How do PPO dental plans work?

You can usually get a PPO dental plan directly as an individual or through your place of work if it’s offered.

While PPO dental plans allow more flexibility with larger provider networks and partial to full coverage, it’s important to be aware of other costs.

  • Higher out-of-pocket costs. May include an annual deductible you must meet before dental costs are either fully or partially covered.
  • Going out of network might cost you. You will usually pay more for services you receive outside of your plan’s network, even after you meet your deductible.
  • Annual maximums. Your plan might limit the amount of coverage you can receive in a year through an annual maximum for dental services and procedures.

People who obtain dental insurance with Guardian can elect a Maximum Rollover benefit option for their dental PPO plan. Maximum Rollover allows you to roll over portions of the money you do not use in the years you do not meet your annual maximum. This means you can use the rolled-over amount in the event you need dental services with costs that force you to exceed your annual maximum in a given year.

Dental HMO plans

Another type of dental coverage is the health maintenance organization (HMO) dental plan. Much like a PPO plan, DHMO plans allow you to receive discounted dental coverage when you see a dental care provider within the plan’s network.

How PPO and DHMO dental plans compare

Cost is where DHMO plans and PPO plans differ significantly. Unlike PPO plans, DHMO plans:

  • Have no deductible
  • Have no annual max
  • Will provide discounted (and sometimes free) dental services to participants if you receive the services inside the DHMO network

However, DHMO plans usually limit which dentists you can see and still receive full or partial coverage. The network of dentists offering lower-cost dental care is much smaller, sometimes making it difficult to find a network dentist near your home.

Types of dental PPO plans

When shopping for a dental PPO plan, you can usually review a few options that vary in coverage and cost. There will be different coverage amounts for different procedure types across each plan variation, so it’s important to consider how much you’ll save in the event you or your family need certain dental procedures.

Dental PPO plans can be offered in tiers labeled something like “Gold,” “Silver,” and “Bronze.” There might also be a group PPO option through a person’s employer.

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