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What are the different types of dental plans?

Individuals may get dental plans at work. They may also get dental plans on their own or from a state Health Insurance Marketplace or private exchanges.

The four types of plans are:

  1. Dental Health Maintenance Organization (DHMO)
  2. Dental Preferred Provider Organization  (DPPO)
  3. Dental Indemnity Insurance
  4. Discount Dental Plans

Today, 82 percent of all dental policies are DPPOs. Here are some helpful definitions:

  • DHMOs limit the dental services they pay to their list of dentists. You must use dentists on the list for the dental care to be covered. They have the lowest premiums of all dental insurance plans. DHMOs pay for both general dental services and specialty dental care. Dentists receive payments for the number of patients on the DHMO. DHMOs have a deductible but usually don’t have an annual maximum. So there is no limit on the dental services that you can have in a year. Some DMOS allow consumers to opt out of the network at the time of service. If you “opt out” you pay more of the cost of dental services yourself.
  • Dental PPOs pay for the most for services you receive from dentists on their list. Dentists on the DPPO list get more patients and are paid a discount from their usual fees. DPPOs pay less for services that you receive from dentists that are not on their list, but the DPPO will still pay part of the cost. Because you can see any dentist, DPPOs have higher premiums than DHMOs. DPPOs usually have a deductible. This is the amount you pay before the carrier shares in the payment for services. After the deductible is paid, the DPPO will pay part of cost of services. For basic services like fillings, this may be 80%. For major services like crowns, this may be 50%. DPPOs also have maximum amounts they will pay toward your claims for dental services each year. Less than 5 percent of consumers use more dental services than the annual maximum. When the annual maximum is reached, consumers pay the full cost of dental services but at the discounted charge set by the DPPO.
  • Dental Indemnity Plans do not have lists of dentists. You can go to any dentist for dental services. Dental Indemnity Plans also don’t negotiate discounts on the dentist’s usual fee. Dentists are paid their usual fees for the services they perform. Dental Indemnity Plans have the highest premiums of any dental insurance plan. There are still deductibles and co-payments similar to those of DPPOs. After the insurance pays the claim, you receive a bill for the balance up to the dentist’s usual fee.
  • Discount Dental Plans are not insurance. A group of dentists agree to offer enrollees discounted prices through the Discount Dental Plan. When you have a discount plan, you pay the dentist directly. The discount plan does not pay the dentist. Another name for discount plans is “savings plans.”

About NADP

National Association of Dental Plans (NADP), a Texas nonprofit corporation with headquarters in Dallas, Texas, is the “representative and recognized resource of the dental benefits industry.” NADP is the only national trade organization that includes the full spectrum of dental benefits companies operating in the United States. NADP’s members provide Dental HMO, Dental PPO, Dental Indemnity and Discount Dental products to more than 177 million Americans, approximately 90 percent of all Americans with dental benefits.

Importance of Dental Plans

Why is it important to understand dental care? Oral health is a critical part of overall health. Dental plans help you get to the dentist for care. People with dental plans are

  • 49% more likely to see their dentist twice a year.
  • 42% more likely to take their children to the dentist that often. – NADP 2007 Consumer Survey.