Wednesday, June 22, 2022

What Does Prepaid Dental Insurance Mean

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Why Has Dental Insurance Become So Popular

Need to Know Dental Insurance Terms, Claim & EOB, Pre Determinations, Percentages for Billers

A person’s smile often is the first thing others notice about them. A beautiful set of pearly whites can make or break that first impression.

Keeping our teeth, gums and mouth healthy goes a long way in improving our appearance. As we age, our teeth develop numerous issues which should be monitored and treated by a dental professional. But let’s face it – dental procedures can be expensive. Even a routine exam and cleaning can cost over $100 in most areas. Costs can be even higher for those without dental insurance.

Recent figures indicate that 42 percent of all Americans go without dental insurance, which in turn results in a lack of regular visits to the dentist.

However, studies in recent years have linked improper dental care and health to everything from heart disease to diabetes and even cancer. A healthy mouth is the first step toward a healthy body.

Some people are lucky and have dental insurance included as part of their regular health insurance package through an employer. For those people, espousing the benefits of proper dental hygiene and care are unnecessary. They have the benefits in place and are happy to use them.

For those who are not lucky enough to have dental insurance through an employer, the benefits of purchasing your own plan through an insurance broker or directly from a dental insurance company are numerous.

What Is Metlife Pdp Plus Mean

MetLife Preferred Dentist Program MetLife Preferred Dentist Program More choices for healthier smiles. You have a network that gives you access to thousands of participating dentists. Its called PDP Plus. More choices mean its easier than ever to get the dental care you need for a happy, healthy smile.

Types Of Dental Insurance

There are a number of different kinds of dental insurance. When shopping for dental insurance and choosing a plan, you will want to know the following:

  • Is there a deductible and coinsurance?
  • Are you required to choose a primary care dentist?
  • Are you required to see dentists within a certain network to be covered?

Understanding the main differences between the types of dental insurance can help when choosing the plan that’s right for you.

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What Are The Different Types Of Dental Insurance

Besides DHMO plans, there are PPOs . The majority of dentists will accept a PPO plan, but not all accept DHMO insurance.

PPO plans do have an annual cap on coverage, and plan members may pay a higher percentage in co-pays than they would with a pre-paid plan. Deductibles tend to be $50 for an individual plan, and $150 for a family plan. The benefits of a PPO are being able to choose from a broader network of dentists.

Dental indemnity insurance plans, also known as Fee-for-service plans, are not offered by every insurer. These plans offer a higher annual cap, low or no deductibles, and enable you to choose from a very wide variety of dentists. Premiums for these plans tend to be significantly higher than for DHMO or PPO plans.

What Dental Services Are Covered By A Dhmo Vs A Dppo

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Whether you buy a dental plan on your own through an individual insurance carrier, the health insurance marketplace, or through your employer, DHMOs and DPPOs may cover the following:

  • Preventive dental care: Usually covered at 100% by both DHMO and DPPO plans. Preventive dental care covers teeth cleanings, oral exams, certain types of X-rays, fluoride treatments, and sealants. Age limits and limits on how many of each you can have in a plan year may apply.
  • Fillings, root canals, extractions: These services may also be called basic restorative in the details of your dental plan. For DHMO plans you will typically have a flat fee to pay for these types of dental services. For DPPO plans you will need to first meet your deductible, then you will share a percentage of covered costs with your plan for non-preventive services up to any annual maximum.
  • Crowns, bridges, dentures, etc.: Major restorative care like crowns, bridges, dentures, and oral surgery procedures and gum grafts are covered up to a certain amount. See your plan details for terms.
  • Braces and other orthodontic care: If youre looking for coverage for braces, then shop for DPPO and DHMO dental plans that offer these types of benefits. Pay attention to age limitations, too. If your plan has a deductible, you may be required to meet that first, before your plan begins to share costs. After that you and your plan will each pay a percentage for covered orthodontic services until you meet your annual maximum.

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How Much Does A Aarp Dental Plan Cost

Plan prices vary, check the AARP dental insurance page for specifics of plans available near you. But as an example, in Florida, zip code 33135 :

$136.61

At least one enrolled family member must be an active AARP member to qualify for any of the AARP dental insurance plans . Coverage is offered for Individuals, an individual plus one eligible dependent , or a Family. A dependent child can include unmarried grandchildren, stepchildren, adopted children and foster children.

Do Prepaid Plans Exclude Pre

Typically, with a prepaid plan there are no exclusions for pre-existing conditions. In contrast, PPO insurance often will not pay to restore teeth that were decayed, broken or missing before you purchased the policy, and may not play to complete any dental care treatment that was already underway prior to the policy going into effect. Coverage for preexisting issues can make prepaid plans a good choice for people who have dental health problems.

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Do You Have To See Dentists In A Network With A Dhmo Plan Vs A Dppo Plan

DHMO plans can be more affordable because they require you to see dentists within the network, in order to be covered. Most DHMOs will only cover out-of-network services in an emergency or where required by law. In comparison, a dental PPO will permit you to see any licensed dentist you want, in- or out-of-network, but you will pay less if you choose to see a dentist from the plans network.

