There are many kinds of dental insurance plans out there but not all are created equal. The three main types are Indemnity, Preferred Provider Organization (PPO) and Dental/Health Maintenance Organization (DMO / HMO) Plans. What are the differences and do you need one?
1. Dental insurance is not required to obtain orthodontic treatment with braces or Invisalign. Flexible monthly payments allow nearly everyone to attain a straight, beautiful smile.
2. Indemnity Plan: This type of plan gives you the most flexibility as it allows you to see any Orthodontist that you wish. You do not need to worry about whether the doctor is in-network or out-of-network. You pay at the time services are rendered, and we complete a claim on your behalf so that you can get reimbursed by your Indemnity Plan. We are happy to assist you in making sure that your claims are completed correctly.
3. Preferred Provider Organization (PPO) Plan: This is a plan that gives you access to a panel of participating Orthodontists that will render services at a reduced fee. PPO dentists participate in the network thereby agreeing to accept contracted fees as payment in full rather than their usual and customary fees. When you visit a PPO dentist, you typically pay a certain percentage of the reduced rate (called coinsurance) and the plan pays the rest. PPO Plans typically cover Orthodontic treatment at a rate of 50%. PPOs usually have a lifetime maximum of around $1000. The great news is that Orthodontic Harmony is in-network with most PPO Plans!
4. Health/Dental Maintenance Organization (HMO / DMO) Plan: This is the lowest cost plan. However, these types of plans often do not include Orthodontic benefits, so as a result, the patient bears the burden of a larger out of pocket. Fortunately, Orthodontic Harmony is in-network with most HMO / DMO Plans!
5. Please keep in mind that not all dental insurance plans cover orthodontic treatment. Your dental insurance plan is generally chosen by your employer. It costs the employer more to include orthodontic benefits in their plan, so as a way to manage costs, some employers will offer plans that only provide orthodontic benefits up to a certain patient age, and some may not offer orthodontic benefits at all.
6. Patients often ask if they should self-pay for dental insurance with orthodontic benefits. We highly discourage this as this tends to be extremely expensive, and the monthly premium for these plans tend to far exceed the monthly payment for orthodontic treatment if you were to self-pay.
If you have any questions about your orthodontic benefits, feel free to call us at 914.923.5089 and we would be happy to help!