What are the different types of dental insurance plans?
Posted on July 23, 2021 in Dental benefit information
Are you in the market for a new dental insurance plan for yourself or your family? Before you get started, it’s a good idea to familiarize yourself with the various types of dental plans out there.
There are several different types of dental insurance plans – each will work differently in terms of out-of-pocket costs, benefits, deductibles, and so on. Some dental plans will offer a wider network of dentists for a higher monthly premium; others may be less expensive but restrict coverage for certain procedures or require more out-of-pocket spending on treatments such as root canal therapy or dental implants.
We’ve summarized the four most common types of dental insurance plans below: PPO, DHMO, Dental Discount Plans, and Managed Fee-for-Service Plans. Read on to learn more.
Preferred Provider Organizations (PPO)
Dental Preferred Provider Organizations (PPO) are contracted so that members have access to a network of dentists who accept reduced fees for covered services. Dental insurance companies offering these plans also share a portion of the reduced fee, which means members will lower out-of-pocket costs when receiving treatment from an in-network dentist.
The out-of-pocket cost that members do pay is a designated percentage of the reduced fee, called coinsurance – also known as a copay. The plan then pays the remainder subject to your deductible and annual maximum. Members have the flexibility to receive care from dentists outside of the PPO network, but may experience higher out-of-pocket costs when doing so.
According to the National Association of Dental Plans, Dental PPO plans are the most predominant type of plan in the U.S. market; 82 percent of all dental policies are PPOs.1
Of course, every PPO plan will be unique. As is true for each of the following insurance plan summaries, make sure to reach out to the individual insurance company to understand the specific benefits, network size, and limitations of their PPO plan. Visit here for more information on Delta Dental of Illinois’ individual and family PPO plans or to enroll today
Dental Health Maintenance Organization (HMO)
A dental HMO provides lower cost coverage with a focus on preventive care, which typically includes cleanings, periodic oral evaluations, x-rays and sealants.2 Dental HMO benefits are provided in exchange for a fixed monthly premium, and members must use in-network dentists in order to obtain coverage
The dentist network size of an dental HMO plan is smaller than that of a PPO, but the cost also tends to be lower due to the limitation described above. Delta Dental of Illinois offers DHMO dental plans under DeltaCare® as an additional plan option to groups.
Managed fee-for-service plans
Managed-fee-for-service plans generally offer the largest network of dentists for the members to choose from.
Like a PPO plan, members pay a certain percentage for each service provided by a dentist and the plan will pay the remainder subject to your deductible and annual maximum. The percentage you pay out-of-pocket will vary based on the service received. Members in managed fee-for-service plans have a larger network of dentist to choose from than those in a PPO plan. This is also why the members in manage fee-for-service plans pay a higher out-of-pocket cost.
Delta Dental of Illinois offers managed fee-for-service plans as Delta Dental PPO Plus Premier. These plans provide members access to both the Delta Dental PPOTM and Delta Dental Premier® dental networks. Many of Delta Dental of Illinois’ plans that are provided by an employer or group are Delta Dental PPO Plus Premier plans. Delta Dental of Illinois also offers access to both the Delta Dental PPO and Premier networks through its Platinum individual and family plans.
Know what’s covered by each plan before selecting one
You may not have access to all of the types of dental insurance plans listed above – the plans you can choose from will depend on what’s available in your area. Once you have a solid understanding of the types of dental insurance plans available in your area or offered by your employer, individual & family dental insurance plans, or Medicare Advantage. You can begin to conduct additional research into the details - such as covered procedures, waiting periods, and annual limits.
Final thoughts
Every dental insurance company will offer slightly different plan types with different benefits and levels of coverage. Consider weighing each plan’s monthly premiums and out-of-pocket costs. Do your research thoroughly before selecting a plan – make sure that your current dentist, if you are hoping to continue using him or her for routine cleanings and procedures, is covered under your desired plan. To compare these plans side by side, please see our individual dental insurance page.
Additional resources
Looking for more information? Brush up on dental insurance basics:
1What are the different types of dental benefits products? (n.d.). National Association of Dental Plans. Retrieved from nadp.org/Dental_Benefits_Basics/dental_bb_10
2What do dental plans normally cover? (n.d.). National Association of Dental Plans. Retrieved from nadp.org/Dental_Benefits_Basics/Dental_BB_2.aspx