You can visit any dentist with dental PPO insurance, but the costs are usually lower if you visit one of their network providers. These providers contract with the insurance company and have agreed to their service fees.
Most plans have an annual maximum that caps how much the plan will cover in a year. All costs paid beyond that limit are your responsibility.
More Choice of Dentists
Unlike Dental HMO plans, which only reimburse for care from dentists within their network, PPO insurance plans offer more flexibility. These plans typically list dentists in their network but also allow you to use any dentist you want. However, using an out-of-network dentist will result in higher deductibles or coinsurance.
The dental PPO insurance plans work by negotiating with dentists to reduce their fee structure, and they then reimburse these discounted rates to plan enrollees. In addition, many PPOs will allow a member to see a specialist without a referral from their primary care dentist, and they may not be limited to the number of times they visit a particular provider in a year.
However, while PPO plans allow you more flexibility when choosing dentists, they are often more expensive than DHMO dental insurance plans and have lower maximum benefit limits. Therefore, considering dental discount plans is a good idea if you are looking for the best value. This type of plan is less expensive than traditional dental insurance, but it does not limit your choice of dentists and offers the advantage of more savings on procedures.
More Control Over Your Care
The choice of dentists is one of the most significant advantages of having PPO dental insurance. Unlike DMO plans, which require you to stay with your assigned dentist unless you get a referral to see another specialist, DPPOs allow you to visit any of their network dentists without restriction.
In addition, the dentists on a DPPO plan are contracted with the insurer to provide services at set fees. Those fees are usually lower than what an uninsured patient pays to the dentist.
Most DPPOs also allow you to visit dentists outside the network. However, that will typically require a higher fee based on an industry concept known as “usual, customary, and reasonable.” Because of this policy’s flexibility and low rates, it remains one of the most popular types of dental insurance available. Many people obtain group DPPO coverage through their employers or other group coverage programs, such as the Affordable Care Act Marketplace and government programs like Medicaid and CHIP. However, some people choose to purchase individual DPPO policies, as well.
Lower Rates
Dental PPO plans often have much lower rates than other types of dental insurance. This is because the dentists participating in the plan’s network agree to accept a reduced rate for their services.
When patients use a participating provider, they don’t have to pay a copay, and the dentist’s office will submit the claim directly to the insurer on their behalf. However, it’s essential to understand what the insurance plan covers. Most PPOs have an annual maximum that caps the amount they’ll pay for a specific dental service or procedure. Usually, that limit is less than $1,500, and it’s the insured person’s responsibility to pay for expenses that exceed this maximum.
Another advantage of PPOs is that they typically don’t require a referral to visit a specialist. In contrast, DHMOs require a referral and restrict patients to a list of contracted specialists. This limits the insured’s freedom to choose a primary care provider and hinders their ability to find a specialist for needed specialty care.
More Flexibility
Dental PPO plans have broader networks than DHMOs and may allow plan enrollees to see dentists outside the network for reduced rates. Often, the carrier will have an annual maximum of how much it will cover for out-of-network visits.
In addition, dental PPOs don’t require a patient to select a primary dentist. They may also not need a referral to see a specialist. They usually have lower out-of-pocket costs than DHMOs and can have an annual deductible that the subscriber must pay before the insurance kicks in.
In contrast, a dental HMO requires choosing a primary dentist and only covers care from in-network providers. This can lead to restricted services and higher out-of-pocket costs for a patient. Dental HMOs can sometimes have lower premiums than PPOs, although that depends on the coverage amounts and other factors. This is a good option for individuals with a limited cost-sharing tolerance who want to avoid paying copays. It’s also a good choice for employers who are okay with a higher cost-sharing model in exchange for a more extensive network of dentists.
More Savings
Dental PPO plans offer more savings to patients than HMO (health maintenance organization) plans. This is because HMO plans have limited networks and only pay for services provided by dentists contracted with the plan.
With a PPO, insurers have negotiated discounted rates with dentists and providers. The patient then pays a low percentage of the negotiated rate, and the insurance company covers the rest. This gives the insurance company more flexibility and helps them control costs.
While HMO plans may have lower premiums, they also tend to have annual maximums and require the patient to choose a primary care provider for referrals to specialist services. These limitations make them less flexible for many consumers. In addition, they often have annual deductibles for basic and major procedures. For these reasons, dental PPO plans are more flexible for most consumers. However, it is essential to compare the benefits of different plans carefully before deciding. The key is finding a plan that offers the right balance of cost-sharing, flexibility, and coverage to suit your needs.
