Dental Plans - HMOs

These insurance plans, also known as "capitation plans," operate like their medical HMO cousins. This type of dental plan provides a comprehensive dental care to enrolled patients through designated provider office. A Dental Health Maintenance Organization (DHMO) is a common example of a capitation plan. The dental office provider is paid on a per capita (per person) basis rather than for actual treatment provided.

Participating individual and family dental offices receive a fixed monthly fee based on the number of patients assigned to the office. In addition to premiums, client co-payments may be required for each visit. Some typical features of these plans:

• Monthly premiums (some require you to prepay a year's worth)

• Co-payments for office visits

• Free preventive or routine care

• You must select from an approved network of that family or individual dental insurance providers

• May have an initial enrollment fee

• Annual dollar cap

• Your average monthly cost: $10 to $25

• Companies selling these plans are regulated by state insurance departments.

Preferred Provider Organizations

Another true insurance plan, a Preferred provider organizations (PPO) falls somewhere between an indemnity plan and a dental HMO. This plan allows a particular group of patients to receive dental care from a defined panel of individual or family dental facility. The participating individual or family provider agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser.

If the patient chooses to see a dental specialists who is not designated as a "preferred provider," that patient may be required to pay a greater share of the fee-for-service.  A group of individual and family dental offices agree to provide services at a deeply discounted rate, giving you substantial savings — as long as you stay in their network. Unlike the more restrictive DHMO, though, you can go out of network and still receive some benefits. Some typical features of these plans:

• Monthly premiums

• Annual dollar cap

• You must stay within the approved network of individual or family dental providers or pay higher deductibles and co-payments

• Your average monthly cost: $20 to $25

• Companies selling these plans are regulated by state insurance departments.

What are Dental Discount Plans - Remember they are not insurance

This type of dental plan is not insurance. The managing organizations have negotiated with local dental offices to establish a set price for a particular dental procedure and offer deep discounts (some up to 70%) off the regular ADA pricing code.

This plan has several advantages over traditional dental insurance plans, namely, there are no exclusions for pre-existing conditions. This allows a patient to receive immediate coverage for work without meeting any waiting period requirements.

How do discount dental plans work? As we become aware about our oral health, there has been a demand for affordable dental care. Discount dental plans are the newest option for those without coverage. These dental discount plans are much cheaper than traditional dental insurance, and also offer almost equal coverage for all dental work, even cosmetic procedures not covered by standard indemnity dental plans.

Dental Dental Insurance for the Best Price

The catch is that dental discount plans are not really insurance at all. They work more like club memberships, where the cost of membership (your "premium") earns a steep discount on any club service (dental work) you buy. The discount normally applies to all dental office services performed by an approved "plan" individual or family dental providers, but no procedure is covered completely.

What are the ins and outs of discount dental plans? When it comes to dental discount plans, the good news is afford ability, breadth of services, and immediate coverage. The bad news is greater financial risk and responsibility on your part.

Supplemental Dental Insurance Insurance

Although the monthly cost of most discount dental plans is very low compared to the price of a traditional dental insurance or indemnity insurance policy, there's more allover financial risk with a dental discount plan. No care is totally covered, so an expensive procedure will mean a big out-of-pocket expense, even with the dental plan. And even when undergoing a low-cost service (like cleaning), you'll still be expected to pick up a part of the cost.

However, on the plus side, discount dental plans are effective immediately - so are many procedures you need now will be covered as soon as you buy the dental discount plan. Traditional indemnity and/or insurance dental plans usually impose a waiting period of between 6 and 18 months for any major procedure. The last "pro" is that all good dental discount plans should come with a money-back guarantee.

Direct Reimbursement Plans

A dental care plan now coming into vogue is the direct reimbursement plan. This is a self-funded benefit plan — not insurance — in which an employer pays for dental care with its own funds, rather than paying premiums to an insurance company or third-party administrator.

You, the patient, pay the full amount directly to the individual or family dental care provider, then get a receipt detailing services rendered and the cost, which you show to your employer. The employer reimburses you for part or all of the dental costs, depending on your specific benefits.

Your company might reimburse 100 percent of your first $100 of dental expenses and then 80 percent of the next $500, and 50 percent of the next $2,000, with a total annual maximum benefit of $1,500. Or it might reimburse only 50 percent of your first $1,000, resulting in a $500 yearly cap.

Some typical features of a direct reimbursement plan:

• Neither you nor your employer pay monthly premiums

• Freedom to choose any of the best individual or family dental offices

• Typical employer cost: depends on the number of employees and benefit caps

• Benefits usually capped at $500 to $2,000 annually.

Who controls treatment decisions--you and your dental office or the dental plan? Many plans require the office to follow treatment plans that rely on a Least Expensive Alternative Treatment (LEAT) approach. If there are multiple treatment options for a specific condition, the plan will pay for the less expensive treatment option.

If you choose a treatment option that may better suit your individual needs and your long-term oral health, you will be responsible for paying the difference in costs. It's important to know who makes the treatment decisions under your plan. These cost control measures may have an impact on the quality of care you'll receive.