Local Dental Care - Individual Dental Insurance Plan

What Type of Dental Plans Have the Best Benefits?

Dental PPO, POS, DHMO Or Fee For Service

Indemnity and managed care dental plans differ in their basic approach. Put broadly, the major differences concern choice of providers, affordable out-of-pocket costs for covered services, and how bills are paid.

Usually, an indemnity dental plan offers more choice of dentists than managed care plans. An indemnity dental plan pays their share of the costs of a service only after they receive a bill.

Managed care plans have agreements with certain dentists to give a range of services to plan members a family at an affordable cost.

In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care-type plan and a broader choice of dentists if you select an indemnity-type plan.

Managed dental plans include Dental PPOs, POSs, and Dental HMOs (DHMOs).

What is a Dental PPO, POS, and DHMO?

A Dental PPO (Preferred Provider Organization) provides dental care to its members through a network of dentists who offer discounted fees to its affordable dental plan members. You can typically use dentists out of the PPO's network, but you will only be reimbursed the discounted fee for the services rendered - you will need to pay any additional amount yourself.

A DHMO (Dental Health Maintenance Organization) provides you dental services through a network of providers in exchange for some form of prepayment. If you use a dentist out of the established network of providers, you may be responsible for paying the entire bill.

A Dental POS (Point of Service) plan allows a member to use either a DHMO network dentist or to seek care from a dentist not in the HMO network. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care.

What is an Indemnity Dental Plan?

An indemnity dental plan is commonly known as a fee for service or traditional plan. If you select an Indemnity plan you have the freedom to visit any dentist. You do not need referrals or authorizations; however, some plans may require you to pre-certify for certain procedures.

Most indemnity plans require you to pay a deductible. After you have paid your deductible, indemnity policies typically pay a percentage of "usual and customary" charges for covered services; often the insurance company pays 80% and you pay 20%. Most plans have an annual out of pocket maximum and once you've reached this they will pay 100% of all "usual and customary" charges for covered services.

Many dental indemnity plans also require a waiting period before covering certain services.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Dental Fees

Fortunately, in these times, a lot of patients have dental insurance. Insurance is, on the face of it, a good thing. It minimizes out-of-pocket expenses for treatment and encourages people to keep up with the dental care they need. But most dental insurance plans do not pay 100%. There simply is no perfect insurance plan.

Part of the problem is what's called "usual and customary fees." Insurers have come up with a fee structure intended to reflect the "average" cost of "average" dental care. Urban residents may be allowed different compensation than people who live in rural areas. Reimbursement for a crown may be a certain percentage of the actual cost (the dentist's charge to you), and another percentage for a cleaning. Patients are sometimes puzzled at the discrepancy between insurer reimbursement and actual dental fees.

Of course your dentist can't dictate the amount your dental insurance plan decides is "average." And they don't ask your dentist what cost he or she thinks is fair. The dilemma is this: your dentist can't, in good conscience, recommend less than quality dentistry, even though your insurer may impose an unreasonable ceiling on treatment. It's a rock and a hard place.

For this reason, you should take objections directly to the insurer or compare dental plans with your employer. If enough people make enough noise, the reimbursement picture might improve.

Ask your dentist to sit down with you and go over your dental plan and your dental financing options. He or she will try to make your dental insurance plan work to your advantage. Your dentist cares about your finances, and your health.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.