Preferred Provider Organizations (PPOs)
Dental Health Maintenance Organizations (HMOs)
- 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 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.
Table of Allowances
- 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.
- 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 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.