Dental insurance use to be one of the most economical and full coverage health related products you could buy, that’s not necessarily true anymore. Premiums have increased and out of pocket expenses have also gone up – this is one reason you need to ask the right questions when looking for dental insurance.
PPO and DMHO
Dental insurance and medical insurance travel down the same path when it comes to this subject. The question you have to answer for yourself is – do you want to choose your own dentist or will you be happy with one within a network?
With a PPO dental plan you will pay higher premiums and probably have higher co-pays, but you can pick the dentist of your choice. The DMHO plan is like the HMO plan many people have for medical care. There are a network of doctors and specialists for you to choose from. Costs are fixed and the only thing you pay is a co-pay fee. Generally this fee ranges anywhere from $10.00 to $30.00. The fees for specialists and hospital care can be a little higher, but not as high as the PPO plan.
Premiums - as mentioned, the premiums for the PPO dental plan is higher because you have choices outside of the plan network. The DMHO premiums are generally much lower and in the case of an employer subsidized plan your monthly premium could be zero.
Coverage - Good dental plans should cover at least two cleanings a years with one x-ray session annually. Here are a few other things to look for:
- 75/25 split for fillings, caps, root canals, and other repair items (the 25% is your out-of-pocket cost)
- $1500.00 maximum payout per year
- 50/50 split for braces, bridge work, and orthodontic treatment
One issue that dental insurance plans have lagged behind on is “annual maximum payouts.” You’ll find that there are many plans out there that still only have a annual maximum payout limit of $1500.00. This can be eaten up with a few root canals and caps. If you can get that payout limit raised up a bit for a small increase in cost, then do it…it’s well worth it.
Does the Dental Plan Pay Direct?
This question is asked both of the insurance company and the dentist. In the case of a DMHO plan this is not an issue, the dentist is part of a network where payments are fixed. The PPO plan is different.
Some PPO plans want the patient to pay all fees upfront, and then the insurance company will pay the patient directly after the fact. With some dental procedures costing in the thousands of dollars, many patients have a hard time with this payment plan. On the other hand some dentists, even if the insurance company pays them directly, don’t want the hassle of collecting from insurance companies – in this case you would still need to pay the entire bill upfront.
So, if the PPO dental plan is your preference, then just make sure you know how the payment plan works, and make sure that plan works for you too.
Lisa Collins a well known writer has been writing numerous articles on health insurance. for more information on different health insurances visit the website Dentalinsurance.net .