There are four types of private insurance plans and one main type of government insurance (Medicaid).
DHMOs and PPO plans are the most common types of private dental insurance.
DHMO stands for Dental Health Maintenance Organization. These are also known as Pre-paid Plans. You choose one dentist or dentist office that you’ll visit.
If you need to see a specialist, your dentist will refer you to one but you may need to receive approval from your DHMO first.
DHMOs don’t have deductibles or a yearly maximum coverage amount. Sometimes there is a short waiting period before you can get treatment.
DHMOs have a fixed fee that you’ll have to pay for each type of service, known as a copayment. Diagnostic and preventative services often have no copayment, meaning you pay nothing.
If you visit a dentist other than your approved DHMO dentist, you might have to pay the entire bill.
Every month, you pay a certain dollar amount. This is called a premium. Monthly premiums for DHMOs can be very inexpensive, around $5–$15.
PPO stands for Preferred Provider Organization.
There is a network of PPO dentists, but you may see dentists outside of the network if you are prepared to pay more for services.
Dentist fees are split between yourself and the insurance company. The portion that you pay is called co-insurance. The amount of co-insurance you pay usually depends on what type of dental service you get. There is usually a deductible, which is a set amount that you have to pay before your insurance will start to cover any of your services.
There is a maximum yearly amount of coverage. This means you can only be covered up to a certain amount per year.
PPO monthly premiums usually cost more than DHMO premiums.
Depending on the PPO plan, you may have to pay the full cost of the plan at the time of your visit, and wait for them to pay you back.
But a more common option is that you’ll only have to pay your portion of the cost. Then the dental office will have to get payment from your insurance company.
Fee-for-Service Plans are also known as indemnity plans or traditional plans. You can choose from many possible dentists on a Fee-for-Service plan, more than with a PPO.
With these plans, you have a deductible and a yearly maximum amount of coverage. You’ll probably have the highest monthly premiums with this plan.
Like PPO plans, you only pay a percentage for each service. This is called co-insurance. You’ll pay a little more for services than with a PPO, but you’ll also have more choices for dentists you can visit.
With these plans, you have a deductible and a yearly maximum amount of coverage. You’ll probably have the highest monthly premiums with this plan.
You might also have to deal with more billing paperwork than other insurance types. Fee-for-Service plans also sometimes have a waiting period before you can start dental services.
With a discount plan you pay a monthly fee. This gets you dental services at a discounted, fixed rate.
Discount Plans aren’t technically insurance. But there usually isn’t any paperwork involved. There are also no deductibles or yearly maximums. You may have to pay more for each service than with PPOs or DHMOs.
With a discount plan, you can only see dentists who are participating in the discount plan.
Medicaid is a government health insurance for low-income individuals including children, families, the disabled, and the elderly. All states are required to cover dental services for children in low-income families. Only half of the states provide dental services for adults beyond emergency care.
To find out what kind of Medicaid dental coverage adults can receive, call your state’s Medicaid office.