Your smile can stay healthy for a lifetime with the right aftercare. Although your toothbrush and floss are essential, they are only half the care you need. Your dentist is invaluable to your oral health; however, if you’re like many Americans, you’re probably concerned about the cost. If you have dental insurance, you don’t have anything to fear. Your policy provides access to the affordable services you need, but did you know there are many types of dental insurance in Edmond? Here’s what you need to know to choose the best coverage for your smile.
HMO VS. PPO
When choosing a dental policy, you’ll need to determine if you want an HMO or a PPO plan. While they may seem similar, there are distinct differences between them, such as:
- Deductible
- Coinsurance
- Annual maximum
- In-network requirements
- Primary dentist requirements
- Waiting periods
- Services covered
The deductible is one of the single most important factors to consider when choosing a policy. It is the amount you’ll need to pay out-of-pocket for services until you’re able to access your annual limit. Typically, PPO plans have a deductible while HMO do not.
The coinsurance is also important because it’s the percentage of the costs you and your plan share for included services. The coinsurance for PPO plans become active after you’ve met your deductible while HMOs may require you to share a portion of the costs. Typically, it’s a flat rate for each dental service, and you aren’t required to meet your deductible beforehand.
Annual Maximums and Services
An annual maximum is the amount your plan will pay during a calendar year. Most HMO plans don’t have a yearly limit, unlike a PPO, which generally vary from $1,500 to $2,000. To make the most of your annual limit, HMO plans require you to choose a dentist who is in their network because they have pre-negotiated rates with the dental practice. They will not cover services from a dentist who is outside of their network. A PPO plan differs because they encourage you to visit an in-network location, but they will still cover a portion of the cost if the dentist in out-of-network.
No matter the policy you choose, most HMO and PPO plans include:
- Preventive Services: Both HMOs and PPOs cover preventive care 100%.
- Basic Restorative Services: HMO plans provide a flat fee for basic restorative treatments while PPOs will pay about 80% of the cost.
- Major Restorative Services: The amount covered under both plans varies.
Choose the Best Coverage for Your Smile
Choosing a dental insurance is a decision that shouldn’t be taken lightly. Consider all your options to make the best choice for your smile.
About Dr. M. Kent Smith
Dr. Smith has over 30 years of experience in dentistry. He earned his dental degree at the University of Texas Health Science Center and has completed extensive training in many areas of specialty. His dental team strives to provide affordable services for all patients by accepting a variety of insurance plans. If you need to schedule an appointment, or you have questions about your coverage, contact our office today.