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A Comprehensive Guide to Dental Insurance Plans

Understanding your dental coverage is crucial. Our comprehensive guide sheds light on the essentials, covering deductibles, co-insurance, maximums, and in-network dentists.

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Everything You Need to Know About PPO Dental Insurance

When it comes to dental insurance, it can be a bit overwhelming to navigate all of the policies, deductibles, and coverage percentages. In this blog post, we’ll break down the essential information you need to understand your dental insurance. So, let’s dive right in and help you become well-informed about your dental insurance.

Feel free to check our page on dental insurances for more information.

A PPO Insurance policy is a regular indemnity plan that uses a network of dentists that are contracted by the insurance company to provide services for lower fees per their contracts. Sometimes terms are used interchangeably for plan, policy, but they all have separate meanings so please try to keep that in mind.

PPO Dental Insurance

The Importance of Knowing Your Dental Plan

To help you understand what insurance benefits you have, we want to educate you about what your dental plan is. Why should a patient be well-informed about dental insurance policies, especially PPO plans? This information comes from the National Association of Dental Plans, about 263 million people had a commercial or publicly funded dental program in 2019.

That means that 80% of the US population has some form of dental benefits. Also 85% of commercial dental plans are PPOs which outnumber the other types of plans that employers consider.

Call Now: To learn more about your Wheaton, don’t hesitate to give us a call at (630) 765 – 7557.

What Your Typical PPO Policy Includes

Now that we’ve covered the basics, let’s take a closer look at what a typical PPO policy typically includes in its coverage:

  • 100% Covered Preventive and Diagnostic Services (Exam and Cleanings)
  • $50 Annual Deductible except Preventive and Orthodontics
  • 80% Coverage for Basic Restorative
  • 50% Coverage for Major Restorative
  • 50% Coverage for Orthodontic Maximum of $1500
  • $1500 Annual Maximum for all service except for orthodontics

To make the most of your dental insurance, it’s crucial to understand a few key terms:

Deductible: The DEDUCTIBLE is the initial amount of fees for which the beneficiary (i.e., patient) is responsible before a dental plan will assume any liability for payment of benefits. This means the amount you have to pay before insurance kicks in. The deductible is usually once a year, and may apply to an individual or a family. Today $50 is the most common deductible.

Co-Insurance and Patient Costs: COINSURANCE or COPAYS are built into your policy to ensure the beneficiary pays a share of the cost of covered services, usually on a percentage basis after the deductible is paid. When a patient sees an IN-NETWORK dentist, a plan may pay 80% of its allowed fee and the patient is responsible for the other 20% of the plan’s allowed fee.

Common Example:

Fee: $200       

Deductible of $50       

Insurance pays 80% of $150= $120     

Patient Pays $80

Maximum: Almost all policies have a total annual maximum. This is a maximum dollar amount that insurance will pay each year, even if the patient’s dental costs exceed that limit. Common maximums are $1,000 or $1,500, but some have maximums of $2,000 or $3,000. These can be based on individual or family maximums.

In-Network Dentists: Most PPO plans allow benefits for out-of-network dentists. However some exclusive provider organization (EPO) plans only allow benefits if the patient receives treatment from a network dentist. In this case, benefits are not paid if the patient sees an out-of-network dentist.

Keep Us Updated

For the smoothest experience with your dental insurance, it’s essential to keep us informed of any changes. If your insurance changes or you need to update us, please don’t hesitate to contact our office at (630) 765 – 7557.

Understanding your dental insurance, especially if you have a PPO plan, is the key to making the most of your benefits and maintaining excellent oral health. If you have any questions or need further clarification on your specific insurance policy, please reach out to us. We’re here to help you navigate the complexities of dental insurance and ensure you receive the best care possible.