What is the best type of dental insurance plan: HMO, PPO or indemnity?
If
you are wondering what type of dental insurance, HMO, PPO or indemnity
is right for you, the answer will vary person to person. It will depend
on how much you can afford to pay in premiums and what type of service
you want.
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As you can imagine, each of these different types of insurance offers
their own coverage levels as well as offering different levels of
flexibility, which may be important to you.
You will find that HMO, PPO and indemnity plans are very similar to
their health insurance counterparts, with some minor differences.
Reading through this article will help you get an idea of what each type
of insurance has to offer.Dental HMO Insurance Plans
A Dental HMO dental plan or a DHMO is the most affordable option for
dental insurance. Every dentist within the network agrees to only charge
the insurance company a certain amount of money for each type of
service provided. Because of this, HMO providers require that the
insured persons remain within the network in order to receive care. If
you receive care from outside the network, then you will have to pay for
your care out of pocket. There is no flexibility when using this
option.
If you need to see a specialist, then you are going to have to
receive a referral from your dentist. What’s more, the referral has to
be to a dentist within your network or you won’t be covered for you
care. Even if there are no dentists in your area that provide the
additional work you need, if the dentist is out of network, you will be
unable to get your care covered.
A DHMO typically has a co-pay
that you will have to pay each time you visit your dentist. This copay
will usually be $20 or $30; however, you can choose some plans that have
a $50 or $75 copay. These plans have even lower premiums than a
traditional HMO, so it simply depends on how much you can afford to pay
out of pocket for each visit.
DHMOs often receive criticism because many DHMO insurance providers
require the dentist to see a specified amount of DHMO patients each day
in order to remain under their plan. Some argue that this means that a
dentist cannot spend the appropriate amount of time needed to give a
patient quality care.
Another criticism is that DHMO providers only pay a certain dollar
amount for each type of service. For example, a DHMO may only pay $100
for an exam where the average cost in the dental industry is $200. The
suggestion is that a dentist will use lower quality and faster methods
when treating a DHMO patient because of these costs. Your best bet, if
choosing a DHMO, is to do a thorough background check on the dentists in
your area to see who has the best reputation regardless of who their
patients are.
A major benefit to choosing a DHMO is that most well care visits are
free to the insured person. Usually this means that your bi-annual
cleanings are covered under your plan with no out of pocket expenses,
which means that you don’t have to pay a co-pay for a well visit.
Dental PPO Insurance Plans
Dental PPO plans or DPPO is sort of a hybrid of a DHMO and an
indemnity dental plan. That is because a PPO still has a network of
dentists that you can choose from but it will still pay for some of your
costs if you visit a dentist outside of the network.
If you do choose to go out of the DPPO network, your out of pocket
costs will be higher. This is because within the network, much like a
DHMO, the insurance company has negotiated with the dentist to keep
costs for each type of care under a certain dollar amount. If the
dentist you see out of the network stays within that agreed upon amount,
then you will not have an increased out of pocket expense. Generally,
however, the costs outside of the network will be higher.
DPPO providers do not require dentists to see a specified amount of
patients each day so there is no concern about whether or not they will
rush through an appointment. They do, however, pay no more than the
agreed upon amount, which brings up some of the same concerns that a
DHMO has. However, DPPO plans typically provide a higher allowance for
services than a DHMO.
Of course, this higher allowance for services and the flexibility you
get when you choose your own doctor comes with a price tag. Although a
DPPO will be less expensive than an indemnity plan, it will be more
expensive than a DHMO. In addition, many DPPO service providers require
you to pay for your care out of pocket and then submit a form for
reimbursement.
It will be in your best interest to find a dentist that will allow
you to submit a claim for a direct pay to the dentist so that you don’t
have to pay out of pocket at the time of your visit. If you have a good
insurance company then it is possible to get a dentist to agree to this,
especially if the dentist is well established and can afford to wait on
a claim to get paid.
Much like a DHMO, you will find that your cleanings are usually 100%
covered and most of the time you won’t have any out of pocket costs at
the time of your visit.
Dental Indemnity Plans
Dental indemnity plans offer you the most flexibility in terms of
your care. Naturally, you pay for this flexibility with higher annual
premiums than other types of insurance plans. If you want the freedom
to:
- Trade dentists whenever you want
- Visit a specialist, such as a periodontist, without a referral
then an indemnity plan is for you.
Dental indemnity plans pay a certain percentage of your care,
typically 80% for standard care and 50% for high-end care, such as
crowns. Sometimes they offer three different levels of care coverage,
such as:
- 80% of cleaning, x-rays, and fillings
- 70% of root canals, gum therapy
- 50% of crowns, braces, etc…
Of course, you have to review your own policy to see what your dental insurance offers.
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When you choose an indemnity plan, you will receive a Table of
Allowance, which will detail each of the most common treatment types and
just how much they are willing to pay for each type of treatment. Most
insurance companies also offer a usual, customary and reasonable fee
addendum to your policy so that you understand that if the cost of care
exceeds their Table of Allowance breakdown, then you will pay for the
difference out of pocket.
For example, if the insurance company deems that a reasonable fee for
a filling is $150 and your dentist charges the insurance company $175,
then you will have to pay an additional $25 out of pocket. Before you
purchase an insurance plan, you can review their reasonable fee schedule
to determine if they are offering enough for the dental coverage you
think you will need.
As you can see, there are a lot of things to consider when deciding
between these three options. If money is a major factor, then a DHMO or
DPPO may be your best choice. Once you have decided which option is best
for you, then it’s time to use our free quote tool to find the best
premiums.
