A Step-By-Step Guide to Enrolling in an Individual PPO Dental Plan

a step by step guide to enrolling in an individual ppo dental plan

Whether through your employer or alone, you must find a dental insurance plan that meets your needs. Luckily, most plans offer open enrollment periods throughout the year.

It’s essential to select a new plan and review your current coverage. Here are some helpful tips to guide you through the process.

Determine Your Needs

People should start their search for an individual dental plan by assessing their needs. They should consider how often they want to visit the dentist, what procedures they need to be covered, and their budget for this expense.

The next step is to research different plans available in the Marketplace and those offered by private insurers. They should take note of monthly fees, deductibles, and maximum benefits for each plan.

People should also ask about the size of a plan’s network. Large networks can offer more options for consumers when it comes to selecting a dentist. Moreover, these networks can also negotiate lower rates with dentists, which can help reduce the cost of dental services for patients. In addition, some dental PPO plans can roll over portions of unused annual maximums for future years. DHMO and Core DPPO plans may not have these perks.

Look at Your Budget

Often, people purchase individual PPO dental plans to supplement health insurance coverage not provided by an employer. These plans are usually more affordable than those offered by employers and provide flexibility to select a plan with the largest network of dentists.

Before you enroll, make sure you budget how much you can afford to pay each month for your premium and any out-of-pocket expenses like a deductible or annual maximum. Also, consider how your chosen plans may affect your current finances by examining their coverage limits and other details for non-preventive services.

For example, some DHMOs require subscribers to select a primary dentist and only cover services provided by in-network providers. DPPOs typically do not require this and allow you to visit out-of-network dentists for an additional fee. Lastly, most DPPOs negotiate discounted fees with dental providers so that they are less expensive for patients than without the insurer discount.

Review Your Current Coverage

If you have dental coverage through your employer, find out if it’s a PPO or HMO. If you have HMO coverage, find out if they allow you to see outside dentists. If you are unhappy with your current plan, consider looking into a standalone dental insurance plan available in your area. You can buy these individually or through your state’s health insurance exchange/Marketplace. However, this option is typically only open during an open enrollment period or when you have a qualifying life event.

Many dental PPO plans have annual maximums on the benefits they will pay during a plan year, and consumers are responsible for any expenses exceeding this limit. This is one of the main reasons some people choose to get a standalone dental insurance plan rather than an individual PPO.

To keep costs down, consider a DHMO or Core DPPO plan that only covers visits to in-network dentists. These tend to have lower monthly premiums and more superficial fee structures. Out-of-network dental PPO plans generally cover services based on the “usual, customary, and reasonable” or MAC fee.

Compare Plans

Several dental plans are available, from group insurance through the workplace to individual and family dental policies purchased directly. Different plan types have different premiums, cost of coverage, and out-of-pocket expenses. Look for deductibles and annual maximums, caps on the amount a plan will pay for dental care in one year. Generally, HMOs have lower monthly premiums than PPOs, but they limit you to in-network dentists.

There’s also the option of a dental discount plan, which is less expensive than traditional insurance but offers discounts on dental care rather than actual coverage. These typically don’t have a deductible or an annual maximum.

Get quotes for plans offered by your employer through your state’s health insurance marketplace or through a private company that offers individual and family dental coverage. Then, compare the cost of premiums, deductibles, copayments, and the benefits and service levels covered. Find a plan that covers your preferred dentist and that you can afford.

Make Your Decision

It would help to remember a few things when selecting a dental plan. Premiums and deductibles will vary between plans, so it’s important to compare options before deciding. Also, pay close attention to the annual limits and covered procedures. Contacting the insurance company directly for specific information is always a good idea.

It’s also a good idea to consider whether the dental plan requires you to stay in-network for coverage. While this can be more expensive, it may also save you money in the long run. Finally, remember to consider the coinsurance cost and any other out-of-pocket costs.

If you are looking for individual dental insurance, remember that there is a specific time, typically near the end of the year, that is considered open enrollment. This is one of the few times you can change your insurance policy throughout the year, including adding dental insurance. This can be unclear, especially if you are trying to decide between a health plan that includes dental insurance and a standalone dental insurance policy.