What Types of Dental Plans Exist?

What Types of Dental Plans Exist?


Are you shopping for the best dental insurance plan? The first thing you’ll need to do is understand the types of coverage available. Even from one dental insurance company to the next, the plan that you enroll in will determine the type of coverage (and out of pocket expenses) involved in your oral health care.

Dental PPO

When you enroll in a PPO dental plan, you can choose to see a dentist in your network or out of your network. However, you may wind up paying more to see an out-of-network dentist in certain situations, as they are not a part of the insurance company’s fee agreement. In-network dentists have agreed to lower their treatment costs to patients who are members of the plan that they are in a contract with.

Dental HMO / Pre-Paid

Dental HMO plans are capitation plans. Your insurance company will pay dentists within their network a flat fee to provide you with dental care. Enrollees must see a dentist within the network, and may have to deal with restrictions on how often they can receive certain types of dental treatments

Indemnity / Fee-for-Service

An indemnity dental plan is a “traditional” insurance policy. You can see any dentist that you like, regardless of whether or not they are in-network. You pay your dentist directly for any treatment that you receive. Then, a claim is filed with your insurance company, and you’re reimbursed by your insurance carrier for any services covered by your plan.

Most indemnity policies also require that you submit a“pre-determination” (a treatment plan from your dentist, detailing what needs to be done and why) prior to treatment being started, so that your insurance company can give you an idea of what is or is not covered, and by how much.

Discount Dental Plans / Reduced Fee-for-Service

Due to changes in the healthcare and insurance industries, many individuals are choosing to enroll in discount dental plans that provide reduced costs on dental care.

Enrollees are charged a monthly subscription fee and are provided with discounts at all participating dental offices, regardless of their location. There are no pre-determinations, annual spending maximums, or deductibles involved. Rather, the patient receives a flat discount on their dental treatment and pays for the remaining balance out of pocket.

Many dentists actually prefer reduced fee-for-service plans, as it is easier for everyone involved. There are no surprise bills after a claim is rejected, and patients know exactly what is due before treatment even starts.

Which Plan is Best for Me or My Family?

There are a few things that you’ll want to consider when it comes to choosing the best type of dental insurance policy to enroll in:

  • Do I want to keep my current dentist?
  • How much do I usually spend on dental care? Do I need lots of work, or am I usually only in need of routine preventive services?
  • Are you considering cosmetic work? Most traditional insurance will not cover elective services (or dental implants)
  • Can I work around waiting periods or maximum allowable (how much your insurance is willing to pay per year)?
  • Do I need an affordable plan that offers fixed discounts?
  • Do I mind waiting on a reimbursement check?

Our dental savings experts can answer any questions you have about Cigna dental savings plans. Contact us today!

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