FAQs About Dental Insurance and Discount Plans
Descriptions of Dental Plan Types
The following four types of dental quotes are available from DentalInsurance.com. Click the links after the descriptions to view more detailed information.
DHMO Dental Plans: A dental health maintenance organization or DHMO is a type of “managed care.” With this type of coverage, a network of highly qualified dentists provides comprehensive and affordable care for individuals or families. Consumers choose a dentist from the network, and they pay a low monthly premium to receive services at either no cost or a reduced price (some services may require a copayment). The participating dentists receive fixed monthly fees. Learn more about DHMOs
PPO Dental Insurance Plans: Another type of managed care plan is called a preferred provider organization (PPO). Consumers with PPOs select a dentist from a network of preferred dental providers who have agreed to provide dental care to members at reduced rates. PPO dental plan participants are made aware of their annual maximums.. Learn more about PPOs
Indemnity Dental Insurance Plans: A dental indemnity plan, also known as “traditional” insurance, allows consumers to choose from the largest pool of dentists. Individuals with this type of dental insurance are free to visit any dentist, unlike those with managed care plans. Subscribers pay their dentist’s bill in full and then submit a claim for reimbursement to the carrier. Learn more about indemnity plans
Discount Dental Plans: Discount dental plans (DDPs) or “discount dental cards” are not insurance. However, they help consumers save on dental care costs. Members make monthly or annual payments and may receive unlimited dental care services at discount prices based on a fee schedule. Services are provided by dentists who participate in the plan’s dental network. Learn more about discount dental plans
(*Discount plans are not insurance and are not intended to replace health insurance.)
Using the Site Frequently Asked Questions
It is generally recognized by healthcare practitioners that oral health plays an important role in overall health. However, like general health care, the costs of dental care can be expensive. Dental care can be as simple as a twice-yearly checkup, or it may involve oral surgery, getting a full set of dentures, or needing a crown, any of which can be quite costly. On the other hand, dental insurance products for individuals and families are generally low enough in cost to be very affordable. In addition, most insurance plans pay 100% for check-ups every 6 months, so those who purchase it begin to benefit right away.
DentalInsurance.com provides you with online tools and dental resources
, including informative articles, blog posts, a glossary, and a Dental Insurance Checklist
, which is available to download for free. Using these resources can help make selecting dental insurance that will fit your needs easier, and they can help you save on the cost of dental work.
Here are 3 important reasons why anyone who doesn’t already have dental coverage should consider getting dental insurance or a discount dental plan:
- To maintain a healthy mouth: Preventing oral health problems before they start is one of the best ways to keep dental costs down
- To cover the costs of dental care: Dental expenses can mount quickly – especially if dental work is required as a result of an emergency – so it truly pays to be covered
- To protect overall health: Regular checkups allow dentists to screen patients for symptoms related to more than 120 different non-dental diseases, including diabetes and heart disease
Dental insurance plans are commonly divided into two types: “fee-for-service” and “managed care.” Indemnity dental insurance plans (also known as “traditional” insurance plans) are the original type of fee-for-service dental insurance plan. Plan subscribers have the freedom to visit any dentist. However, unlike managed care providers, indemnity dental insurance providers only make payments after receiving and reviewing the dentist’s bill. Subscribers must pay for their dentist’s services in full and submit a claim to the carrier for reimbursement. Learn more about dental indemnity insurance
in the Dental Resources area.
Sometimes referred to as fee-for-service or scheduled plans, dental fee schedule plans reimburse patients for a prearranged portion or dollar amount of their dental costs based on information in the plan carriers’ fee schedule, which lists all covered procedures and the amounts plan subscribers will be reimbursed for each. Any balance due after the scheduled fees have been reimbursed are the patient’s responsibility. Visit the Dental Resources area for more detailed information about fee schedule plans.
A preferred provider organization (PPO) is a type of dental insurance plan in which individuals select their dentist from a dental provider network (the preferred providers). Because the network members have agreed to provide dental care to individuals at reduced rates, PPO dental plans may be able to help contain patients’ costs. However, PPO dental plans also restrict access to some services. The types of dental treatment available to the patient and the amount of time participating dentists are willing to invest in any given procedure are typically subject to limitations. Learn more about PPO dental plans
in the Dental Resources area.
Typically the least expensive of dental insurance plans, a dental health maintenance organization (DHMO) is an organized system of dental health care in which a network of highly qualified dentists, who receive fixed monthly fees, provides comprehensive and affordable care for individuals or families at a low monthly premium with services at either no cost or a reduced price. This type of plan is also referred to as a “capitation plan.” Visit the Dental Resources area for more detailed information about DHMOs.
DentalInsurance.com provides consumers with access to dental insurance plans throughout the US. Visit the States page and select the link to any state dental insurance page
to learn about dental coverage options in that area.
