Forty-five million Americans don't have dental insurance, according to the Centers for Disease Control and Prevention, or CDC. If you have access to a dental plan, whether through an individual or group plan, it's important to understand the type of plan you have and how to utilize it without incurring any unexpected out-of-pocket costs. A health maintenance organization, or HMO, plan works a bit differently than a preferred provider organization, or PPO, plan.
Review the differences between dental plan options. HMOs typically require you to use a network provider, while PPO plans provide some out-of-network coverage. This information may be outlined in brochures provided by the insurance company or on the dental insurance company's website. Note the premiums, co-pays, coinsurance and deductibles for each plan option. Typically, the HMO will have a lower premium than a PPO.
Consider whether or not you're comfortable with having a primary care dentist that you're required to see before obtaining any specialized services. One of the defining characteristics of an HMO, whether dental or medical, is the requirement to choose a primary care provider, who serves as a "gatekeeper" for accessing other services. PPO plans allow you to see any dentist you'd like, though you may have to pay more out-of-pocket if you see a dentist outside of the network.
Video of the Day
Review each plan's co-pays and coinsurance. Dental HMO plans may not have any co-pays for preventative services like cleanings and exams, as long as you're seeing your primary care dentist. There may be a co-pay for other services like crowns and bridges; the co-pay is the same for each procedure regardless of which network dentist you see. For example, if a crown for a molar has a $50 co-pay, it will be $50 no matter which dentist you go to. PPO plans are based on coinsurance, which means the dental plan will pay a percentage of what the dentist charges for the procedure. For example, if a dentist charges $500 for a crown for a molar, and the coinsurance is 50 percent, your out-of-pocket cost is $250. If the dentist across the street charges $600 for the same procedure, your out-of-pocket cost is $300.
Review each plan's deductible, if any, and benefit maximum, if any. Dental HMO plans may not have a deductible or maximum due to the cost controls in place through their network and primary care dentists. Dental PPO plans typically have a deductible and a maximum benefit amount. These vary from company to company, and may vary from plan to plan offered by the same company.