PPO Dental Insurance

By Insurance Expert & Author
Updated on
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PPO dental plans are the most common form of dental insurance in the American market, representing about four-out-of-five dental plans purchased by individuals and families. This resources provides:

What is PPO Dental Insurance?

PPO stands for “preferred provider organization.” In a preferred provider organization, plan enrollees have the option of using an in-network dentist or an out-of-network dentist. The most inexpensive care for a PPO plan enrollee would come from an out-of-network dentist. Out-of-network dentists offer enrollees more options for dental service but out-of-network providers have more expensive out-of-pocket costs.

PPO dental plans (sometimes referred to as a DPPO or “dental PPO”) often have large networks consisting of thousands of dentists. This scale provides plan enrollees with a broad inventory of dentist from which to choose. HMO dental insurance, in comparison, is more likely to have narrow, restrictive dentist networks (for a more extensive comparison of PPO and HMO dental plans, see Dental PPO Plans versus Dental HMO Plans).

One of the advantages of a networked dental plan is that the insurance company negotiates lower costs for services than would be the case for an uninsured dental customer. Large dental networks along with the advantage of negotiated pricing are among the main reasons why PPO dental plans have become so popular across the United States.

PPO Dental Insurance Providers

There are dozens of insurance companies selling dental policies across the United States. Some are nationally-known brands and others are regionally or serve a single state. Interested to see what dental insurance providers offer plans in your area? Just visit our page for free dental insurance quotes. You can review plan options and compare rate quotes in a matter of seconds.

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PPO Dental Insurance Buying Guide

While our introduction touched on PPO’s availability, provider networks, and rate discounts, there are more characteristics that account for their popularity. To explain these issues, we need to review a few concepts: maximum benefits, deductibles, and dental insurance waiting periods.

Maximum Benefit

A “maximum benefit” is annual cap on how much the PPO plan will pay for covered services during a one-year enrollment period. Consumers are responsible for 100% of any service costs charged during this period in excess of this limit. While PPO plans (in contrast to HMOs) have maximum benefit limits, many PPOs have limits well above the typical dental expenses a consumer will experience during a year. Many PPO plans have a maximum benefit of $1,500 a year, with some as low as $500 annually. We have also seen a maximum benefit as high as $5,000 (NCD Nationwide 5000 Plan and the Humana Extend 5000) and there are plans entering wider distribution with even higher maximums.

Deductibles

The deductible of a PPO dental plan is a dollar amount that the consumer pays at the beginning of a new plan year before the plan contributes to the costs of covered dental treatment. Deductibles vary by plan. Many PPO plans charge a modest deductible of $50 per enrollee per year. In some cases, there is a cap on the deductible for a family (e.g a maximum combined deductible of $150 a year covering all enrolled family members).

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PPO Dental Insurance - No Waiting Periods

A dental insurance waiting period is the time that must pass from the date your insurance plan become active to the date a specific benefit becomes eligible for coverage. Some PPO plans have no waiting periods on covered services.

DentalInsurance.com’s dedicated plan pages include information about waiting periods. PPO plans without waiting periods are sometimes called “immediate coverage dental plans” or “no waiting period dental plans.” To see the specific dental services covered by a PPO dental plan and whether any of them have a waiting period, compare PPO plans in your area with our price tool and then click on the More Details arrow on any plan that interests you. If you more particulars on the plan, you can click the Full Plan Information button within the More Details section.

PPO Trade-Offs

Below are some brief issues to consider when shopping for a PPO dental insurance plan. Like all dental plans, PPOs have both advantages and disadvantages.

PPO Benefits:

  • Many PPOs have large dentist networks that increase your chances of using a dentist you prefer
  • Negotiated prices within the dentist network helps reduce costs compared to the retail price of uninsured dental care
  • PPO enrollees still benefit from negotiated prices even if they exceed the plan’s yearly maximum benefit
  • Out-of-network dental care is an option for PPO enrollees, in contrast to HMO plans where enrollees are restricted to in-network dentists

PPO Trade-Offs:

  • Out-of-network care comes with higher out-of-pocket costs
  • Plans have an annual limit on how much the insurance company will pay for care
  • Larger dentist networks and greater out-of-network care flexibility makes PPO premiums more expensive than HMO premiums

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Our agents can:

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PPO Dental Network: The Size Advantage

PPO dental insurance is the most popular type of dental coverage in the market for private (i.e. non-business) dental insurance. The average dentist who accepts PPO coverage belongs to 26.5 different networks, according to statistics from the National Association of Dental Plans. PPO networks can have tens of thousands of participating dentists across the nation, with some of the largest networks exceeding 100,000 dentists.

If you want to see a dentist who is not part of your PPO plan s network, some PPO plans will pay based on an industry concept known as “usual, customary and reasonable fees” (UCR). 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.

PPO Dental Insurance Near You

If the above information on PPO dental plans has made you want to enroll in one, it is likely that one or more are available in your area. Just visit our page for dental insurance quotes. Review plan benefits and compare monthly premiums in a matter of seconds.

State-Specific Examples of PPO Dental Insurance Plans

Below are examples of PPO plans offered by DentalInsurance.com in each state. For a full list of PPO plans offered in your region, visit our dental insurance quote page.

