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There are four types of dental plans which work similar to the way medical plans work.

 

 

 

 

 

 

 

 

Dental Maintenance Organization (DMO) (a type of “managed care”) is a network made up of dentists who provide comprehensive and affordable care for individuals or families. Consumers choose a dentist from the network, and they pay a low monthly premium to receive services at either no cost or a reduced price (some services may require a copayment). The participating dentists receive fixed monthly fees. DMO’s are generally the less expensive plan and have no waiting periods. 

Preferred provider organization (PPO) is one of the most popular forms of dental insurance coverage. In this type of plan, consumers select a dentist from a network of preferred dental providers. The providers agree to provide dental care to members at reduced rates. PPO dental plan participants are assured of the maximum cost of their dental treatment in advance. With a PPO, participating dentists have agreed to pre-negotiated fees. While the choice of dentists is somewhat limited, some PPO plans do provide the freedom to select an out-of-network dentist. In addition, after PPO members have used their maximum annual benefits, the costs for services still remain at pre-negotiated levels.
 
Indemnity plan If being able to choose from the largest pool of dentists is high on your list of priorities, you may be interested in this type of plan. Individuals with indemnity insurance are free to visit any dentist, unlike those with managed care plans. Subscribers to this type of coverage, also known as “traditional” insurance, pay their dentist’s bill in full and then submit a claim for reimbursement to the carrier. Some key strengths of indemnity dental plans include the fact that indemnity plans typically cover a major part of the patient’s bill, and also that they help consumers plan ahead. Completing a pre-claim before having major services done lets consumers know up front what part of their bill the carrier will cover.
 
Discount Dental Plans are not insurance, also known as discount dental cards, are another type of coverage that can help consumers save on dental care costs. DDP members make monthly or annual payments in exchange for unlimited dental care services that are priced based on a discounted fee schedule. Services are provided by dentists who participate in the plan’s dental network. Discount dental plans provide people who have no dental insurance with a cost-effective alternative. People can also use a DDP for services that are covered by one of the other types of insurance but unavailable due to a waiting period. Consumers can save up to 50% on dental work with a DDP compared to having no dental coverage. Moreover, the monthly or annual payments are usually a fraction of the cost people pay for other types of dental coverage.
 
How Dental Benefits are paid For plans that have a network of preferred providers, the payment amount is generally determined by a contract that each provider signed in advance. Payments to non-network providers under most traditional indemnity dental plans are based on a "Usual, Customary and Reasonable" (UCR) schedule. This schedule pays benefits based on a fixed percentage of the lesser of the dentist's fee or the fee determined by the insurance carrier. The patient is responsible for making up the difference between the UCR percentage and the dentist's professional fee for the service rendered. A Dental Maintenance Organization (DMO) bases payment on the number of patients who have selected that dentist as their primary dentist, rather than on the actual treatment provided. (Dental specialists are usually paid on a reduced fee-for-service basis.) Under this plan you pay for treatment not covered and pay any copayments.
 
Types of dental services that are generally covered All plans are different therefore you should refer to your plan description for a complete understanding of what services will be covered and how much. Dental plans typically allow the patient to submit a plan of treatment to see how much the plan would pay for proposed care. This will help you budget for the treatment. Some plans cover orthodontia services separately, subject to additional deductibles and annual or lifetime maximums per participant. Typically, yearly oral examinations, X-rays, teeth cleanings and topical fluoride treatments are covered in full with no deductible. Basic treatment like of root canals, and repair or bridges are generally covered at a percentage. Most plans are not as liberal in paying for major services like crowns, and oral surgery, usually covering 50% of the cost.
 
Pretreatment Review Pre-treatment reviews are required by some dental plans when the projected cost of dental treatment exceeds a certain amount, usually determined by the plan administrator. The dentist will estimate the total cost of the treatment before providing services. This allows you and the insurance company to review the proposed treatment and estimated costs before your treatment begins. With this information, you can determine your budget or possibly decide on a less expensive treatment.
 
Choosing a Dentist The American Dental Association recommends asking your friends, coworkers, or your family physician for dentist recommendations. You should consider speaking with multiple dentists and confirming credentials. While there check to see if the office is clean and that the dentist uses infection-control procedures.
 
Utilize the benefits to the fullest
  1. Get regular dental check-ups. Most dental plans will pay for one visit per year.
  2. Have your dentist do a pre-treatment review for big treatments to help you plan ahead and make the best cost effective decisions for treatment.
  3. Confirm if your medical plan will cover the full or partial cost of a treatment. You medical insurance may include some dental coverage.
  4. Split your treatment between two plan years. Dental plans routinely have annual maximum benefits. Start your treatment towards the end of one plan year and complete it in the next so that a new annual maximum would begin.
  5. Use a flexible spending account to help pay for treatments like orthodontia that is not wholly covered by your dental plan. The FSA pays for unreimbursed medical, dental and vision expenses.
  6. If you’re thinking about declining coverage, be sure to see what rules the plan has for allowing you or your family members to join the plan later. You might not be able to join during the next open enrollment period and you will lose out on this benefit altogether.


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