Dental Plans

There are a few basic types of dental coverage - any of them can help you maintain great dental health. Dental insurance's low cost makes it generally affordable for individuals and families. And, because dental insurance encourages and generally pays for regular check-ups, many people who purchase protection start to benefit immediately. Don't get stuck with a big bill: the price of fixing a major tooth or gum problem, such as a crown or root canal, can easily reach into the thousands of dollars.

Dental Plans Takeaway Information:

  • Types of Dental Plans
  • The Medical Dental Connection

Types of Dental Plans

Dental PPO (Preferred Provider Organization) plans allow you to visit any licensed dentists but you usually pay lower costs when you visit a PPO network dentist. These plans offer a balance between lower costs and dentist choice. PPO dentists who participate in the network agree to accept contracted fees as payment in full for patients with the PPO plan, rather than their usual fees. When you visit a PPO dentist, you typically pay a certain percentage of the reduced rate (called coinsurance) and the plan pays the rest. The percentage usually varies by the type of coverage such as diagnostic and preventive, major services, etc.

Prepaid Dental Plans, also referred to as dental HMO plans, require you to choose one dentist or dental facility to coordinate all of your oral health needs. If you need to see a specialist, your primary care dentist will refer you; specialty care may require preauthorization. A typical DHMO-type plan doesn't have any deductibles or maximums. Instead, when you receive a dental service, you pay a fixed dollar amount for the treatment (a "copayment"). Often, diagnostic and preventive services have no copayment, so you pay nothing for these services. Generally, if you visit a dentist outside of the network, you may be responsible for the entire bill.

Discount plans, or reduced-fee-for-service plans are not insurance but instead offer access to dental services at a discounted rate from participating dentists for a monthly or annual charge. There is generally no paperwork, annual limits or deductibles, but you must visit a participating dentist to receive the discount. Also, you may be responsible for a greater portion of the treatment cost than with a PPO or Prepaid plan.

The Medical Dental Connection

There is mounting evidence of a connection between oral health and a person’s overall health. It is well documented that a high percentage of health conditions have an oral component such as swollen or bleeding gums, ulcers, dry mouth, bad breath, metallic taste and various other changes in the oral cavity. Since most people have regular oral examinations, their dentist may be the first health care provider to diagnose a health problem in its early stages. Some health problems that your dentist may become aware of include diabetes, cancer, heart disease, kidney disease, anxiety and other medical conditions.