PPO stands for “preferred provider organization.” In a preferred provider organization, plan enrollees have the option of using an in-network dentist for the most inexpensive care or an out-of-network dentist with the prospect of paying higher out-of-pocket costs in exchange for dentist choice flexibility. 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 are so popular in the United States.
Dental PPOs in Your Region
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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.
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.
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 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.
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.
Many PPOs have large dentist networks that increase your chances of selecting a dentist you prefer
Negotiated prices within the dentist network helps reduce costs compared to uninsured dental care
Enrollees still benefit from negotiated prices even if they exceed the plan’s yearly maximum benefit
Out-of-network dental care is an option, in contrast to in-network only care covered by HMO plans
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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PPO: The Network 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.
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