Dental Insurance

PPO dental insurance plans are what most people are familiar with. They will generally cover a maximum amount per year, usually between $1,000 and $5,000, of dental services. They have large networks of dentists and specialists that you can go to, and services are usually covered the same, whether they are performed at a general dentist or specialist. 

​

Dental procedures are covered according to what tier they belong too. Services are usually divided into three (3) tiers: Preventative services, Basic Services, and Major Services.

​

Preventative services are usually covered 100%, sometimes with a small co-pay you pay the dentist at your visit. They include things like cleanings, exams, x-rays. For kids, preventative services will usually also include things like fluoride treatments, sealants, and space maintainers.

​

Basic Services usually include things like cavity fillings and simple extractions, while major services usually include crowns, root canals, and dental surgery, like surgery to remove impacted wisdom teeth. PPO dental plans usually cover these services at rates between 40-80%, depending on the plan. Waiting periods may also apply, and usually do for major serives.

Sometimes, plans have a small deductible you must satisfy. This deductible usually only aplies to basic and major services. PPO dental plans usually are the best bang for your buck.

HMO Dental Plans

HMO dental plans work differently than the normal PPO model. They usually do not have a maximum amount per year that they will cover, instead they will cover as much services as needed. Each service has a predetermined co-pay associated with it. For example, a cavity on a molar filled with amalgam (metal filling) may come with a $70 co-pay, while a composite (clear) filling may have a $90 co-pay. 

​

One of the good things about dental HMO plans is that you know the exact cost of each procedure you may need done, before you have to pay, and again unlike dental PPO plans, there is no annual limit. One of the drawbacks is that the co-pays usually only apply at General Dentists, and will not apply at a specialist. 

​

While most dental procedures can be completed at a general dentist's office, in some cases the general dentist will have to refer you to a specialist. In these cases, the co-pays will not apply and generally only a discount (usually around 25%), will be given.