There are three main kinds of dental plans
available in the market
Let's first a take a look a these three different models of dental insurance in California.
PPO stands for Preferred Provider Organization.
It's sometimes called DPO for Dental Preferred Organization which just means the PPO model is applied to dental insurance. With PPO dental networks, you will have a large network of dentists and dental groups to choose from as in-network providers.
When you use these in-network providers, you will get better benefits which means less out-of-pocket. You are not locked into a particular dentist or area when accessing dental services. You can choose to use an out-of-network provider but you will pay more out of pocket if do so. The PPO is essentially a large group discount for the members that access in-network providers.
PPO dental networks are usually quite large in California with 10's of thousands of participating providers up and down the State. The plan is also more expensive than HMO plans but usually less expensive than Indemnity plans (which we'll talk about later). With a PPO dental network, you can refer yourself out to a specialist.
Some PPO plans cover orthodontics but it is not as common as with HMO plans. If it is offered, you typically get a percentage paid for orthodontics up to a maximum lifetime benefit. PPO usually have waiting periods for minor and major dental issues and a cap of maximum yearly benefits.
For example, once the carrier pays $1000 in-network for covered benefits, it will not pay additional claims for that calendar year. Most carriers offer some type of PPO plan options and the networks tend to be pretty comparable in size although your particular doctor may participate in one and not the other.
HMO dental plans or DMO (For Dental Maintenance Organization) is structured very different from PPO plans.
With DMO's, you choose a Primary dentist or dental group up front, through which your dental care is managed.
There are fewer providers in the HMO dental networks and you are more likely to deal with dental hygiene groups than independent dentists with an HMO network. Occasionally, you will find a dentist in both the PPO and HMO dental networks but it's more rare than with doctors.
If you do not access care through your HMO primary dentists, you will likely have no benefits.
HMO dental networks are usually considerably smaller than PPO networks. HMO networks tend to work better in large metropolitan or more populous areas. In some rural areas, there can be no HMO providers at all or just a handful. If you are in a course of treatment with a hmo dentists, you may not be able to change providers within the network and stay with the same plan. HMO planned are more managed and also less expensive than with the PPO or indemnity model.
If you are interested mainly in cleanings and are flexible about the dentists or dental groups, HMO should work for you.
Indemnity plans do not have networks.
You can access all dentists or dental groups and the plan will pay the same benefits. Usually, the benefits are based on customary and usual costs for that service and in a general area. Indemnity plans are usually more expensive than HMO or PPO plans.
The major health carriers that offer medical insurance in California typically do not offer indemnity plans any more as they have priced themselves out of the market.
There are some small companies for the individual family market and a few options through major health carriers on the small group market that offer indemnity plans. The benefits are usually pretty comparable to PPO plans with maximum benefit caps and similar copays and minor/major service benefits.
These are three main types of dental networks and plans in the California market.
If you want maximum flexibility in choice of dentists at a higher monthly premium, the PPO plan and network would probably be the better option. If your dentist does not participate with any PPO network, the indemnity plan fits but a higher price.
HMO's work well if cost is the primary concern or if you are more flexible in terms of the type of providers you access to receive dental benefits.
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