Dental insurance works similarly to any other type of health insurance. There is a monthly payment called a premium, deductibles, and coinsurance.
It’s also important to consider which dentists are in the network for your plan. Most plans limit a dentist’s fees to a “usual and customary” price set by the insurance company.
Cost-Effectiveness
Many of the plans on the individual market (that is, not purchased through your employer) come with a dental benefit. These benefits range from a low monthly premium to a percentage of the cost of specific treatments. Most plans include preventive care at no cost to you, and the rest of the benefit is based on a flat rate, a copay, or a deductible, depending on your plan type.
A Preferred Provider Organization (PPO) or a Dental Health Maintenance Organization (DHMO) plan has a list of dentists that the insurance company contracts with. These dentists agree to accept a reduced fee for services, which saves the insurance carrier money and reduces your out-of-pocket costs.
These plans typically require you to pay a deductible before the insurance starts paying, and they often have annual maximums on how much they will pay for your treatment in a year. Moreover, individual PPO dental insurance in California allows residents to customize their dental coverage to meet personal needs, providing a tailored and flexible solution for oral healthcare.
On the other hand, an indemnity plan allows you to choose any dentist, whether in or out-of-network. These plans are usually more expensive in terms of the monthly premium, and they may also have a higher maximum on how much they will pay for your treatment within a year.
Preventive Care
Most people get their dental insurance through a group plan at work, but it is also possible to purchase individual coverage. Comparing prices online and finding programs that meet your needs only takes a few minutes. You’ll want to look for a plan with a robust network of dentists. This means that most of the dentists in the network agree to a set fee with the insurance company, so the cost is typically less than if you visit a non-contracted provider.
In addition to lower costs, PPO plans typically offer the flexibility of a more extensive list of dentists. Most programs will have a list of “preferred” dentists where you can see doctors for a low copayment, or the plan will pay a percentage of the cost up to a certain annual or lifetime maximum.
These limits are designed to reduce your out-of-pocket expenses so that you are more likely to use preventive care to keep your teeth in good shape and avoid more significant problems down the road.
Other types of dental plans include indemnity or discount dental plans, which do not provide insurance benefits but give you a card that entitles you to reduced fees at participating providers. These plans are more like a warehouse club membership and often require a copayment.
Emergency Care
Whether it’s an accident that leads to a tooth extraction or a bad case of gum disease that requires surgery, emergency dental costs can quickly add up. Individual PPO dental plans can help decrease unexpected expenses by covering much of your dental care.
These types of plans typically cover primary preventative care like checkups and cleanings at 100% with no copay, and most of the time, there’s a very low or no deductible for other services considered routine, such as fillings and X-rays. These plans usually cover major work such as dental implants, crowns, root canals, and more at 50%. According to surveyors, they also typically limit how much they’ll pay out during a year, and the average annual maximum is around $1,500.
When choosing a plan, ensure it covers the procedures you need and offers the network options you prefer. It’s also a good idea to compare pricing and choose a convenient provider for your home or office. You can do this by looking at a list of dentists that contract with your preferred plan or asking if your current dentist is in-network. If they don’t, you may be required to switch providers for your dental insurance policy to provide value.
Specialty Care
In addition to general dentists, most PPO plans include an extensive network of specialists. This allows you to find and see any specialist you need without getting a referral from your primary care dentist. This helps you stay in control of your health.
If you need to visit a specialist, your dental plan will pay some of the costs. You will be responsible for the remaining balance. This is known as a coinsurance. Typically, a PPO plan has a much more extensive network of providers and offers lower out-of-pocket costs than an HMO.
Most dental insurance plans have a maximum amount the project will pay yearly. It could quickly reach this limit if you need an expensive procedure, such as a root canal or oral surgery.
Individual PPO dental plans are a smart choice for anyone who needs to maintain oral health. They are affordable and offer a wide range of benefits. HMOs are less costly but require you to select a primary care dentist and only see those in the insurance’s network.
HMOs also have deductibles and waiting periods. The price of an individual PPO depends on how many people will be covered, which dentists you want to use, and whether you have other insurance coverage. To compare your options, use the button at the top of this page to see price quotes for various dental plans.