Questions on Dentists
DentalInsurance.com provides access to dentists associated with PPO and DHMO plans. To begin your search, enter your ZIP code in the box on the homepage and click “Get a Quote.” Then, on the “Plan Summary” page click the “Dentist Search” link associated with a plan you are interested in and follow the instructions in the new window to see the dentists available in your area.
It depends on the type of plan you choose. Indemnity plans have no restrictions; patients can see any dentist when they choose this type of plan. Many PPO plans allow patients to see dentists outside the plan’s network, but doing so may result in higher out of pocket expenses for the patient. If you choose either a DHMO or discount dental plan, you must always use a dentist who participates in the plan’s approved network. If you have a dentist you want to continue seeing, check to see what plans and networks they participate in.
Some plans do restrict which dentists you can visit for services. Indemnity plans have no restrictions; you can see any dentist when you choose this type of plan. Many PPO plans allow patients to see dentists outside their networks, but doing so may result in higher out of pocket expenses for the patient. With either a DHMO or discount dental plan, patients must always use a dentist who participates in the plan’s approved network.
Except for some emergency situations, the dental insurance and discount products available from DentalInsurance.com do not provide out-of-country benefits. Check with your Carrier for specific exceptions and details of coverage.
General Dental Benefits Questions
There is no annual maximum benefit level for discount dental plans or DHMOs. To check the annual maximum balance remaining on a PPO or indemnity plan, you can contact the plan Carrier using their customer service phone line or online customer portal.
Yes. You can replace your dental plan ID card at any time, either by contacting the plan provider or DentalInsurance.com. To contact us, address your email to firstname.lastname@example.org
To understand how to use your dental benefits fully, carefully review the welcome packet you receive from the plan’s Carrier, including any attachments or inclusions. If you need help with the definitions of dental or insurance terminology, check our Resources area for definitions and helpful articles.
If you are enrolled in a dental plan and have questions about your benefits or claims, you should contact your insurance company or “carrier.” The insurance company can access your account and review your eligibility, benefits, and claims activity. Note that some carriers have separate departments that assist with questions about benefits and questions about claims. Before you have work done, the carrier may ask you to submit a pre-claim that describes the work you plan to have done and information about the dentist. The pre-claim data is entered into the carrier’s claim system so the carrier can determine whether the planned procedures are covered and, if so, how much they will pay for each specific procedure.
- Dental Health Maintenance Organizations (DHMOs) – Most DHMO plans will provide a discount on services provided when the service received is a covered service that is completed by a specialist who participates in the plan’s network. Before having services done by a referred dentist, DHMO patients should always check to confirm that the dentist is “in network” or participates with the DHMO. If the dentist is out of network or does not participate, the full cost of the procedure will be at the patient’s expense.
- Preferred Provider Organizations (PPOs) – If you have a PPO plan and you are referred to an in-network specialist, the insurance company will cover the service and you will be subject to pre-negotiated prices as long as it is a covered service as listed in the plan policy. If you are referred to an out-of-network PPO specialist and the PPO plan provides out-of-network coverage, the insurance company will cover the service as long as it is a covered service as listed in the plan policy; however, the dentist is not subject to offer the procedure at any pre-negotiated prices and the plan will cover only up to a maximum allowable fee.
- Indemnity Dental Insurance – because indemnity dental plans do not utilize provider networks, patients with these plans can go to any dentist of their choice. Procedures performed by dentists or other oral care specialists are covered as described in the plan policy.
Discount Cards Basic Information
Discount dental plans
(DDPs), sometimes called discount dental cards, are financial products that help consumers to save money on dental care costs. DDP patients make monthly or annual payments in exchange for unlimited dental care services. Services are provided by dentists who participate in the plan’s dental network, and service charges are based on a discounted fee schedule. Monthly or annual payments for discount dental plans are affordable. Learn more about DDPs in the Dental Resources
Discount dental plans (DDPs) should not be confused with ordinary dental insurance
. Also called dental discount cards, DDPs are financial products that help consumers to lower the cost of dental care. Discount card patients make monthly or annual payments that are affordable in exchange for unlimited dental care services that are based on a discounted fee schedule
. Discount card services are provided by dentists who participate in the plan’s dental network. A patient enrolled in a discount plan is responsible for paying the discounted fee directly to the dentist. The discount dental plan provider is uninvolved in the transaction and makes no reimbursements.
Discount dental plan (DDPs), sometimes called dental discount cards, are especially attractive for people who do not have insurance coverage or who have inadequate coverage for certain services. The monthly or annual DDP payments are typically affordable. In addition, the cost of a DDP is small compared to the potential savings for plan members, and discounted rates typically go into effect within two business days after an application is submitted.
Other than an initial enrollment fee, there are no fees for using dental discount plans or cards, and unlimited services are available to plan members at the plan’s pre-negotiated prices.
Only the dental services providers who participate in your dental discount plan’s network will accept your plan’s card.