the policyholder will have a higher out-of-pocket expense.
  • Indemnity plans contain an annual maximum and typically require a deductible.
Table of Allowances
  • A table of allowances is a variation of an indemnity plan.
  • A fixed benefit amount is set for each procedure, regardless of what the dentist charges.
  • If the charges exceed the benefit amount, the patient is responsible for the balance.
  • Table of allowance plans allow the patient the freedom to choose his or her dentist.
Discount Plans
  • Discount plans are not considered insurance, but they are viewed by many people as a means of saving money on dental care.
  • The member pays a membership fee in exchange for discounted treatment at specific dental providers.
  • There are no maximums on benefits.
  • Most discount plans claim to provide savings of 20 to 50 percent on dental treatment.