Math warning: Lots of numbers at the end of this blog.
For most people, the only thing worse than going to the dentist is paying for it…or rather, not knowing how much you’ll have to pay for it.
Let’s take some of the mystery out of the process.
I recommend a Dental PPO (DPPO) plan for most of my clients. Why? In San Diego, as well as many parts of the country, popular dentists do not accept the alternative option, a dental HMO.
DPPO plans are usually at least $60 per month for an individual. If that sounds high to you, it means that you have worked for a large employer before that subsidized the cost for you.
Despite the cost, DPPO plans are popular because they allow you to see any licensed dentist. There are a few dentists who do not accept ANY insurance, but we’ll disregard those for the purposes of this blog.
There are 4 main things to know about the anatomy of a DPPO plan, so let’s talk about them:
DPPOs have a network - a list of dentists - with whom the insurance company has negotiated prices. If you see a dentist in this network, the dentist has agreed to accept that negotiated rate. You can also see a dentist outside this network, but your out-of-pocket costs may be more. We’ll discuss this more later.
DPPOs often have a deductible for certain services. Recall that a deductible is the amount YOU pay before the insurance pays. $50 per year is common.
A good plan will cover:
Preventive care (cleanings and exams) at 100%
Basic Care, which may include fillings, x-rays, and certain types of tooth extractions. These will typically be covered at 60-80%, and you pay the difference.
Major Care, which may include bridges, crowns, and root canals among other services. A good plan will cover these at 50%, but there may be a waiting period of up to a year before they’ll cover Major Care. A few number of plans may also cover-
Orthodontia. Typically there are several stipulations if they do, such as a lifetime coverage limit.
The last component to know about is the Annual Maximum. This is the most that the insurance company will pay for your dental care per year. $1500 is common, but some plans could be more or less.
Once you understand the nuts and bolts of your plan, including the coverage limits and exclusions, you’ll feel more comfortable using your plan and predicting the costs of care. Now, let’s talk about the cost difference between seeing an in-network dentist and an out-of-network dentist.
For the sake of the below examples, we’ll assume your plan costs $60 a month, has a $50 annual deductible, and a $1500 annual maximum. We’ll also assume you’ve been on the plan for longer than 1 year, (satisfying a 1-year waiting period.)
In-Network Dentist
Oh no, at your last exam, your dentist discovered that you need a crown! On most plans, this is in the “Major Care” category and your plan will cover it at 50%. Your dentist writes it up as a $1700 expense, but the in-network negotiated price is $1250, so you are saving money right away. You also have a $50 deductible, so you pay that. Now the balance is $1200. You and the insurance company each pay 50%, or $600. The bill is then considered paid in full and you have personally paid $650 in total. The $600 that your insurance paid comes out of your $1500 annual maximum, leaving you with $900 for covered dental work for the rest of the calendar year.
Out-of-Network Dentist
You’ve discussed the need for a crown, and your dentist writes it up for $1700. You pay your $50 deductible, leaving the balance at $1650. The insurance will only pay the rate they pay to in-network providers for this particular service, which is $625. You are now left to pay the balance, ($1650-625= $1025.) In total, you have paid $1025+50=$1075.
Having good dental insurance can save you tons of money, especially if you’re prone to dental woes. If you’re in the market for a Dental PPO plan with good value, Check this one out! If that doesn't fit your needs, feel free to send an email with the specifics of what you're looking for and I'll do my best to help you out. But, take care of your teeth - they're the only set you get for free!
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