Dental Insurance

Dental insurance works in much the same way that medical insurance works. For a specific monthly rate (or “premium”), you are entitled to certain dental benefits, usually including regular checkups, cleanings, x-rays, and certain services required to promote general dental health. Some plans will provide broader coverage than others and some will require a greater financial contribution on your part when services are rendered. Some plans may also provide coverage for certain types of oral surgery, dental implants, or orthodontia.

Like health insurance plans, dental insurance plans are usually categorized as either Indemnity or managed-care plans (Dental PPO plans fit in this latter category). Put broadly, the major differences concern choice of dental care providers, out-of-pocket costs and how bills are paid. Typically, Indemnity plans offer a broader selection of dental care providers than managed-care plans. Indemnity plans pay their share of the costs for covered services only after they receive a bill (which means that you may have to pay up front and then obtain reimbursement from your insurance company).

Managed-care plans typically maintain dental provider networks. Dentists participating in a network agree to perform services for patients at pre-negotiated rates and usually will submit the claim to the dental insurance company for you. In general, you’ll have less paperwork and lower out-of-pocket costs with a managed-care dental plan and a broader choice of dentists with an Indemnity plan.

Although there is no one “best” dental insurance plan, some plans may work better for you and your family than others. Plans differ primarily in how much you’ll have to pay monthly for your coverage and how much you’ll have to pay when dental services are rendered. Some plans will require that you pay a certain co-payment for services, or meet a specific deductible before the dental insurance company begins payment. Other plans may limit coverage to a specific dollar-amount maximum per year.

An in-network dentist is one contracted with the dental insurance company to provide services to plan members for specific pre-negotiated rates. An out-of-network dentist is not contracted with the insurance company. Typically, if you visit a dentist within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network dentist. Though there are some exceptions, in many cases, the insurance company will either pay less or not pay anything for services you receive from non-network dentists.

As a general rule, Dental PPO (and other managed care) plans utilize provider networks. Dental Indemnity plans typically do not utilize a network of providers.