Dental insurance covers some or all costs related to preventive, basic and major procedures performed under American Dental Association (ADA) codes.
Consider monthly premiums, deductibles and annual maximums when selecting a dental plan. In addition, look for plans with no waiting period for basic and major services and plans that offer increasing coverage annually.
Many dental insurance plans utilize a PPO network to negotiate fees with dentists, giving you the option of visiting any licensed dentist in your area while keeping costs under control. Any services rendered outside the PPO’s network typically incur more costs.
PPO plans offer more flexibility than HMO plans by allowing you to select your dentist of choice; however, any charges exceeding your annual maximum amount will fall on you alone.
PPO dental insurance plans can be obtained either as an employee benefit, through an Affordable Care Act marketplace health plan or from private insurers. PPO plans typically offer more flexible options when selecting their dentist than HMO plans, with higher monthly premiums but additional dentist choice often making up for it – just ensure the plan you select has sufficient network coverage! When making this choice, always double check its network list before selecting it to make sure your preferred dentist(s) can be reached!
As dental insurance continues to evolve, moving away from traditional fee-for-service models towards integrated care and value-based reimbursement models, PTS suggests taking time to educate your patients on their options as well as reevaluating your plan offerings.
HMOs and DMOs typically utilize a closed network of providers who contract with an insurer to offer discounted fees for approved services. Patients typically select a primary care dentist from among those participating and must visit them for all non-emergency and routine treatments; in certain instances, this provider may need to refer patients out for specialty visits.
Preventative care services like teeth cleanings, oral exams and certain types of x-rays are typically covered 100% under both types of plans. For other services rendered under either plan, patients typically pay either copays or share in costs up to an annual maximum. HMOs tend to offer lower annual maximums while also typically offering more restrictive deductibles and waiting periods than PPOs.
People enrolled in PPO dental plans can visit dentists outside their plan’s network at higher fees; these plans often feature an annual deductible which must be fulfilled before coverage will start being covered by their insurer.
Like HMOs and PPOs, DHMOs and DPPOs require patients to stay within their primary care physicians (PCPs) network when seeking referrals to specialists; however, they offer greater coverage for out-of-network providers.
Dental insurance can be an overwhelming topic with various nuances and regulations that need to be understood, which is why dentists need to be knowledgeable of various forms of insurance coverage available to their patients as well as what benefits each offers them. Communicating clearly and concisely about this matter with patients helps reduce confusion and anxiety – leading to improved treatment outcomes overall.
Dental EPOs differ from HMOs in that patients can visit any dentist they choose; these plans tend to have smaller networks of providers and may even require the services of a primary care physician for enrollment.
Many dental insurance plans feature an annual maximum that establishes how much the insurer will cover during one year of coverage. Once that threshold has been reached, all costs become the responsibility of the policyholder.
Plan dates vary – some plans run on a calendar year while others use fiscal years that run from January through December. Both dental offices and patients should be aware of which dates they need to keep an eye on for each plan.
Insurance plans are created through negotiations between an employer and an insurance provider to negotiate specific parameters (like deductibles, copayments and limitations) that make each plan suitable to individual needs. You may obtain your plan either through work or independently through providers such as Humana.