Understanding the basics of a dental insurance PPO plan can help you shop smarter. It can also help you make the right decisions for your family’s health. PPO plans offer a network of dentists who have agreed to charge lower service fees. These discounted rates can significantly reduce your out-of-pocket costs.
PPO stands for Preferred Provider Organization
Dental insurance PPO plans typically offer a more comprehensive network of dentists than HMO plans. They also have negotiated rates for dental services, meaning that the plan’s member pays a portion of the dentist’s contracted fee, and the insurance company covers the rest. This allows patients to choose their preferred dentist and save money. The most popular PPO plans feature annual maximum benefit limits that allow consumers to get the most coverage possible. PPO plans also often feature a deductible, the amount a plan enrollee must pay before the insurance plan starts covering costs. While these deductibles vary from plan to plan, they are usually lower than those of HMO plans. Dental PPO plans are also popular because they offer greater flexibility in selecting a dentist than DHMO plans. While a DHMO requires that you choose a primary dentist, a PPO does not, and you don’t need a referral to see specialists. In addition, you can visit a dentist outside the network for care, but out-of-network visits will likely cost more than in-network services.
It’s a contract
Different dental insurance plans exist, including the Preferred Provider Organization (PPO) and the Dental Health Maintenance Organization (DHMO). Both are traditional indemnity plans that pay for procedures per a set fee schedule. However, the PPO plans usually offer a more comprehensive network of dentists and allow patients to choose their providers. These types of plans contract with a large group of dentists who agree to discount their fees for patients that the insurance company covers. This differs from HMO plans that require you to visit a specific primary care dentist or obtain a referral before visiting a specialist. While PPO plans offer a more extensive network of dentists, they also have limitations. Many have maximum benefit limits that cap how much the plan will pay in a year, leaving consumers to cover 100% of charges over this amount. This limit is typically well above the average cost of a procedure. It is essential to understand these limitations before choosing a plan. This can help you decide whether or not a PPO plan is the best option for your needs.
It’s a high-deductible plan
PPO plans offer more flexibility and a more extensive network of providers. However, they also come with higher out-of-pocket costs than DHMOs. These fees are based on the cost of each treatment and are determined by the insurance company. This type of plan usually has a deductible, annual maximum, and coinsurance. Dental PPOs work by providing a list of dentists who have agreed to discount their services for plan members. These discounted rates are typically between 25% and 50% less than the usual, customary, or reasonable (UCR) fee for a specific procedure. The plan member pays a portion of the fee, usually a percentage of the discounted rate, and the insurance company covers the remainder of the bill subject to the deductible and annual limit. Unlike HMOs, dental PPOs may have a deductible that the patient must pay before the insurance plan pays for covered services. Depending on the particular plan, this can be an individual or family deductible, and the amount varies from plan to plan.
It’s a flexible plan
Unlike HMO and DHMO plans, which require selecting only dentists who work within the plan’s network, PPO dental insurance allows you to use any licensed dentist. You may have to pay some of the costs, but your insurance company will cover the rest. The benefits of a PPO plan include lower rates and increased choice, which is why they remain one of the most popular types of insurance available. PPOs typically feature a list of dentists who have contracted with the insurance company to provide services at discounted rates. These fees are usually 25% to 50% less than a dentist’s usual and customary charges. While these discounts are not as great as those offered by an HMO, they are still significant savings for patients. Most DPPO and POS plans require that you pay coinsurance, the percentage of the cost of covered services you are responsible for paying after the deductible has been met. Depending on your dental insurance type, your plan may also have an annual maximum determining how much coverage will be provided in any given year.