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PPO Dental Plans

By Insurance Industry Expert & Author
Updated on

PPO dental plans are the most common form of dental insurance in the American market, representing about four-out-of-five dental plans. This resources provides:

  • A quick explanation of what makes a dental plan a PPO
  • Why consumers buy PPO dental plans
  • Trade-offs association with PPO coverage
  • A link to review PPO options available in your region

A Brief Introduction to 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 for the most inexpensive care or an out-of-network dentist with the prospect of paying higher out-of-pocket costs. PPO dental plans (sometimes referred to as a DPPO or "dental PPO") often have large networks of dentists, providing customers 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 and the greater likelihood of a person's preferred dentist being in-network are among the main reasons why PPO dental plans are so popular.

Dental PPOs in Your Region

Interested to see what PPO plans DentalInsurance.com has available in your area? Just visit our page for dental insurance quotes. You can review plan options and compare prices in a matter of seconds.

What Are the Features of a PPO Dental Plan?

While our earlier introduction touched on the provider networks and dentist choice issues associated with PPO dental plans, there are many more characteristics of these plans. There are often limits on dental work as well as requirements on how long you must be enrolled before a major service is covered. 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. The maximum benefit amount varies by plan. 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).

The term "maximum benefit" is sometimes called the "calendar year maximum."

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 deductible of $50 per enrollee per year. In some cases, there is a cap on the deductible for a family (e.g a maximum of $150 a year in deductible expense).

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. Not every plan has a waiting period and these delays are usually attached to more expensive care such as a crown or dental implant.

DentalInsurance.com's Plan Details pages include information about waiting periods when these types of plans appear in search results. PPO plans without waiting periods are sometimes called "immediate coverage dental plans" or "no waiting period dental plans."

PPO Trade-Offs

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

PPO Benefits:

  • 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

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 higher than HMO premiums

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.