Dental Insurance – What Types of Plans Are Available?

Dental insurance offers a way for individuals to pay for preventive care and receive compensation for more expensive treatment. It often includes a yearly maximum, which is the amount of money that a plan will reimburse for procedures within a given year.


Patients should also consider deductibles, annual maximum limits and waiting periods for non-preventive work when comparing plans. Some providers offer DHMOs with smaller networks, while others provide fee-for-service options.

Discount or referral plans

When choosing a dental plan, you must take into account the cost and coverage benefits. In addition to the premium, you must also factor in any deductibles or annual limit. A deductible is the amount that you are required to pay for a treatment before the insurance company starts to pay. Some dental plans also have co-payments, which are flat fees charged per visit or treatment and do not count toward the deductible.

Dental Preferred Provider Organization (DPPO) and Health Maintenance Organization (HMO) dental plans offer flexible networks of dentists and are less restrictive than traditional dental insurance. DPPOs and HMOs generally require that you choose a primary care dentist and get a referral from the dentist to see a specialist. These dental plans are available for individuals and families, and their monthly premiums vary depending on the type of plan and network.

These plans offer lower premiums than traditional dental insurance and are typically bundled with vision insurance. They can cover a variety of preventive services, such as oral exams and x-rays. They can also cover basic and major procedures, such as fillings, extractions, crowns, and dentures. Some plans also include a whitening benefit, which is an important part of good oral hygiene. In-house dental discount plans, however, do not have the same level of oversight as traditional insurance and may be subject to misleading upselling practices by dental clinics.

Exclusive provider organization (EPO) plans

A dental EPO plan offers a network of doctors and hospitals that agree to offer reduced fees to patients on behalf of the insurance company. These fees are known as negotiated rates. These negotiated rates are much lower than what a dentist would normally charge and allow the insurance company to pay for some or all of the procedure.

This type of plan has benefits that are similar to PPO plans, but the networks are usually smaller. In addition, they typically don’t allow you to visit outside the network unless it’s for an emergency. If you want to use a provider not in the network, you’ll have to pay full cost.

Depending on the plan, an EPO might also limit you to a specific network of pharmacies and imaging facilities. This may limit your options and can make it harder to find affordable care.

An EPO also usually doesn’t require a referral from your primary care physician (PCP) to see a specialist. However, it’s important to note that you’ll probably still have to pay a deductible before your plan starts paying. If you’re looking for an EPO plan that can help you get affordable health and dental care, eHealth’s tools and services can help you compare and choose the best option. You can also speak with one of our licensed insurance agents for help navigating the process.

Direct reimbursement plans

Unlike traditional insurance plans, direct reimbursement plans are self-funded and allow employees to choose any dentist they want. These plans are similar to a Preferred provider organization (PPO) or dental health maintenance organization (DHMO) but have lower costs for patients. They also do not require deductibles and do not pay for services that are not covered by the plan.

In a DRP, the company sets aside money each year for a predetermined amount of coverage. The employee pays for the treatment, and the company reimburses them a percentage of the cost. These plans do not exclude treatments, and they are a good option for those who want flexibility. However, they do have some limitations. They typically do not cover routine cleanings or preventative services, and they do not cover the cost of crowns and dentures.

DRPs are an excellent alternative to traditional insurance and can save companies a lot of money. In addition, they do not have the same administrative expenses as a traditional insurance program. Furthermore, they can be a great way to increase patient satisfaction and loyalty. Moreover, DRPs can reduce the cost of health care in the workplace by allowing employers to focus on what they really need to save money: cost control measures that promote responsible utilization of benefits. This includes a review of UCR/Table of Allowances payment schedules and periodic benefit maximum limits to ensure that the plan provides fair and equitable coverage.

Dental health maintenance organization (DHMO) or capitation plans

These plans work within a network of dental providers and have fixed copayments. They also typically have lower annual maximum limits. However, patients have less choice when selecting a dentist and can only see doctors who accept the plan. This type of insurance can be more affordable, but it’s important to understand the limitations.

Most dental plans have a cap on how much they’ll pay in a year, and the patient is responsible for any expenses that exceed this amount. This is called the annual maximum, and it’s important to know what this limit is before you sign up for a plan. You should also check the company’s reputation with state regulatory agencies.

Some dental insurance companies may require your dentist to submit a treatment proposal for any services over a certain amount. This process is often referred to as preauthorization, precertification, or pretreatment review. This process helps the dental insurance company determine your eligibility, services covered, and your deductible.

Most dental PPOs (preferred provider organization) have an annual maximum of $1,500. While this may seem low, it’s enough to cover the cost of many routine procedures like fillings and crowns. Some dental plans also have a separate lifetime maximum for orthodontics costs, so it’s important to compare the benefits of different plans before signing up. Also, make sure to calculate the cost of any deductibles or coinsurance that you’ll be responsible for.