In-Network vs Out-Of-Network Dental Insurance Plans

In-Network vs Out-Of-Network Dental Insurance Plans
With the rising cost of dental care, many people are debating whether or not they should purchase dental insurance plans. Whether you are considering getting dental insurance independently or through your employer, you should understand the difference between plans before signing on the dotted line.

Most dental insurance plans fall under one of two categories: Preferred Provider Organizations (PPOs) or Health Maintenance Organizations (HMOs). Dental PPOs and Dental HMOs both offer access to quality dental care. The primary difference between the two lies in your out of pocket costs and the network provider restrictions.

Dental HMO Plans

Dental HMOs are prepaid dental insurance plans that some people refer to as “in-network” plans. That`s because all of your dental checkups, lab work, surgeries and other dental services must be provided by members of the HMO`s network.

There are several advantages to choosing an HMO dental plan. You never have to worry about deductibles or co-insurance payments. You also don`t have any billing hassles. You simply pay your monthly insurance premiums and your HMO takes care of the rest.

Most insurance companies offer a variety of Dental HMO plans. This allows you to choose your dental insurance premiums and the amount of coverage you receive. Selecting an HMO plan with lower monthly payments allows you to save money.

Despite these advantages, HMO dental plans also have a few drawbacks. The primary disadvantage is that you cannot choose your own dentist. You must choose your primary care provider (PCP) from a list of in-network dentists. Your PCP will refer you to another in-network dental professional, such as an orthodontist, if you need specialist care.

Your HMO won`t pay for any expenses you incur if you receive dental care from an out-of-network professional. If you need emergency dental treatment and can`t find an in-network dentist that can see you right away, you will have to pay the full cost of any care you receive. Another disadvantage is that HMO patients often have to wait for several months to receive routine dental services, such as checkups, x-rays and cleanings.

Dental PPO Plans

Dental PPO plans also utilize provider networks, but you don`t face as many restrictions regarding which professionals you visit. PPO dental plans will pay for part of your bill, even if the dental professional isn`t a member of your PPO network. This is why PPO policies are sometimes called “out-of-network dental insurance plans.”

PPOs don`t require you to choose a primary care provider. This means that you can visit any licensed dental professional without needing a referral. Most PPO insurance companies also allow you to set your own dental plan options including the amount of your deductibles and your co-insurance levels.

The bad news is that PPOs are typically far more expensive than HMOs. You will have to pay a higher monthly premium plus any co-insurance payments and your deductible. Although you can visit out-of-network professionals, many Dental PPO plans set a cap on the yearly amount of services that you can receive from out-of-network providers. If you go over that maximum limit, you will have to pay for any additional expenses yourself.

Which Dental Plan Should You Choose?

Choosing the right dental plan really depends on your specific needs. Consider purchasing an HMO dental plan if you need to keep your out-of-pocket costs and your monthly premiums as low as possible. A PPO dental plan might be a better choice if you want the flexibility of selecting your own dental professionals.

Whether you decide to go with an HMO or a PPO, shop around for the best rates. Various websites offer comparison tools so you can find a purchase price that works for you. Not only can you compare the cost of dental plans, but you can also compare life insurance rates at sites such as saving you more money that can go towards your dental care.

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