Dental Insurance Basics


There are two primary types of dental insurance: traditional indemnity plans and direct reimbursement plans. Traditional indemnity plans cover a fixed percentage of total dental care costs. A direct reimbursement program pays only the cost of the dentist’s time and skill; they do not limit coverage by treatment category. A direct reimbursement plan also gives you the freedom to choose your dentist and works to achieve healthy solutions through collaboration. It is often more affordable than traditional indemnity plans, but there are some things to consider before you purchase a policy.

First, determine the deductible. Most policies have an annual deductible, and some have a family deductible, which is different than a single person’s. Most have an amount that the plan will pay regardless of the dentist’s fee. You’ll be responsible for paying any difference between that amount and the underlying fees. Some plans also have a lifetime ‘capitation’ limit, which can be either a fixed dollar amount or a percentage of the total cost.

Another type of dental insurance is called a PPO. It has a list of dentists that are contracted with the insurance company. You can choose a dentist who is not in the network of participating providers, but you’ll likely pay more out-of-pocket for any additional treatments. A dental PPO, on the other hand, will provide you with the same number of dentists, but the deductibles will be higher.

A PPO and an HMO are two types of insurance for employers. A dental PPO has a network of dentists, and you can choose to go out of the network if you need to. In a health insurance PPO, you’ll pay a higher deductible but you can choose your dentist based on your convenience. A dental HMO has a fixed deductible, but a set co-pay or fee is required. If you’d prefer to go out of the network, you may have to pay an out-of-pocket fee or a fee.

Despite the differences between the two types of dental insurance, these plans offer a variety of benefits that make them ideal for different types of people. Some of them are ACA-compliant, while others are tailored to fit a specific person’s needs. Most of these policies will include a list of dentists who are in-network with a certain network. A few of these dentists are out-of-network, while others will not be.

A dental PPO will have a network of dentists that are approved by the insurance company. A dental HMO will have the same list of dentists but may require an out-of-network fee. A dental HMO will not allow you to go out of the network, but will generally cover most of the procedures in your mouth. There are other types of out-of-network policies that are not PPOs. Aside from PPOs, dental HMOs are similar to dental health plans. They both have a fixed co-pay or a flat fee.