nav


What should I think about before I shop for coverage? 

Before you shop, think about what is most important to you or your employees:

Is it most critical for out-of-pocket expenses to be predictable and low?  If so, a dental HMO might be best suited to your needs or those of your employees. Dental HMO co-payments are published and offer more predictability as they are usually stated as specific dollar amounts. As well premiums are also lowest among insured dental benefit products and there is rarely an annual maximum on care. As well they typically have the lowest deductibles. In 2015 NADP found 93% of DHMO deductibles under $25 while only 15% of DPPO or dental indemnity deductibles are at this level. The trade-off for this predictability and lower cost is a requirement that the consumer go to a dentist in the network for care. Only when a dental emergency occurs outside of the consumer’s home area is a dentist that is not in the network paid for dental care.

Do you or your workforce have a greater tolerance for cost-sharing and an interest in a broader network of dentists?  If so a dental PPO or a Discount plan may suit you. Co-payments in dental PPOs are usually stated on a percentage basis and some coverage is still provided if you or your employee goes outside the network for care. DPPOs have an annual maximum on the amount the carrier will pay for services and about 72% of deductibles are between $50 and $100. Discount plans do not pay anything toward the cost of care; they simply make a network of providers available to the consumer that offer services at a discount. So, while Discount plan monthly fees are lower than dental PPO premiums, the full cost of care must be paid out-of-pocket at the discounted rate.

If freedom to choose a dentist is paramount a dental Indemnity plan may be your best match. Annual maximums and copayments are similar to those of DPPOs. Premiums are often slightly lower than DPPOs as there is no network organization cost to the plan. While there is no restriction on the choice of dentist, there is no discount on fees, so fewer services may be paid for by the indemnity plan which means more potential consumer out-of-pocket cost.