Quick Video about Dental Plan Types
PPO dental plans are generally the best dental insurance plans available, offering a compromise between lower costs and choosing the dentist you wish to visit. Choosing PPO dental coverage generally results in the lowest expenses when you visit a PPO dentist, but your dental treatments will still be covered according to your plan agreement should you choose or need to visit a dentist outside the network. There are huge networks of PPO dentists across the country, so finding one to suit you is easy, and many participating dental practices will bill your insurance directly for your care and treatments, so you pay only your copayment, rather than paying the full amount and waiting for reimbursement. PPO dental coverage usually covers varying levels of treatments at different rates - for example you may only pay 20% of the full bill for preventative treatments, but 50% for more specialized treatment - but they generally offer the most comprehensive coverage for your dental care.
While many people refer to these service plans as dental plans, they are not, in fact, insurance at all. Discount dental plans require you to pay a monthly or annual fee and simply offer access to dental services and treatments at a reduced rate when you visit participating dentists. While there are no limits, deductibles or insurance forms to fill out, this is simply because you do not actually have insurance. Discount plans are only valid at your participating dentist, and often charge patients for a greater portion of their dental treatments than PPOs or HMOs. Specialist and emergency treatment are generally not available on discount dental plans.
Exams and Consultations
As you probably already know, when you first visit the dentist you are given an exam that typically includes x-rays and an evaluation from the dentist. Most dental plans include coverage or discounts for this process.
Though we find that most people dislike having to go to the dentist, frequent care is critical for maintaining healthy oral hygiene and limiting the necessity of serious dental problems in the future. Preventative dental treatment includes repeat exams, cleanings, and deep cleanings. Typically dentists recommend check-up service every six months. This is another standard service that is included in most dental plans.
Basic Dental Service
These treatments mostly consist of cavity fillings, scaling, fluoride, sealants, and other minor restorative care. These services are usually covered and accessible with most dental plans with no waiting period.
Major Dental Service
This is the level of care that is ordinarily expensive, painful, and the outcome of poor preventative oral maintenance. Dental plans that include coverage and discounts on major dental services will typically save thousands of dollars versus an uninsured consumer with the same problems. However, most plans can be limited by implementing a 6-12 month waiting period and low annual maximum benefits. A low annual maximum simply means a dollar limit and is commonly found to be $1000.00.
**A dental plan that is insurance and includes coverage for ALL four of the above levels is considered Full Coverage. **
Most insurance plans do not include coverage for cosmetic procedures. Because these procedures are considered the most expensive and medically unnecessary, dental insurance companies will almost always deny these claims. There are very few insurance companies that provide some coverage, but they do exist for additional monthly premiums.
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