So what I want to know is if I buy a typical dental insurance plan, what would I get from it? Some plans say free cleaning and X-rays, but is that all I get? Can I have fillings done at a low cost? What about the rest of the dental services? Do all dental insurance plans make you wait until you can have anything beyond a cleaning done? They offer complimentary cleanings, but you must hope you do not need anything else for a year. Please advise why that is the case.

Reply: First, you should know there are different types of dental insurance plans that work differently. Your meaning of a typical dental insurance plan needs to be clarified, but I will briefly explain how types of dental insurance work to benefit your dental care needs. 

1) HMO Dental Insurance Plan: An HMO dental insurance plan, also known as a dental health maintenance organization, typically requires you to choose a primary care dentist from a list of network providers. You will receive most of your dental care services from this primary care dentist, who will refer you to a specialist within the plan network if needed. With an HMO dental insurance plan, you will usually pay a fixed copayment for each service, and you may not be required to pay any deductibles or coinsurance. Typically, HMO dental insurance plans do not have waiting periods before you can receive certain services (however, read the plan terms carefully to confirm this, as some may have short waiting periods for major dental care services). You may have less freedom to choose your dental provider than you would with other types of dental insurance plans, as you must pick a network plan dentist. HMO dental insurance tends to be the lower-cost insurance option, and since dental services are scheduled on a detailed list, you know the cost for each dental care service covered under the plan you are reviewing. Knowing your fee for services makes it easier to budget. 

2) PPO Dental Insurance Plan: A PPO dental insurance plan, also known as a preferred provider organization, gives you more flexibility in choosing your dental care providers. You can visit any dentist within the plan’s network and receive coverage or choose an out-of-network dentist, sometimes at a reduced benefit. With a PPO dental insurance plan, you may have a deductible to meet before Insurance kicks in, and you may be responsible for a percentage of the cost of each service (coinsurance). However, PPO dental insurance plans usually cover more services than HMO plans, including major dental care services like extractions, crowns, and bridges. 

Some PPO dental insurance plans may have waiting periods before you can receive certain services, such as major dental care services. Some PPO dental insurance plans may offer free cleanings and X-rays as a preventive care benefit, but you may need to pay for other services and take into account the deductible if there is one.

Reviewing the plan terms carefully to understand what is covered and what costs you may be responsible for with a PPO dental insurance plan is essential.

3) Indemnity Dental Insurance Plan: An indemnity dental insurance plan is another type of dental insurance that works differently from HMO and PPO plans. An indemnity dental insurance plan allows you to choose your dental care provider more freely. You can visit any dentist you want, and the insurance company will pay a set percentage of the cost of each service covered under the plan. 

Like a PPO dental plan, with an Indemnity dental insurance plan, you may have to pay a deductible before the insurance company starts covering any of your expenses. You may also have waiting periods for basic and major dental care along with a maximum limitation. It’s essential to review the plan terms carefully to understand what is covered and what costs you may be responsible for with an indemnity dental insurance plan.  

Call our office at 310-534-3444 m-f 8-4 if you have any questions on what plan type will work best for your dental care needs.