NOTE - Some of the below plans may not be available in all regions of the state for which it is listed.

State Insurance Company Plan
Alabama Guardian Advantage Starter
Alaska MetLife TakeAlong Dental Medium
Arizona Nationwide Premier Select 1500
Arkansas Renaissance MAX Choice
California Anthem Blue Bross Essential Choice Silver
Colorado Ameritas Hollywood Smile Premier 2500
Connecticut NCD Nationwide 3000 Plan
Delaware Delta Dental Dental for Everyone Gold
Florida MetLife TakeAlong Dental High
Georgia Guardian Advantage Achiever
Hawaii Renaissance Plan III
Idaho Humana Bright Plus
Illinois Nationwide Select Plus 1500 + VSP Standard
Indiana Humana Loyalty Plus
Iowa Renaissance MAX Choice Plus
Kansas NCD Nationwide 1500 Plan
Kentucky Delta Dental of Kentucky Happy Smiles
Louisiana Delta Dental Immediate Coverage Plan
Maine Anthem Blue Cross Blue Shield Essential Choice Bronze
Maryland Dominion National Select Plan Basic
Massachusetts Guardian Advantage Core
Michigan Ameritas Hollywood Smile Premier Plus 2000
Minnesota MetLife TakeAlong Dental Low
Mississippi Delta Dental Dental for Everyone Platinum
Missouri NCD Nationwide 5000 Plan
Montana Delta Dental Dental for Everyone Platinum
Nebraska MetLife TakeAlong Dental High
New Hampshire Renaissance Plan II
New Jersey Guardian Advantage Starter
New Mexico Ameritas Hollywood Smile Premier Plus 1500
New York Anthem BlueCross BlueShield Essential Choice Platinum
North Carolina Renaissance MAX Choice
North Dakota NCD Nationwide 5000 Plan
Ohio Anthem Blue Cross Blue Shield Essential Choice Gold
Oklahoma Humana Bright Plus
Oregon Nationwide Select Plus 2000 + VSP Standard
Pennsylvania Delta Dental Dental for Everyone Gold
Rhode Island NCD Nationwide 1500 Plan
South Carolina Humana Loyalty Plus
South Dakota Ameritas Hollywood Smile Premier Plus 2000
Tennessee Delta Dental of Tennessee Brighter Advantage
Texas Ameritas Dallas Smile Plan
Utah Delta Dental Dental for Everyone Platinum
Vermont MetLife TakeAlong Dental Medium
Virginia Anthem Blue Cross Blue Shield Essential Choice Bronze
Washington State Guardian Advantage Core
Washington D.C. Dominion National Select Plan Premium
West Virginia Delta Dental Immediate Coverage Plan
Wisconsin Renaissance Plan III
Wyoming Humana Preventive Plus

Frequently Asked Questions

Are There Limitations or Restrictions on PPO Dental Insurance?

All PPO insurance plans have conditions regarding their benefits. These can apply to who can provide dental care (i.e. network considerations), when a benefit is available (waiting periods), and the limit on dental costs during a plan year (i.e. the maximum benefit). A plan’s Summary of Benefits or Plan Brochure summarizes these conditions.

Unlike HMO plans, a PPO dental plan does not require an enrollee to choose a primary care dentist and the plan may not require referrals or prior approvals.

How Quickly Can I Get PPO Dental Coverage and When Will It Become Active?

PPO dental insurance can be purchased an online application process. During the application process, the applicant is told how quickly the insurance will become active after the application is submitted and approved. This is known as the Effective Date and it is often a few weeks from the time of application.

How Can Dental PPO Insurance Save Money?

There are several ways PPO dental plans can save a consumer money. First, the plan may have negotiated rates on dental care that are lower than standard retail rates. Second, a PPO plan pays money toward covered care with the enrollee paying a copayment or coinsurance fee. Third, a PPO may waive out-of-pocket charges for preventive dental care (i.e. annual exams and teeth cleanings).

Are There any Additional Perks or Benefits to PPO Dental Insurance?

Some PPO plans bundle additional benefits (such as vision and hearing care) with their standard dental coverage.

Do All Dentists Accept PPO Coverage?

No but, because PPO dental insurance is the most common form of private dental insurance, PPO dental coverage acceptance is very high. However, just because a particular dentist accepts some PPO dental plans does not mean he or she accepts all PPO dental plans.

Are PPO Dental Plans Available in Every State?

Yes. There are PPO dental plans in every state as well as the District of Columbia (Washington D.C.).

Can Individuals Enroll in PPO Dental Plans Year-Round?

Yes. There is not a fixed annual enrollment period for privately purchased dental insurance. Consumers can apply for coverage throughout the year.

How Straightforward Is The Enrollment Process for PPO Dental Insurance Plans?

Most PPO dental plans have a simple online application form that can be completed in a few minutes. The form will ask for information such as a credit card number as well as full name, address, age, sex, and similar information for additional family enrollees if applicable.

Need help choosing a plan? Call us at 800-296-3800

Our knowledgeable customer service team will assist you with any questions you may have prior to enrolling in a dental plan. They can guide you through the process of choosing coverage that matches your needs as well as your budget.

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