The Dental PPO Plan

With the end of the year quickly approaching, you may have to start thinking about dental insurance for 2017. Insurance can be confusing, so in the next few articles we are going to highlight the differences between the types of dental plans and provide you with information that may benefit you in deciding what plan to choose.

The most common dental plan is the Preferred Provider Organization or PPO plan. The draw to this plan is the list of dentists that are in-network with the dental plan. Being an in-network dentist means that dentist agrees to give enrollees in the plan a discount on dental services. PPO plans can also pay for dental treatment to non-participating dentists but these dentists do not have a contract to discount their fees and you may be left with a larger bill for treatment.

Seeing an in-network dentist can save you money when you are enrolled in a PPO dental plan. For instance, if you need a filling and the normal fee is $200. If you see an in-network dentist, the insurance discount may be $100 and the insurance may cover 80%. That leaves you with an out of pocket cost of $20. If you see an out of network provider and are faced with a $200 fee, the insurance may still only pay 80% of their rate of $100, and this could leave you with an out of pocket cost of $120.

PPO plans, like most plans have a deductible and yearly maximum. A deductible is the amount of money you must spend before the insurance will start to pay for treatment. Typical deductibles range from $25 to $100. When looking at deductibles, the lower the deductible, the higher your monthly premium. When looking at a plan, you also must keep in mind the yearly maximum. The yearly maximum is the amount of money the dental insurance company will pay for your dental needs. Maximums typically range from $500 to $2,000. How do you know which one to pick? If you haven’t been to the dentist in years, it would probably be smart to select a plan with a lower deductible and higher maximum. If you go to the dentist regularly and haven’t had any problems in years, you will probably want to look at the plans with a higher deductibles and lower maximums. Deductibles and maximums do not usually apply for cleanings, exams or x-rays.

PPO plans, like most plans will cover a specific percentage of your dental treatment. Most plans cover the entire cost for cleanings, x-rays and exams twice a year if you see an in-network dentist. Where plans may vary is how much they cover for fillings, extractions, crowns, and other more invasive dental treatment. These percentages can range from 50-100%. If you participate in a plan that covers a filling at 80%, that means that once your deductible has been paid, the insurance company will pay for 80% of the cost of the filling and you will be responsible for the other 20%.

Be aware that if you are signing up for a PPO plan as an individual there may be a waiting period in which the insurance will pay nothing for things like fillings, deep cleanings, crowns, bridges or extractions. During the waiting period you will still have access to the PPO discount as long as you are seeing an in-network dentist and most plans have no waiting periods for cleanings, x-rays and exams.

To sum up, when looking at a PPO plan it is usually more cost effective to see an in-network dentist. However, if you have a dentist you like and trust that isn’t in-network, you can still see that dentist but you may end up paying a little more out of pocket.

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