- 1. How do I know what plan is right for me?
- 2. How can I compare plans?
- 3. What kinds of dental plans are there?
- 4. What is the difference between coinsurance and a copayment?
- 5. What is a PPO (Preferred Provider Organization)?
- 6. What is a Traditional Indemnity Plan?
- 7. What is an in-network dentist?
There is no one best dental plan, some plans will be better than others for you and your family's dental needs. Plans will primarily differ in how much you have to pay. Although no plan will pay for all the costs associated with your dental care, some plans will cover more than others depending on what services you get.
With any dental plan you will pay a basic monthly premium to buy the dental insurance coverage. In addition, there are often other payments you must make along the way. These payments will vary by plan but are usually-- deductibles, copayments, and coinsurance.
List of questions to consider in choosing the plan that best fits you:
How much will it cost me on a monthly basis?
Are there deductibles I must pay before the insurance begins to help cover my costs? After I have met the deductible, what part of my costs are paid by the plan?
What dentists are part of the plan? Are there enough of the kinds of dentists I want to see?
Where will I go for care? Are these places near where I work or live?
If I use dentists outside a plan's network, how much more will I pay to get care?
You can compare benefits and prices of different plans by selecting up to 3 plans by clicking on "Compare Plans" at the top of the page. You can view specific coverages for each plan by clicking "Plan Details."
Dental insurance plans usually are described as either indemnity (fee-for-service) or PPO. Indemnity and PPO plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of dentists than PPO plans. Indemnity plans pay their share of the costs of a service only after they receive a bill. Managed care plans have agreements with certain dentists to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out-of-pocket costs if you select a PPO plan and a broader choice of dentists if you select an indemnity plan.
An office visit copayment is a fixed dollar amount or a percentage that you pay for each dentist visit or for each dental service provided. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee - or coinsurance -- for the visit. So if your copayment is 10% and the dentist visit was $200, you would pay 10% which, in this case, would be $20.
A Dental PPO (Preferred Provider Organization) provides dental care to its members through a network of dentists who offer discounted fees to its plan members. You can typically use dentists out of the PPO's network, but you will only be reimbursed the discounted fee for the services rendered - you will need to pay any additional amount yourself.
An indemnity plan is commonly known as a fee for service or traditional plan. If you select an Indemnity plan you have the freedom to visit any dentist. You do not need referrals or authorizations; however, some plans may require you to precertify for certain procedures. Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of "usual and customary" charges for covered services; often the insurance company pays 80% and you pay 20%. Most plans have an annual out of pocket maximum and once you've reached this they will pay 100% of all "usual and customary" charges for covered services.
Many dental indemnity plans also require a waiting period before covering certain services.
An in-network dentist is within the approved network of dentists for a particular dental plan. Out-of-network dentists are not on the list. If you visit a dentist within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network dentist. In many cases, the insurance company will not pay anything for services your receive from dentists outside their network; however, there are exceptions to this.