There are a number of different kinds of dental insurance. When shopping for dental insurance and choosing a plan, you will want to know the following:
- Is there a deductible and coinsurance?
- Are you required to choose a primary care dentist?
- Are you required to see dentists within a certain network to be covered?
Understanding the main differences between the types of dental insurance can help when choosing the plan that's right for you.
What are the different types of dental insurance?
The most common include the following:
- Dental Preferred Provider Organization (DPPO)
- Dental Health Maintenance Organization (DHMO)
- Dental Indemnity
- Dental Exclusive Provider Organization (DEPO)
- Dental Point of Service (DPOS)
Here is an overview of the different types of dental insurance:
What is a Dental PPO plan?
Dental PPOs have a network of providers to choose from. You can opt to see a dentist outside the network, but your costs will be higher. You are not required to choose a primary care dentist.
DPPOs typically have an annual deductible and coinsurance. Once you meet your deductible, your dental plan will kick in to start sharing costs as part of the coinsurance up to the annual maximum each year. Most in-network preventive dental care, like cleanings, routine exams, and routine X-rays, is covered at 100%. You may be required to pay a copay at the time of your visit and share costs with your plan for any care that goes beyond preventive.
A DPPO can help keep your costs lower if you are willing to see dentists within the network. This is one of the most common and popular types of dental plans.
What is a Dental HMO plan?
Dental HMO or DHMO plans tend to be some of the more affordable dental plans. There is typically no deductible and only a set fee for non-preventive dental services. Most preventive dental care, such as cleanings, exams, and routine X-rays is usually covered at 100%.
Costs are usually lower because you are required to choose a primary care dentist from the network. These plans typically do not provide coverage if you choose to see dentists outside the network (there may be exceptions for some emergency services). Networks may be smaller and more local. Dentists in a network agree to offer lower costs. These cost savings are passed on to patients as part of plan coverage.
Dental HMO plans usually do not have an annual maximum for covered services. This means that no matter how many covered dental services you need within a year, you will not have to worry about "running out" of benefits for the year.
If you need to see a specialist, your primary care dentist will refer you to a provider within the network.
What is a Dental Indemnity plan?
Dental indemnity is a type of dental insurance that gives you a lot of freedom. It's often referred to as a “traditional” dental plan or a “fee-for-service.” You can typically see whatever dentists you want—there is no network. You don't need to choose a primary care dentist and you may not need referrals to see specialists or receive emergency dental care, depending on the plan.
A dental indemnity plan usually has an annual deductible and coinsurance. You'll pay for services out of your own pocket until you meet the deductible. Then you and your dental plan will share costs for covered services, up to what is considered usual, customary, and reasonable (UCR) under your plan. These types of dental plans tend to cost a bit more. If you like a lot of options and few requirements, a dental indemnity plan may be right for you.
What is a Dental EPO plan?
These types of dental insurance plans give you options to choose between seeing general dentists and specialists. You don't need to choose a primary care dentist and you don't need referrals to see specialists.
With a DEPO plan you must see dentists in the network, to be covered. Out-of-network coverage may apply for some types of dental emergencies.
These plans usually have a deductible and a coinsurance.
What is a Dental POS plan?
These dental plans combine aspects of DHMOs and DPPOs. Like a DPPO, you are free to see dentists outside the network, but your costs will be lowest when you stay in-network. Like a DHMO, you are required to choose a primary care dentist who will provide any needed referrals to specialists, in or outside the network, as you choose.
This kind of freedom may mean you have a higher deductible, plan premium, and copays, depending on the plan. If you don't really intend to see dentists outside your network, a DHMO may offer better cost savings.
What types of dental insurance cover orthodontic care?
Orthodontic care, such as braces and other teeth-straightening services, can be expensive and not all dental plans provide coverage for braces. When exploring types of dental insurance for orthodontic care, consider the following:
- Are orthodontic services covered? The plan information should indicate the services that are covered and which are not.
- Some dental plans come with limits on how much the plan will cover in a plan year. If you expect to need costly orthodontic services, examine any plan limits and how that could affect your costs.
- Does the plan have a network of providers you need to use? If you have a preferred orthodontist, you might want to make sure they accept your plan, otherwise you may not be covered for their services.
- Does the plan have age limits? Some plans only cover orthodontic care up to a certain age.
What types of dental plans cover crowns, bridges, and dentures?
When you're shopping for a dental plan, look for those with coverage for major restorative care. This kind of dental care usually covers crowns, bridges, and dentures. Check the plan annual maximum. This is the most your plan will pay for covered services in a plan year. If you reach that limit, you will be responsible for paying any and all additional costs for your dental care. If you expect to need more restorative care, a dental plan that has a higher annual maximum and more coverage for restorative care may be right for you.
Do all types of dental insurance have waiting periods?
Not all dental plans have a waiting period. A waiting period is the time between the date your plan is effective and the date you are covered to receive dental care. There may be a waiting period for basic care versus major restorative care. This means you may be able to get a filling done sooner and be covered, but have to wait longer if you need something like a crown or bridge. Some plans may waive waiting periods if you had previous coverage with them.
Dental plans can vary a lot depending on the insurance carrier and plan design. When you're comparing types of dental plans, you might want to consider the kind of dental care you expect to need. Do you only need cleanings or routine exams? Or could you need fillings, or orthodontic services, as well? Make sure you understand the details of plan coverage before making a final decision on the type of dental insurance that's right for you.
This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations.