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Dental Insurance: Public Access

TYPES OF DENTAL PLANS

INDEMNITY
This the traditional form of reimbursement. An indemnity plan allows the patient to go to the dentist of their choice. These plans generally pay a portion of the dentist's fee or a set dollar amount (usually, whichever is less).
Payments may be made to the patient or directly to the dentist. If there is a difference between the amount paid and the dentist's charge, the patient pays the difference.
These plans almost always have a yearly maximum benefit, typically $1000 or $1500 and allow the patient to freely choose their own dentist. The benefits are determined by the agreement between you or your employer when you signup.
When the patient pays the fee personally, it is prudent to consider how much treatment they need as to avoid paying more in premiums than in care received.

DHMO - DENTAL MAINTENANCE ORGANIZATION
Typically, the least expensive dental plans. The dentist who provides your services agrees to provide specific treatments and services to patients at no charge (some services may require that you make a partial payment.)
Dentists are paid a monthly fee for as long as you remain that dentist’s patient. The insurance company pays only that monthly fee to the dentist, regardless of how much or how often you use the covered services.
Patients pick from a specific list of dentists and must pick a dentist only on that list. Therefore, the cost of insurance may be less, but the choice of dentists is limited.
 

PPO - PREFERRED PROVIDER ORGANIZATION
PPO’s are generally less expensive than indemnity dental plans. Individuals select their dentist from a list of dentists who have agreed by contract to accept reduced fees.
Individuals can also seek treatment from dentists outside of the PPO (non-participating dentists) but may be responsible for higher deductibles and/or co-payments.

SCHEDULED
A scheduled plan reimburses you for a specific amount based on a fee schedule with any balance due being your responsibility. Scheduled plans do include a calendar year maximum, a deductible and have waiting periods on certain procedures. A Scheduled plan shows every covered procedure and the amount you will be reimbursed for each procedure.
For example, if the insurance reimburses $147 for a cleaning, and your dentist charges you $150 for a cleaning, you would be responsible for the difference of $3.