Dental insurance helps protect you from unexpected dental expenses and makes it easier to afford to keep up the regular checkups, cleanings, and other preventive treatments you need to keep your mouth healthy.
Like medical insurance, dental insurance provides benefits for a specific rate or premium. Different plan designs offer various levels of coverage and different choices in which dentists you can visit.
These participating dentists agree to perform services for patients at pre-determined rates and usually will submit claims for you. You’ll usually pay less when you visit a network dentist. Most (but not all) traditional indemnity or fee-for-service insurance products do not provide a network feature, so you may have to pay for services up front, file your own claims, and wait for the insurance carrier to reimburse you. However, there are advantages, such as having the freedom to visit the dentist of your choice.
Typically, this is the least expensive of dental plans. All dental services are provided by professional dentists who agree to provide specific treatments and services, at a predetermined cost, to patients. Dentists are paid directly by the insurance company for each individual, regardless of how much or how often covered services are used.
A scheduled plan or scheduled reimbursement plan reimburses you for a specific amount based on a fee schedule with any balance due being your responsibility. Scheduled plans do include a calendar year maximum, a deductible and have waiting periods on certain procedures. A Scheduled plan shows every covered procedure and the amount you will be reimbursed for each procedure. For example, if the
insurance reimburses $47 for a cleaning, and your dentist charges you $50 for a cleaning, you would be responsible for the difference of $3.
PPO dental insurance plans are generally less expensive than Indemnity dental plans. Individuals select their dentist from a network or listing of dental providers who have agreed by contract to reduce their fees. Individuals can also seek treatment from dentists outside of the PPO (non-participating dentists) but may be responsible for additional costs.
Indemnity plans allow the patient to go to the dentist of their choice. These plans pay a percentage of the cost of treatment, and the patient pays the rest. This type of dental insurance plan allows the patient the most freedom to choose their own dentist.
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