How To Pick The Right San Diego Dental Insurance Plan

There are 2 questions you have to ask yourself in order to find the right San Diego Dental Insurance plan for your specific needs. Once you know the answers to these questions you can easily narrow your choices to just a few San Diego Dental Insurance plans that will fit your budget and needs.

1. Do you have a Dentist you want to continue to see? (Yes/No)

If the answer is Yes, then you will want a PPO Dental Insurance plan.  PPO plans allow you to see any dentist or any of the Dentist’s in the insurance company’s network of dentists.   The best option is a PPO Dental plan that allows you to see ANY Dentist because this gives you the most options.  If the PPO plan only allows you to see Dentist’s in the insurance companies’ network, then you’ll want to make sure that your Dentist is in that network before you sign up.  You can use this link to find out if your Dentist is in an insurance company network:  Dental Provider Network List.

If the answer is No, then you can select from the HMO Dental plans, and the PPO Dental plans that require you to use network Dentist’s.  These plans will typically cost less than the San Diego Dental Insurance plans that allow you to see any Dentist.

2. Do you need immediate dental care?  (Yes/No)

If the answer is Yes, then you will want to pick an HMO Dental Insurance plan or a Dental Discount plan.  These low cost San Diego Dental Insurance plans offer preventive services and restorative services at a discounted price.  These discounted prices can save you up to 65% off the regular prices.   To choose between the HMO Dental Insurance plans you’ll want to look at the benefit descriptions and compare the prices for the services you expect you might need (typical services are office visits, cleanings, cavity fillings [called amalgams or Minor Services], root canals [called endodontics or Major Services], and Crowns [called Major Services]).  The downside of HMO Dental Insurance plans is that you will have to select a Dentist from a smaller network of Dentist’s.  If you don’t like the Dentist you initially choose, you can switch to another Dentist in the network by calling the insurance company.

If the answer is No, decide which Dentist you would like to see and call their office to ask them which Dental Insurance plans they accept.  Most of the time you will get “We accept all PPO Dental plans.”  In that case, you can choose from the any of the PPO Dental Insurance plans, and then call the Dentist’s office again and ask them if they will accept the specific PPO Dental Insurance plan you want (just to be safe).

These 2 main questions will enable you to simplify the process of picking a good San Diego Dental Insurance plan for your specific needs.  Obviously, there are other factors and questions that will impact the final decision, but these questions will significantly reduce your search time.  For additional help please contact our office and one of our advisors would love to help you.

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How PPO Dental Insurance Plans Work

PPO (Preferred Provider Organization) Dental insurance plans are the most common type of San Diego dental insurance.  This type of plan has been available for almost 40 years now, and has the largest number of enrolled members.  The characteristics of a PPO plan are that each has a network of dentists, provides free preventive care, has a small deductible for diagnostic or corrective care, pays a specific percentage of the cost for any corrective services, requires a waiting period from the time you get coverage to the time you can receive minor and major services, and potentially has a maximum cap on the total benefits you can receive in any year.

Most dentists prefer to accept patients that have PPO plans, and some dentists will accept any PPO coverage a patient has.  PPO Dental plans typically have a network of dentists that have agreed to accept patients using the PPO dental insurance plan.  These network dentists have an agreement with the insurance company that limits the rates they will charge for their services.

There are some PPO Dental insurance plans that will allow you to see any dentist, whether they are in-network or out of network, and get the same costs for your dental services.  However, in most PPO plans you will pay less for dental benefits if you go to an in network provider, and more if you go to an out of network dentist.

Preventive dental care is usually free in a PPO dental plan; an annual checkup with x-rays and cleanings every 6 months are considered preventive.  If the dentist finds an issue that needs to be fixed, such as a cavity, then the most common PPO dental plans will require you to pay the annual deductible ($50 to $200), and then the insurance company will pay for 80% of all minor restorative services (services that restore your teeth to working condition) and 50% of all major restorative services.  Root canals and crowns are typically considered a major restorative service.

Child Brushing TeethAll PPO dental plans require that you wait 6 or 12 months before you can use the plan to receive minor and major restorative services.  For people that want to set up dental insurance because they know they need corrective care, PPO dental plans will probably not be a good fit because of the waiting period.  The waiting periods are put in PPO plans to prevent people from signing up when they need dental care and then dropping the plan once the care is completed.

In any year there is a cap on the total amount of dental benefits that the San Diego dental insurance company will pay.  The caps range from only $500 to as much as $2000 per year.  One strategy, that can be used to “increase” the annual cap on benefits, is to schedule dentist visits for the end of the year, and get part of the work completed in one year, and the remainder at the beginning of the next year.   So it’s important to select a plan with an annual benefit cap that will meet your needs.


How HMO Dental Insurance Plans Work

HMO Dental insurance plans are a low cost form of San Diego dental insurance.  They are somewhat similar to HMO health insurance plans in that you have to select a specific dentist to be your primary dental care provider, and all your dental needs are handled through that dentist’s office.  HMO dental insurance plans provide free or inexpensive preventive care, have a network of dentists to choose from, have a pre-defined set of costs for all dental services, no waiting period, and no cap on the amount of dental benefits you can use in a year.

Smiling Brunette Networks for HMO dental plans typically have only a limited number of dentists that will accept the plans.  For example, in the San Diego county area, many of the HMO plans have networks that include only 200-300 dentists, compared to the PPO networks which may have up to 2000-3000 dentists.  Finding your dentist in an HMO network may be very difficult, so you will most likely have to select a different dentist if you choose an HMO dental insurance plan.

Preventive care, such as an annual check-up and periodic cleanings are typically free, or require a $10-$20 copay.  The basic idea in these HMO plans is to encourage people to do regular preventive care so that restorative care can be minimized.  All major and minor restorative care have specific out of pocket costs that are set each year, so you will know in advance what your cost should be for all restorative care.  The cost list for these restorative services is available from the insurance company.

One of the primary benefits of using an HMO dental insurance plan is that these plans have no waiting period for major and minor corrective care.  Once you are enrolled in the plan you gain the full benefits of the plan on day 1.  If you need to have a cavity filled or a root canal and a crown, you can get the benefits of an HMO dental plan immediately after signing up.

HMO dental insurance plans also do no cap the amount of services you can use in any year.  Because all HMO plans have pre-set prices for the dental benefits, you are able to have extensive care at any time once you are enrolled in one of these plans.

These last two characteristics of HMO dental insurance plans make them very attractive for people that need immediate care and/or extensive care, and can’t wait 12 months to get the benefit of San Diego dental insurance.


How San Diego Dental Discount Plans Work

These plans are inexpensive and are set up to provide pre-set discounts off the regular price for dental care.  Dental discount plans are not dental insurance.  These plans offer no waiting periods, discounts of up to 65% off the regular price for dental services, and no limits to the amount of dental discount benefits.

There are a variety of dental discount plans.  Some are offered as a benefit of being a member of an association, organization, or club.  There is little regulation of discount plans, so it’s important to do some homework before selecting one.

The key differences between discount plans are how many dentists in your area accept the plan, and how do the discounts compare with other discount plan offerings.  Many dentists won’t accept discount plans so if you have a dentist you want to see, a discount plan may not work.  The dental networks for discount plans are usually larger than the networks for HMO dental insurance plans, so definitely check with your dentist to see what discount plans they accept.

Discount dental plans are a good option for someone that does not have a specific dentist they want to see, and is unwilling to pay for the cost of a PPO dental insurance plan, but wants lower out of pocket costs for dental care.  These plans also work well if you need to receive immediate dental care.

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