Is It Better To Have Hmo Or Ppo Dental

What Dual Coverage in Dental Insurance Means

Dental HMO vs. PPO: Either can be a good choice, but there are trade-offs with each type of plan. A PPO dental plan may have higher premiums, but it typically gives you a far greater selection of network dentists and if it has a big enough PPO network, your current dentist could already be in the plan. An HMO dental plan usually offers lower monthly premiums, with no deductibles or annual maximums. But the networks are generally much smaller than a Dental PPO, so you may not get to see your current dentist.

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Who Is Dental Insurance Good For

The choice to get dental insurance is ultimately up to you and your budget. But even if your mouth is healthy, dental insurance that covers preventive care at 100% can be valuable to have, especially when unexpected issues arise like filling a cavity or fixing a chipped tooth.

Dental insurance may be right for you if you:

  • Have missed the annual open enrollment period through your employer
  • Are on Medicare and dont have a dental plan
  • Are in-between jobs or have been laid off.
  • Are a part-time or temporary worker and your employer does not offer dental benefits.
  • Are a student, a recent graduate, or have aged out of your parents dental plan.
  • Do not have a dental benefit through your employer

Preferred Provider Organizations Plans

PPOs usually involve a network of dentists who work with an insurance company and provide discounted prices for their services. The insurance company tends to negotiate for these discounts on behalf of the clients. In exchange, the dentists get a constant stream of patients who have opted for these plans so they dont have to spend time marketing themselves.

As a patient under PPOs, you can select your own provider. However, that dentist has to be within your plans list. If you choose an out-of-network dental care provider, you will have to pay much more for their services.

Read More: HMO Vs. PPO Dental Insurance

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What Is A Dhmo Dental Plan

A Dental Health Maintenance Organization is a prepaid dental insurance plan that aims to minimize out-of-pocket costs. They provide in-network dental coverage, meaning you can only choose from dentists who have decided to sign up with the insurance company.

A DHMO plan focuses on dental health maintenance. They nudge customers towards prevention and treatment of less serious issues now, rather than waiting for them to become severe problems later. For this reason, you will see basic care fully covered, while dental coverage drops sharply for advanced treatment.

In many cases, the same insurance company will offer different types of dental insurance. You can compare DHMO and PPO plans by cost and covered services together, as their advantages and disadvantages meet different needs.

Summary

DHMO dental insurance plans provide cost-effective dental care from a limited range of in-network dentists.

Indemnity Plans Overview: What Is Indemnity Dental Coverage

What does Coordination of Benefits mean in Dental Insurance?

Indemnity plans generally are similar to other dental plans with respect to the services they cover. While dental benefits are not standardized, it is typical to see some level of coverage for the following services:

  • Annual exam, teeth cleaning
  • Crown
  • Root canal

As with other dental plans, indemnity plans may have some waiting periods associated with more expensive dental services. Waiting periods are specific to the insurance company and the plan.

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What Does A Aarp Dental Plan Cover

Coverage varies according to the type of plan you choose, and there may be variances in the plans offered in your state. In general, though AARPs basic, preventive and restorative dental coverage is very comprehensive.

If you opt for a DPPO plan, basic and preventive are covered as soon as you meet your deductible. There is, however, a 12-month waiting period before you are covered for restorative care, which includes crowns, inlays and onlays, bridges, dentures, dental implants, Periodontics treatment or treatment for Temporomandibular Joint Dysfunction . The waiting period is enforced even if you have had continuous dental coverage from another provider. And if you switch to another AARP DPPO plan, your waiting period begins again.

With the Prepaid plan, as noted above, there is no waiting period. Basic, preventive and restorative care are covered right from the start. Depending on when you enroll, your plan may not activate for over a month though. For example, joining after the 21st of August means your plan doesnt activate until October.

You can also see what dentists near you are in the plans networks, something that you should check prior to purchasing. You can see reviews of the dentists on social media just by clicking the number of dentists near you option. Checking reviews is especially critical if youre choosing the Prepaid plan option, since the Prepaid network is smaller than the DPPO one, and Prepaid members must see an in-network dentist.

What Is A Dental Indemnity Plan

Dental indemnity is a type of dental insurance that gives you a lot of freedom. It’s often referred to as a traditional dental plan or a fee-for-service. You can typically see whatever dentists you wantthere is no network. You don’t need to choose a primary care dentist and you may not need referrals to see specialists or receive emergency dental care, depending on the plan.

A dental indemnity plan usually has an annual deductible and coinsurance. You’ll pay for services out of your own pocket until you meet the deductible. Then you and your dental plan will share costs for covered services, up to what is considered usual, customary, and reasonable under your plan. These types of dental plans tend to cost a bit more. If you like a lot of options and few requirements, a dental indemnity plan may be right for you.

