Dental Insurance FAQ
This page is divided into sections based on the type of dental plan. Plus, there is a general dental FAQ section as well.
General Questions
You can get almost immediate coverage, even for major dental procedures like crowns and root canals with our HMO plan and our Discount Dental Plan.
PPO plans either have a one-year waiting period or, in some cases, they will pay a very tiny percentage during the first year of coverage.
Yes, most plans will cover implants. HMO plans cover them at a fixed price. PPO plans generally have low coverage limits and an implant can easily exceed these limits. If you need implants and are satisfied with one of the dentists in the network, you will be better off with an HMO. You can always drop it after the work is done and switch back to a PPO or discount plan.
Yes and No. If you use a PPO plan you can use any dentist even if they are not in the network. However, you will pay full price for any work done and only get a small percentage reimbursed. It really never pays to go to a dentist that is not in your plan. It is a waste of money.
With HMO plans or discount dental plans you must use a network dentist. But you will save a substantial amount on your dental bills.
No, virtually all plans require at least one adult on the plan.
The cost of billing each member, recording the transactions, sending out late notices, etc., is too expensive. The only way to pay for dental insurance is through a direct bank draft or credit card.
HMO Dental Insurance Questions
Maybe, but that is not a guarantee. HMO plans require you to use a dentist that is part of the network. There are no exceptions. However, the NETWORK is fairly extensive and there should be a number of dentists near you.
So far we have not found anything not included in the list of covered procedures. All routine dental work as well as crowns, root canals, and bridges are covered. It even covers implants and orthodontia.
Routine maintenance like x-rays, cleanings, basic fillings, etc., are at no cost to you. Major procedures like crowns show a dollar amount. For example, a crown is shown as $450. Most dentists, depending on where you live, would charge $1,200 to $1,600 for this same procedure. That is why many of our clients will travel a little further to use an HMO dentist. The savings for someone who needs a lot of dental work is considerable.
No, unlike a PPO dental plan which might only cover the first $1,000 of dental work, an HMO has no maximum.
The cost of billing each member, recording the transactions, sending out late notices, etc., is too expensive. The only way to pay for dental insurance is through a direct bank draft or credit card.
Discount Dental Plan Questions
A dental plan might be issued by a major insurance company. However, is not considered insurance and not governed by state insurance laws.
It essentially gives you the advantages of a network discount at participating network dentists. You show your card when you show up for your appointment and you will only be charged the discounted network rates.
No, you can literally use the discount plan the next day. There are no maximums because it is a discount and the company is not paying anything to the dentist.
It is not a flat percentage. Each covered procedure has its own discounted price. Cleaning is about $35 and a crown is about $525. You can see more examples on this web page.
We used to sell two separate dental plans that each had its own network. One was with Careington and the other was with Aetna. We had a slightly more expensive option that gave you both plans. We eliminated the extra cost and give both plans to everyone.
You can see the combined network here.
PPO Dental Insurance Questions
First, you should select a dentist in the network.
The dentist will tell you how much you will pay for each procedure.
Before the plan pays out for anything, there is a deductible that must first be met. This normally runs between $50 and $100 per person.
In addition to the deductible, the plan might have a copay that is paid on each visit.
The plan does not fully cover anything other than a routine cleaning or x-ray. It will pay out a percentage.
There is a waiting period for major expenses like crowns or root canals, it will not cover them until the second year of the plan.
There is also a coverage limit. This means that once the insurance company pays out a certain amount in a year, it stops paying until the following year. This is often $1,000 to $1,500.
This is very misleading. There are a few plans that will pay out 10 – 20 percent in the first year. But the full plan feature of perhaps 50 percent coverage will still not be available until the second year.
Yes, if the dentist is in the network, you will only need to pay the discounted PPO rate. This is an agreement between the network dentist and the insurance company.
Technically, yes it is true. But, when you are not using a network dentist there is no discounted PPO rate. Plus, you will need to pay your bill in full and then wait for the reimbursement from the insurance carrier.
Using a PPO plan without using a network dentist is in most instances a complete waste of money.
We do sell PPO dental insurance. However, with few exceptions, it is a bad deal for the consumer and a great deal for the insurance company. If you need a lot of work done and want a complete dental insurance plan, you are much better off with a dental HMO plan.
Still have questions. Use the Contact menu link at the top of this page to contact us.