The annual maximum is the dollar limit on the amount your plan will pay for dental care during a calendar year. Most plans also have a co-pay rate.
Preferred provider organization (PPO) plans include a list of dentists who have agreed to accept the plan for a lower fee. These plans may also have a deductible and coinsurance.
Whether an employer offers it as part of a benefits package or you purchase it alone, dental coverage helps overcome one of the main barriers to receiving care. Most plans cover 100 percent of preventive services such as twice-yearly cleanings, fluoride treatments, and X-rays, and around 80 percent for basic filling procedures. Extensive work, such as crowns and root canals, is typically covered at a much lower rate, about 50 percent.
The most significant factor determining the cost of your plan is the type you choose. Dental health maintenance organization (HMO) plans tend to have lower monthly premiums and out-of-pocket costs because they only pay for care from dentists and other providers in the HMO network. Dental preferred provider organization (PPO) plans typically cost more but offer greater flexibility because they allow you to use dentists both in and out of the network.
Most plans also have an annual maximum, which means you’ll have to pay for any treatment over the amount your insurer pays in a year. If you want a plan that doesn’t limit your annual coverage, look for a DPPO, which usually has a more extensive network of dentists. Discount plans function differently, with members paying discounted fees directly to the dentist and then the plan covering a percentage of the cost subject to a deductible and an annual maximum. Delta Dental offers such a plan under its Patient Direct brand.
Dental insurance plans cover many treatment options, from routine exams and cleanings to crowns, fillings, and root canals. They typically come with a monthly premium and various cost-sharing arrangements like deductibles, coinsurance, or annual maximums. It is essential to understand these terms when choosing a plan.
Many dental insurance companies offer different types of coverage, including traditional indemnity, Preferred Provider Organization (PPO), and Dental Health Maintenance Organization (DHMO) plans. The latter are similar to health insurance HMOs in that they have a network of dentists who have agreed to reduce their fees for patients who choose to be seen within the network. If someone decides to visit an out-of-network dentist, their out-of-pocket costs may be much higher.
Individuals can find a variety of affordable dental family insurance plans when they compare costs and benefits. Plans with lower monthly premiums tend to have higher deductibles and copayments; however, the overall cost of getting comprehensive dental care in the long run may be worth it for some people. Dental insurance encourages regular preventive visits and helps detect and treat minor problems before they become more severe and require expensive procedures. Studies show that good oral health directly impacts a person’s overall wellness.
Dental health is essential for your overall health. Regular oral exams detect problems early and prevent the need for more expensive and invasive procedures down the road. That’s why most dental insurance plans cover preventive care at 100% and often require low or no deductibles1.
Suppose you opt for a dental preferred provider organization (PPO) plan, like the type of health insurance PPO you might have through your employer. In that case, you can expect to pay a lower monthly premium for the same coverage as an HMO plan with fewer restrictions. However, the annual deductibles for both types of dental plans can be more costly than an HMO plan with no deductible.
Another option is a traditional or indemnity dental plan, which has no network and allows you to visit any dentist. These plans typically cost less than a PPO plan, but they also lack the discounts offered by network dentists.
If you choose a DHMO or DPPO plan, remember that some DHMOs and DPPOs require you to visit your primary dentist for a referral before seeing a specialist. That may increase the time it takes to see a dentist, but it can help you save money by not having to pay for out-of-network services.
Often, family members have access to two separate dental insurance plans. This situation is known as dual coverage and can significantly benefit many patients. With proper coordination, a second policy can help cover costs not covered by the primary plan. For example, a patient may have reached the annual maximum on their direct dental plan or might need specialized work that isn’t usually covered by the standard plan. When paired with comprehensive preventive care coverage, the additional benefits of the secondary policy can help reduce the overall cost of necessary treatment.
When a patient has dual coverage, they must carefully review the coordination rules of each plan. Most insurance companies, including Delta Dental of Arizona, have established rules for determining how much each plan should pay for certain services. This process is called coordination of benefits (COB).
For most dental plans, the primary insurance pays first, and then the secondary insurance covers the remaining amount up to the limit set by the preliminary plan. This process helps to minimize overlapping expenses and reduce out-of-pocket costs.
However, there are some restrictions to this process. For instance, some dental policies have non-duplication of benefits clauses that prevent the secondary policy from covering more than 100% of a procedure. These restrictive plan provisions can limit how much your patient ultimately saves.