dental insurance guide A 5 Minute Guide to Selecting the Perfect Dental Plan

Finding a dental plan that gives you the coverage you want at the price you want is not easy. There are discount plans, PPO, DHMO and indemnity plans to sort through. This web page is a quick read and will give you the information you need without overloading you with a lot of jargon.

Don't forget, you can always call me (800-272-0512) and I will explain the plans to you. But you will be a much better consumer if you take 5 minutes and read through this information

Let's get started. The first thing I need to explain is the difference between a dental plan and dental insurance.

The Difference Between Dental Plans and Dental Insurance

A dental plan is not an insured product. There is no insurance company behind it. Some discount plans use networks from well known insurance companies like Aetna or CIGNA, but they are still not insurance plans. It can be sold by unlicensed representatives. Bottom line, dental plans are discount plans. But that is not necessarily a bad thing.

They way these plans operate is very simple.

You go to a dentist that participates in the plan and show them your card. If the procedure you are having is one of the covered procedures, you will get a discount. Sometimes the discounts can be quite substantial. Far in excess of what you pay for the plan.

There are no waiting periods for anything and no maximums. You show the card and get a discount. That is all there is to it. But remember, you will be paying your dentist at the time of the procedure.

If you find a provider you like that accepts the plan, this can be very cost effective coverage. You can find plans in your area and apply online with this Discount Dental Plan Locator.

Dental insurance is backed by an insurance company and is only sold by licensed insurance agents.

We have two types of dental insurance plans; PPO and Indemnity. In many instances they are alike with a few subtle differences. Stay with me a few more minutes, there is not that much more and this is important.

PPO Dental Insurance

Before I get into a description here is a bit of news that will go against everything you every thought you knew about dental insurance. You can use any dentist you want with a PPO, but if the dentist is not part of the member network, you are not getting the coverage you think you are buying. I will explain.

A PPO dental insurance plan utilizes a network of dentists and pays you or the dentist a percentage of the cost of a dental procedure. If you go to a dentist in the network, the dentist can only charge you the discounted, agreed upon price. If the dentist is not in the network (the dentist that tells you they take any PPO plan), they can charge you anything they feel like. You will end up paying a lot more than you expected.

Most of the plans will pay a percentage of the bill charged by an in-network dentist. For example, a typical insurance plan will pay 100% of your expenses for a cleaning, 80% for a filling and 50% for a root canal or crown, etc.

Whenever possible, you should try to use a network dentist. You will end up paying a lot less and your plan will go much further.

What happens if your dentist is not in the network? the dentist is free to charge whatever they want. Your plan might pay 50% of the cost of a root canal. But, it pays 50% of what a network dentist would charge. Your dentist might charge a lot more than the PPO or network rate.

For example, if you go to a PPO network dentist for a crown, the network or discounted price might be $500. If the plan paid 50%, the crown would cost you $250. But, if it were a non-network dentist, he or she might charge $1,000 for the crown. The plan is still going to pay 50% of the PPO rate which is $250. You get stuck for the remaining $750.

While you still get something back, it is not as much as you can get by staying within the network.

If you want to read more about PPO dental plans and get immediate online quotes, go to our page on PPO Dental Plan Quotes

Indemnity Dental Insurance

An indemnity dental plan pays you a fixed amount of money for each dental procedure.

Everything that happens in a dental office has a unique code associated with that procedure. You look up the code for the procedure and you will see how much you are reimbursed. They will pay you or the dentist. They do not care what you do with the money; pay your dentist or go to Vegas.

Many indemnity plans also have a PPO-like network as part of the plan. If you use a dentist in the network, you get the network discount. As with the PPO plan, we recommend that if at all possible, you should use a network dentist. It will save you a lot of money.

With an indemnity dental plan you can use any dentist you want. It does not matter if they are in or out of network. It can be used anywhere in the United States. You pay your dentist and the plan reimburses you directly. Although, some dentists might take assignment and wait to be paid by the insurance company.

A better quality indemnity dental plans gives you the best of both worlds. They have large national networks that give you reduced fees and generally pay out the same as a PPO and in certain instances, more.

For example, one of our quality plans pays out $313 for a root canal in a molar. The network rate for the service could be $550. You would be responsible for $237, which is very similar (and in many cases better) to a PPO dental plan.

Another advantage to many indemnity plans are the higher caps. Instead of the traditional maximum of $1,000 a year that the PPO plan allows, the indemnity plan can pay out up to $2,500 a year and be extended to $3,500 a year. This is a great advantage if you are facing a lot of expensive dental work.

You can read more about this type of plan and get real-time quotes at our Indemnity Dental Plans Quotes and Information.

Go to Any Dentist You Want Plans

If your dentist does not appear in any of our networks, it means that he or she does not accept any of our plans. It is quite possible your dentist does not accept insurance at all, which has become more and more common. Or, they only take the kind of plans you can buy if you are part of an employer plan (group dental).

If this is the case you have a few choices available to you.

  1. You can use an indemnity plan. It will pay out regardless of the whether the dentist is any network.

  2. You can use a PPO plan. You will be reimbursed based on a percentage of what a PPO dentist would normally charge.

  3. You can forget about insurance and try to negotiate a cash discount with your dentist.

Next Steps

I hope this has shed a little light on how dental plans work. Don't worry if this is still confusing. Just give me a call and I will be able to help you find the right plan for your needs.

Do not be concerned if this is starting to look complicated. I promise you that I will explain everything in simple, clear language. You will know exactly what you are buying before you buy it. There will be no unpleasant surprises.

Call 800-272-0512 or use the Contact Us button at the top of this page.

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