A dental preferred provider organization (PPO) is a type of dental plan. Dentists who work with PPO plans agree to charge reduced rates. When you use a PPO, you’ll know in advance the most your dental work may cost. You’ll be able to keep your out of pocket costs down, too, but only if you work with a dentist who is in your PPO plan’s network.
With a PPO, there are limits on the types of dental work you can have done and on how much time your dentist can put into your work. PPOs also include a calendar year maximum, a deductible, and waiting periods for some types of work.
To help you master a few of the basics, here are definitions of twenty of the most frequently used terms you’re likely to see if you’re in the market for dental insurance.
You may be able to keep your dentist with a PPO even if she is not in the PPO’s network. Some (not all) PPO plans let you work with an out of network dentist. Still, doing so will mean you will pay more in out of pocket costs.
PPO Dental Plans and You: What to Consider
Is a PPO dental plan right for you? First, ask yourself these questions:
- If you have a dentist who is not in the plan’s network, are the plan’s cost breaks good enough to tempt you to change to a dentist who is?
- If you know you need some work, are there any limits on the types of work the plan’s dentists will provide?
When they see an in-network dentist, PPO members may meet their annual maximum or exceed the number of cleanings they can get each year and still pay the pre-negotiated rates. This can mean big savings if you need more work, because the work will not be billed at the full rate that dentists charge their patients who have no insurance.
If you want to see a dentist who is not part of your PPO plan’s network, some PPO plans will pay based on a concept known as UCR (usual, customary and reasonable fees). Most out of network benefits, though, are paid by PPOs based on MAC fees (the maximum allowable charge for the plan). If MAC fees are used, you may have to pay the difference between the MAC and what your out of network dentist charges for the work.
Finally, be sure to review any provisions in a PPO dental plan that relate to emergency dental care and dental work that you may need when you’re on the road.
Summary of PPO Challenges and Strengths
- There are limits on the types of dental work you can get and the amount of time your dentist can put into your work
- Some (not all) PPO plans let you choose an out of network dentist: doing so means you will also have higher out of pocket costs
- Check over provisions in a PPO dental plan that relate to emergency dental care and dental work that you may need when you’re on the road
- PPO dental plans help keep costs down: network dentists have agreed charge lower rates
- Those who have used up their annual maximum can still get work at the plan’s low rates
- You’ll know in advance the most your work may cost
- May provide the freedom to select an out of network dentist
Shop for PPO Plans
DentalInsurance.com offers PPO plans from the following carriers:
- Anthem Blue Cross and Blue Shield of Colorado and Nevada
- Anthem Blue Cross and Blue Shield
- Delta Dental Insurance Company
- HumanaOne Texas Dental Plan
- Nationwide Multiflex Dental
- Security Life Insurance Company of America
PPO plans not available in all states.