You have a lot of options when it comes to choosing a dental plan. Your best friend might swear by his or her dental PPO, but you’re leaning toward a dental HMO because it looks cheaper, at least from what you can tell. But who knows if that’s best. Or maybe you have absolutely no clue what either plan is or what you should be looking for. Whatever the case, we’ve outlined a few important questions to ask when shopping for dental insurance. As you’re going through them, ask yourself which of these are most important to you. That will help you narrow down your dental coverage options and point you in the right direction.
What are a DDPO and DHMO?
A dental preferred provider organization (DPPO) plan is more flexible. It allows you to visit the dentist of your choice, but you’ll have more affordable rates if you see one who is in-network. With a dental health maintenance organization (DHMO) plan you’re limited to what dentists you can see, and referrals are required if you need to see a specialist. We’ll talk more about the differences between these dental plans throughout the rest of the article.
How much is the premium?
A premium is an amount you pay each month to maintain dental coverage. You can think of it like a cable bill. You have to pay it every month if you want to watch your favorite shows. If you don’t, your service will be disconnected.
Monthly premiums vary in price depending on your plan type. Most DPPO plans have a higher monthly premium but require you to pay less when you see the dentist. A DHMO is just the opposite. Sure, picking a plan that’s cheaper month-to-month can be enticing, but there are a variety of other factors to consider.
Is my dentist in-network?
In-network dentists are contracted providers who perform work at an agreed-upon rate by your insurance company. If you already have a dentist who you trust and want to continue seeing, find out if they are in your potential new plan’s network. If you go out-of-network on a DPPO plan, you’ll pay higher out-of-pocket costs. However, if you go out-of-network on a DHMO plan, you’re likely to be responsible for 100% of the costs.
If you’re looking to keep costs as low as possible, be sure to always see an in-network dentist.
Is there a waiting period?
If you enroll in a DPPO, you may have to wait to use your benefits. Although diagnostic and preventative services, like cleanings, exams and x-rays, are usually covered from your policy’s effective date, basic and major dental procedures typically aren’t. For example, your plan may require you to wait between three to six months before they’ll pay for an extraction or filling, or between six months to a year before they’ll pay for a crown. If you need dental work done immediately, be sure to look for a plan without a waiting period or a DHMO. And while a DHMO doesn’t have waiting period for procedure coverage, it may limit how often you can see your dentist. Ask about the average waiting time between dental visits before purchasing a DHMO.
How much is my deductible?
A deductible is a total amount that you must pay during a specific benefit period before your coverage kicks in. Deductibles only apply to DPPO plans, not to DHMO plans. If your dental plan has a deductible of $100 and your procedure costs $500, you’ll pay $100 out-of-pocket and the plan will pay the rest. Typically, the lower the premium the higher the deductible. This is important to keep in mind when comparing plans. Now, this isn’t to say high deductible dental plans are bad. If you’ve always had a clean bill of oral health and don’t foresee needing anything beyond routine checkups, a high deductible plan could work for you.
How much is my copay or coinsurance?
Copay is a set fee for dental care that you pay for dental care once your deductible has been met. For example, your copay may be $20 for a tooth extraction. With coinsurance, you are responsible for paying a set percentage of the cost of the service. Since the cost of the service may vary, the amount you pay may vary as well. In-network dentists have agreed to accept a set amount for covered services, but an out-of-network dentist will charge his or her usual fee for all procedures, which is typically higher than the negotiated rates you pay for in-network care. DHMO plans have a copay, DPPO plans have coinsurance.
What is my annual maximum?
Another important thing to look at is the plan’s annual maximum. This is the total amount that the dental plan will pay during a specific benefit period. Most DPPO plans have an annual maximum of $1,000-$1,500. You’re responsible for paying anything above this amount. DHMOs, however, do not have an annual maximum.
Additionally, check to see if the plan you’re interested in has a lifetime maximum benefit. This is the total amount the plan will pay during the insured individual’s lifetime. Annual maximums typically apply to long-term treatments such as orthodontics.
Which dental plan is right for me?
There’s a lot to consider when choosing a dental plan. Figure out what’s most important to you, whether it be sticking with your current dentist, lower out-of-pocket expenses, lower monthly premiums or the freedom to see the dentist of your choice. There really isn’t a right or wrong answer, but what works best for you.
There is a third option — a dental savings plan, an alternative to traditional dental insurance there are no deductibles, waiting periods or annual maximums. Plan members enjoy discounts of 10%-60% on a majority of dental procedures when they visit an in-network dentist.
Now that you have some insight into the dental coverage options out there and what to consider when picking a plan, get yourself signed up for one so you can get the quality dental care that you deserve.