Dental PPO
PPO means Preferred Provider Organization. It is a managed care plan where dental care is received through a network of contracted dentists. This is similar to how PPO medical insurance works. The contracted dentists agree to provide services to the members at a rate that is less than what is charged by most dentists in the area. Members who have a PPO dental plan usually just pay a percentage of the fee and the rest of the fee is payed for by the insurer. You might wonder why dentists will agree to be under their network and give services at a lower rate. This is because this scheme helps in their profession by bringing in more patients. They no longer need to spend on advertising or promotions to draw in new patients.
Dental Capitation Program (DHMO)
DHMOs are also referred to as dental HMOs. With this type of plan, the members pay a fixed amount every month or a monthly premium instead of a fee-for-service system. Everytime they need dental services, the members get care from contracted dentists at little or no cost. Under this kind of plan, members must go to dentists that are within the network. If they go outside the network, members need to pay the full amount on their own. The restricting characteristic of an HMO is what is considered the disadvantage in this type of plan.
Dental Referral or Discount Dental Plans
This type of plan is not an insurance plan but more of a financial aid. In this kind of set-up, there are dentists contracted. Every time a patient sees a dentist, they are given a discount for the service. But they don’t need to pay any monthly premium. This may seem like very minimal help but can save you lots of money whenever you need dental care. Before you commit to a discount dental plan, make sure that you are fully aware of its limitations. Especially when it comes to emergency care. Most likely it will not be able to give you discounts when you’re on a vacation and you need dental care. If this happens to you, the best thing you can do is to call your plan provider and check if they have contracted dentists in your location.
How to Maximize your benefits from your Dental Coverage:
The goal of dental plans in general is to give you easier access to preventive and diagnostic dental care. If you want to maximize your benefits, take into consideration, these points:
- Which of these dental plans will give me more dental services and the most savings? If you choose a PPO plan, staying in the network will give you more coverage which means lower out of pocket cost for you. Usually it will save you 10 – 20% more than doctors outside your network.
- Whatever dental plan you have, in the event that you will need treatment, check if it is covered by your plan. Your dentist should be able to give you an estimate of the costs before you start with the treatment so you could estimate how much you need to pay from your pocket and how much of the cost the insurer will shoulder.
- If you need to undergo a series of treatments, ask your dentist if you can spread it in two coverage years. This way, you spread the costs, making sure that you don’t exceed your annual maximum. Usually the annual maximum for a dental plan is around $1500. This ceiling is easy to reach if you need major dental services.
- If your dentist suggests a treatment or procedure, ask them if you have other options. If they strongly suggest a particular treatment ask them why. The next best thing you can do is to research on it. Read about it. Or you can ask another dentist for a second opinion. After all, there may be other choices with lesser rates.
- Is cleaning covered? How often? 2 cleanings per year? Once annually? Or every six months? Make sure you know this because if you go beyond the allotted schedule, you need to pay for the full amount.
- If you have teens, this is something you’ll want to find out. What is the age limit for dependents? Can I still add my 19-year-old or do I need to get a separate dental plan for them?
- What is the extent of the coverage? Are cosmetic services covered? Does it cover modern dental treatments? If your dentist suggests a procedure and you’re not sure if it’s covered, ask your dentist for a pre-treatment estimate so you can ask your insurance provider. SOme insurers may ask for a written explanation to detail the process and why it’s necessary.
- If both you and your spouse have your children covered on your dental plans, the insurance companies will determine which plan will be their primary or secondary coverage.
- Ask the dental staff if they give discounts if you pay in cash. Some dental office have this arrangement available. This could allow you to save 10% of the cost.
- If you refer a friend, a relative, or a neighbor, will it entitle you to a discount? Ask the dental staff what discounts they have available that could work for you.
Review your dental insurance options
The following are the dental plans available in the market today:
- Dental Insurance
- Capitation Plans
- DHMO Plans
- Discount Dental Plans
As with everything, these plans have their own advantages and disadvantages. Make sure you understand the coverage and limitations of the plan before you commit. You can do your own research on this or ask your dentist on what they think is best for your dental condition.
