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PPO Dental Plans

By Insurance Industry Expert & Author
Updated on

A preferred provider organization (PPO) is a type of managed care dental plan. 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 plans have annual maximum benefits.

PPO Dental Overview: What is a PPO dental plan?

PPOs help you save money because in-network dentists -- dentists who are contracted by the brand -- agree to charge the plan’s lower rates. It’s as simple as that! PPO dental plans are very popular with both consumers and dentists. In fact, nearly 3 out of 4 new dental insurance plans sold today is a PPO plan, according to experts.

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. In addition, 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.

PPOs typically have a calendar year maximum, deductibles, and waiting periods for some types of work.

PPO Dental Plan Calendar Year Maximums

The calendar year maximum is a annual cap on the dollar amount a PPO plan will pay for covered services during a one-year period. Consumers are responsible for any additional service costs charged during this period. The amount varies by plan.

PPO Dental Deductibles

The deductible on a PPO dental plan is a dollar amount that the consumer pays up front before the plan takes over and pays for covered dental services. This amount also varies by plan.

PPO Dental Waiting Periods

Dental PPO waiting periods are simply the time that must pass from the day your plan begins to the day you are eligible for some specific plan benefits.

Not all dental PPO plans include waiting periods. Our plan summary pages include information about waiting periods when these types of plans appear in dental plan search results.

More information about any plan is available by clicking the “Plan Features” link within our “Get Quote” results pages. In addition, you can easily compare various plans.

PPO Dental Basics: PPO Challenges and Strengths

Some strengths and challenges of PPO dental plans include the following:

PPO Challenges:

  • 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 Strengths:

  • PPO dental plans help keep costs down: network dentists have agreed to 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

PPO Dental Benefits: PPO Plans Growing More Attractive to Consumers and Dentists

Nearly 3 out of 4 new dental insurance plans sold today is a preferred provider organization (PPO) plan. This statistic alone speaks volumes about the desirability of PPO dental insurance. But it isn’t just consumers who are eager to participate in PPO plans. Dentists are piling on the PPO bandwagon as well.

Like a health PPO, dental PPOs help patients keep costs under control while they help oral health care professionals connect with consumers more effectively. As a result, not only are more dentists contracting with dental PPOs, they are also contracting with a wider variety of PPOs.

In 2012, the average PPO dental provider had contracts with 8.4 PPO networks, compared with less than 6 networks each in 2008. Also, today the number of unique dentists in the average PPO network is over 72,000

Moreover, the average number of PPO provider access points (locations where a network dentist practices) has also increased, and market penetration (the number of network dentists compared to the total number of dentists available) has grown as well.

More About PPOs

Is PPO dental insurance right for you?

Many consumers and dentists love their PPO networks. But is a dental PPO right for you? If you’re interested in participating in a PPO dental plan, here are a few things you should consider.

Choosing a Dental Care Provider

Choosing a PPO dental plan means you have the opportunity to reduce out-of-pocket costs by using an in-network dental care provider. If you already have a dentist that is not in the plan network, determine whether the higher out of pocket costs are substantial enough to entice you to change your dentist. Some (not all) PPO dental plan providers allow patients the freedom to select an out-of-network dentist. However, patients who select an out-of-network dentist also have higher out of pocket costs

When they see an in-network dentist, PPO members may meet their annual maximum or exceed the number of dental 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 dental plan.

The Key Question to Ask if You Want to Keep Your Current Dentist

No one wants to pay more than needed for dental care. And no one wants to leave the dentist they’ve grown to know and trust just to save a few dollars.

Dentists may accept any number of dental plans. But that doesn’t mean they are in the plans’ preferred provider groups. Until they’ve signed a contract to join a plan’s preferred provider network, your dentist may in fact accept the plan but still have every right to charge higher rates than an in-network dentist would charge for the work they do. And when they do, you, not the plan, will have to pay the difference in cost.

The best way to learn if you can keep your dentist and pay less is to ask both your dentist and the plan carrier or provider. And the question to ask is this: Is the dentist under contract as part of the specific dental insurance plan’s preferred provider network? Being a preferred provider makes a dentist part of a plan’s official network of dentists. That’s where the term “in network” comes from. And being in network or part of a plan’s preferred provider pool is the real key to helping you save money.

Understanding Out-of-Network Costs

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.