It is that time again to make to selections for what type of insurance coverage you will need for the next year. It can be difficult at times to decipher so we are here to assist in helping you have information that you can use to make the best decisions for your family. Here at Gallery Dental, we want you to be as educated about your decision as possible!
Most dental plans cover preventative care, which will include exams and routine (healthy mouth) cleanings and x-rays. However, there are a few that will not cover everything at 100% for preventative care. You will want to know which dental plans offer the best “bang for your buck” so you have less out of pocket expenses at each visit.
Making your selections:
DHMO/PPO? Which one is best for me?
DHMO/DMO PLANS: With DHMO plans (Dental Health Maintenance Organization) is a plan that offers members care within a network of Doctors that they maintain agreements with those providers. They are set up to typically have lower monthly premiums and less out of pocket cost but you will be required to be seen by the Assigned Provider on your plan. You will not be allowed to “choose your provider”. In order to find out who you have been “assigned” to you must speak with your insurance company to ask that question. If you use a provider that is not in the DHMO/DMO network, then typically the plan will not cover your visit. If you are needing to see a specialist, you will be required to get a referral from your primary care doctor before you can be seen at any specialist office that they assign to you.
PPO PLANS: With PPO plans (Preferred Provider Organization) is a plan that has more flexibility to where you seek your medical/dental care (You get the freedom to go where you want without limitations). Your PPO plan has agreements with in-network providers to pay a set fee for each service they provide. You can also see doctors who are out of network however the out of pocket cost is a little higher but you are still covered. If you seek care within a PPO Network then the out of pocket fee is less/if any fee at all. You can also see a specialist without seeking a referral from your primary care physician weather they are in/or out of network.
Think of it as a tradeoff. With a HMO you may pay less but you do not have flexibility where you get your care. With a PPO you may pay more but you have more options.
How do I choose between HMO/PPO?
Maybe ask yourself these questions to see if this will help you make your choice.
· Which is more important to you: lower costs or the freedom to choose who you see?
· How important are low monthly premiums and copays?
· What are the deductibles for each plan?
· How often do you see a dentist?
· Which dental services do you think you’ll need in the near future, crowns/implants/dentures/root canals/cleanings/braces?
· Do you have an existing dental condition that requires you to see specialists often? For example periodontal disease.
· Is your dentist in-network or out-of-network? Gallery Dental is in network for almost all PPO plans.
· Do you have a team of specialists you’d like to keep using, even if they’re out of network?
· Do you travel a lot, which means you need more flexibility when seeking care?
How do I know if my provider takes my insurance?
The best thing to do when you are not certain is to either make a call to your provider and ask if that provider is in-network with your dental plan, or call your dental insurance company and ask if the doctor you would like to go to is in network with your plan. Here at Gallery Dental we accept almost all major PPO’s to include: Aetna, Blue Cross Blue Shield, Cigna, Delta Dental, Guardian, United Health Care, MetLife to just name a few. If you find that your employer only offers a DHMO/DMO plans and you LOVE seeing Dr. Al we offer an in house membership plan. Click here to read all about it!
If you need any more information feel free to contact our office and we can assist you.