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Ppo Dental Plans For Individuals

Many Americans receive dental coverage through their employers. But if youre self-employed or your current employer doesnt offer adequate dental benefits, you can still get a dental PPO plan. Individual PPO dental insurance plans are available to enroll in online, directly from an insurance provider.

When youre purchasing individual dental insurance, you have the freedom to choose the plan thats the best fit for your budget and your coverage needs. But even once youve settled on a dental PPO plan, the freedom continues each person in your family can choose their own dental provider and still enjoy the same level of coverage.

If youre ready to start shopping for dental PPO plans for individuals, get a free quote here.

If you think a DHMO plan might be a better fit for you, you can also enroll in a Guardian Direct DHMO plan on the dental exchange here.

Ppo/hmo Network Comparison Chart

What does In-network mean for dental insurance?
See any dentist and get discounts on services when you visit participating providers.Benefits apply only when you see participating providers. You must also select a primary dentist.
Specialist coverageNo referral needed to see a specialist.Some plans offer specialist coverage check your policy for details. For plans that dont include coverage, you may receive a 25% reduction from Participating Specialists usual fee for covered dental care services performed.
How you payA percentage of the cost is paid when you meet your annual deductible. Copayments may apply for some plans.You pay a set copayment at each visit.
Annual maximumYes, but some plans allow you to rollover unused benefits.No.
Flexibilitysee the dentist of your choice, in- or out-of-network.Larger networks of dentists.No referral needed to see specialists.Lower monthly cost.
Limitations/considerationsHigher monthly cost.Benefits dont apply if you see a nonparticipating provider .

If you have a dentist, check our provider directory to see if your dentist is in our PPO or DHMO network.

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How Does Dental Insurance Work

Dental insurance can pay for things like annual cleanings, minor oral health fixes, or big-dollar dental claims for crowns and bridges. In general, dental coverage is broken out by preventive, basic and major services:

  • Preventive dental care includes diagnostic and preventive services like regular oral exams, teeth cleaning, and x-rays. It may also include fluoride treatments and sealants . In many cases, dental plans include 100% of the cost of preventive care.
  • Basic dental care includes office visits, extractions, fillings, periodontal treatment , and root canals. Your insurance company might pay anywhere from 60 to 80% of the cost for these services, with you covering the rest of the cost. But if you’re paying a lower percentage of the costs, you may have a high-dollar copay.
  • Major dental care covers crowns, bridges, dentures, and inlays. Inlays are something between a filling and a crown: Your tooth might have extensive decay and need a more substantial filling, but it may not be in bad enough shape to require a crown. Meanwhile, crowns completely cover the tooth. Some dental insurance plans include root canals under “major” dental care, while others categorize them as “basic.” The cost of major dental care is higher, and most insurance plans cover about 50% of the fee.

There are two main types of dentail insurance plans:

Whats My Best Dental Plan Option

If youre in the market for dental insurance, youre likely to come across two popular types of coverage a prepaid dental plan and a dental PPO . And if you arent exactly sure what either is, rest assured youre not alone. Dental coverage, like many other types of insurance, has its own lingo and its not always very clear to understand. The good news is that well break down these two popular dental insurance options into bite size chunks, so you can choose the best dental coverage for yourself or your family.

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Dhmo Vs Ppo: Whats The Difference

Dental HMO insurance plans have lower premiums through their prepaid structure. You either select, or are assigned to, a primary dentist if you decide that DHMO plans are the best option. If you dont like your primary care dentist, you can change them, but only in-network dentists are available.

PPO stands for Preferred Provider Network , and they make up the vast majority of private dental plans. You can choose care from an out-of-network dentist, but additional costs will likely be higher. Additionally, you do not need a primary dentist.

A dental PPO will often cover a wider range of treatments than DHMOs, as your dentist receives payment based on services provided, instead of a set monthly amount. For this reason, they are often more popular among dentists. Whether or not you need a waiting period before certain treatments depends on your plan.

Your PPO dental insurance plan will likely work with what is known as 100-80-50 coverage. Here, you can expect to have all of your preventative care and diagnostics covered, and 80% of basic treatment such as fillings or root canals. Major procedures, including bridges, crowns, and covered surgeries, will only be 50% covered under this type of plan.

Summary

Dental care from a DHMO is aimed at helping you cut costs, while a dental PPO provides more flexible treatment options at higher premiums.

Five Things You Need To Understand About Your Dental Insurance Plan

Dental implants mean you donât need to give up favorite food and none ...

We all want to protect our families, and that doesnt stop at installing alarms in our houses to keep them safe. Consider this and keep your whole family smiling.

Imagine this. You are sitting back and relaxing, watching Netflix. You reach for the last bite of popcorn and ouch! Can you believe you just damaged your tooth!

Hefty dental bills can come take you by surprise almost anytime. That is why having dental insurance in place makes sense. It protects your out of pocket costs when the unexpected happens to you or your family members.

Before choosing which dental plan to go with, here are five factors to keep in mind.

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