Dental Insurance FAQ & Discount Dental Plan FAQ
Dental Insurance Questions
What should I do before choosing a dental plan?
Education should always proceed shopping. Knowledge of the dental plan market enables a consumer to recognize a high-value product from a low-value product. Consider reading our introductory article Dental Insurance 101 as well as Six Ways to Lower Your Annual Dental Insurance Costs. DentalInsurance.com also has a robust Learning Center filled with educational resources addressing innumerable dental topics.
Should I buy dental insurance?
Quality dental insurance encourages regular dental visits and promotes oral health. Good dental hygiene is important not only for its physical health benefits but also because it can prevent the development of dental problems that require expensive care. Regular checkups also allow dentists to screen patients for symptoms related to more than 120 different non-dental diseases, including diabetes and heart disease. If you have exceptional oral health (clean teeth, no cavities or other problems), you may want to consider a dental plan with more narrow benefits. However, if you do enroll in such a plan, you may not have coverage for a major dental should one occur (e.g. a broken tooth or the need for a root canal).
A dental plan is only as good as the dentists who accept it so investigating the plan’s network is essential. Additionally, it is recommended to shop for a plan that covers preventive, minor, and major dental care with reasonable out-of-pocket costs. Dental care not covered by a dental plan is the sole responsibility of a patient.
What is a fee schedule dental plan?
Sometimes referred to as fee-for-service or scheduled plans, dental fee schedule plans reimburse patients at a predetermined dollar amount for covered dental services. The reimbursement rate is based on the insurance company’s fee schedule. Any amount left after the reimbursement has been applied to the dental service cost is paid by the patient.
What is a PPO dental plan?
A preferred provider organization (PPO) is a type of dental insurance plan in which enrollees select their dentist from inside or outside a network of dentists contracted with the dental plan. In-network dentists are known as preferred providers. Enrollees have the freedom to use an out-of-network dentist but pay higher out-of-pocket costs than would be the case if care was received from an in-network dentist. 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.
What is a DHMO?
A DHMO is another name for a dental insurance HMO. HMO stands for “health maintenance organization.” A dental health maintenance organization (DHMO) is a form of dental coverage where dental services are delivered through a network of dentists that is usually smaller than is the case for PPO dental insurance. The dentists within the network receive a fixed monthly fee per patient. This type of arrangement is also referred to as a "capitation plan." HMO dental insurance is often the least expensive dental plan option and it has the further virtue of lacking a “maximum benefit.” A maximum benefit is an annual cap on how much an insurance company will pay toward patient care. Read the article “HMO dental insurance” for more detailed information about DHMOs.
What is a carrier?
A carrier, or insurance carrier, is another name for an insurance company. The term carrier is used by insurance industry professionals and it refers to a company that “carries” the insurance policy sold to an individual or entity. An insurance carrier is licensed to sell insurance policies.
What insurance plans are available in my state?
There are two ways on DentalInsurance.com to find dental plans available in your state. The first is to visit our dental insurance quote page. After inputing a few quick details such as your zip code, the site will display the plans offered in your region (along with their rates).
Your second option is to visit our dental insurance by state page and click on your state’s name. Each state page provides links to local dental resources along with a list of DentalInsurance.com’s bestselling plans for the state.
Dental Benefits Questions
What is a maximum benefit?
A maximum benefit is the dollar limit on insurance company payments toward covered dental services during a year. Expenses exceeding the maximum benefit amount are paid completely by the patient and not the insurance company. Large maximum benefits are thousands of dollars while a small maximum benefit may be as little as $500 annually. For more information, see our article “What is a maximum benefit in a dental insurance plan?”
How do I check the balance of my annual maximum?
To check the amount remaining within a maximum benefit for a PPO or indemnity plan, you can call the customer service number of the insurance company providing the plan and ask for your balance. There is no annual maximum benefit for discount dental programs or HMO dental plans.
Can my dental insurance ID card be replaced?
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 email@example.com
How do I use my dental plan benefits?
After enrollment in a dental plan, you should receive documents explaining the proper use of dental benefits, including any conditions or restrictions. If you need help with the definitions of dental or insurance terminology, check our Learning Center for helpful articles.
Who should I contact about my plan's benefits or a claim?
If you are enrolled in a dental plan and have questions about your benefits or claims, you should contact your insurance company. The insurance company has access to your account and will discuss benefits and claims activity. Note that some insurance companies have separate departments benefit questions and claims questions.
What if my dentist refers me to a specialist?
The answer to this question depends on the type of dental coverage you have. Assuming the treatment is covered dental care, the specialist must be in-network if your plan is a HMO. If your plan is a PPO, you may use an out-of-network dentist for specialist care but you should confirm beforehand what the out-of-pocket costs are for this out-of-network care. An indemnity plan does not restrict you to a particular specialist and the plan will provide its normal reimbursement rate for the care received. A discount dental plan, like an HMO, requires an in-network dental professional.
Discount Cards Basic Information
What is a discount dental plan?
Discount dental plans are fee-based membership programs allowing enrollees to obtain dental services at discounted rates from a group of dentists who belong to the discount plan's network. The membership fee may be monthly or annual. These networks are typically narrow as compared to PPO dental insurance. For more information, see our article Discount Dental Plans.
Are there other names for discount dental plans?
Yes. Discount dental plans are also known as DDPs, dental savings plans, dental discount cards, dental discount plan, dental discount programs, and referral plans.
How is a discount dental plan different than dental insurance?
Discount dental plans are not insurance products. The patient pays directly for care instead of the dental plan, but the dental care is received at a discounted rate. Unlike PPO dental insurance, discount dental plans do not have maximum benefit amounts limiting the amount of dental care covered annually.
How much money could I save with a discount dental plan?
Discount dental plan are especially attractive for people who cannot afford large monthly premiums. Another factor favoring discount dental plans is the lack of restrictions of dental service use. The discounts are available without regard to previous usage so long as the patient continues to be a member of the discount dental plan.
Are there any fees for using a dental discount plan?
Yes. A discount dental plan normally charges a monthly membership fee and, in some cases, an enrollment fee. Membership fees are often quite low.
Will all providers accept my dental discount plan?
No. Only the dental services providers who participate in your dental discount plan's network will accept your plan's card. One of the challenges with Discount Dental Plans are narrow networks of dental providers. A consumer should confirm access to a local dentist before enrolling in such a program.
Questions about Dentists
Can DentalInsurance.com help me find a dentist?
DentalInsurance.com provides access to dentists associated with PPO and HMO dental 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.
Will I be able to keep my dentist?
Keeping your dentist depends on the dental plan you choose. For example, indemnity dental plans have no restrictions; patients can see any dentist when they choose this type of plan. Many PPO dental 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 HMO dental plan 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.
Can I go to a dentist in a different state or country?
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 insurance company for specific exceptions and details of coverage.