Dental Insurance Plans: What You Need to Know

There are a variety of dental insurance plans, and each offers slightly different coverages and benefits. We’ve broken down each type of dental plan and other coverage details you should know.

Types of Dental Plans

There are three common types of dental plans: Preferred Provider Organization (PPO), Dental Health Maintenance Organization (DHMO), and Discount or Referral Dental Plans. Let’s take a look at each.

PPO: A Preferred Provider Organization plan is one that has a network of dentists who agree to give dental services at a set price.

DHMO: This plan uses a network of dentists that are paid a fee every month to provide covered dental services to you whether you go to the dentist or not. Some services may be completely covered, while others may require a copay.

Discount/Referral Plans: Both discount and referral plans are contracts with dentists who agree to discount their fees. While neither of these plans cover any services, you will receive a reduced rate determined by the plan.

Insurance vs. Benefits

Yes, there is a difference between the two. Insurance is designed to reimburse you, and the insurer carries the risk. A benefits plan is set up to only cover specific costs. You’ll find that some procedures will be covered fully, and others you’ll have to pay a portion of.

What’s Covered

Regardless of which plan you choose, you will share some of the cost for your dental services. Here are a few different ways that this happens.

Deductibles: A deductible is the amount you have to pay before your insurance pays. Many insurance plans don’t require deductibles for preventative services.

Coinsurance: If you have coinsurance, you will pay for a percentage of the service fee and your insurance will pick up the rest. 

Annual Maximums: The maximum amount your insurance plan will cover during a year. You’re responsible for anything over the maximum amount.

It’s important to do your research and understand your plan and what it offers you. If you have any questions about what your dental insurance covers, please contact your plan administrator or give us a call – we’d be happy to help!