Dental insurance plans fall into three primary categories: indemnity or traditional, dental health maintenance organizations, also known as DHMOs, and preferred provider organizations or PPOs. Other types include discount plans and exclusive provider organizations, or EPOs. Cost, dental needs and provider availability are factors most people weigh when choosing dental coverage.
Indemnity/Traditional
Dental services received under indemnity coverage is covered fully or partially by the insurance carrier, usually 50 percent to 80 percent. The patient is responsible for the amount not covered by insurance. Patients pay a higher premium and higher out-of-pocket costs for services, and they can choose any dentist they want.
Preferred Provider Organizations/PPOs
PPOs are a network of dentists who agree to provide discounted dental services in exchange for patient referrals from the insurance company. Patients covered under such a plan must choose a participating dentist from the network in order to receive the full benefits of the plan at a lower cost. Patients who choose a dentist outside of the network risk paying full cost for their services. Some PPOs allow a patient to receive services from an out-of-network dentist, however, the patient will pay a higher deductible and receive lower benefits.
Dental Health Maintenance Organizations/DHMOs
DHMOs work similar to PPOs, except that the dentists--or network of dental offices--contract with the insurance company to provide dental services as specified by the dental plan in exchange for payment of a fixed amount per plan participant. Some services are provided at no charge while others may require a co-payment paid at the time of visit. A patient can only choose a dentist within the network.
Exclusive Provider Organizations/EPOs
EPOs offer coverage under the same provisions as PPOs; however, you are limited to receiving dental services only from the company's network of dental providers.
Dental Discount Plan
Dental discount plans differ from dental insurance. A third-party company contracts with a network of dentists who agree to offer discounted dental services in exchange for patient referrals from the company. These referrals are in the form of patients who pay a membership fee to the company in order to receive discounted services. Patients are responsible for paying the discounted fees for service at the time of their visit. Companies marketing dental discount plans make it a point to state in their advertising that the plan is not dental insurance. Dental discount plans are feasible for people who do not qualify for subsidized dental coverage such as Medicaid yet cannot afford to pay full cost for dental services.
