Everything You Need to Know About PPO Dental Insurance

A Preferred Provider Organization (PPO) dental insurance plan has an extensive network of dentists and specialists. These providers have agreed to charge a discounted rate for services.

The discount is often much less than what the provider would usually charge. This makes PPO plans one of the most popular options on the market.

In-Network Dentists

Preferred provider organization (PPO) dental plans offer a variety of choices when it comes to dentists, and many people find them to be a good choice for their oral health needs. When you choose a dentist from a PPO plan network, you will often save money because the dentists have agreed to charge lower fees than the insurance company pays.

This allows the insurance company to keep their premiums low, which is why many people opt for a PPO plan over an HMO plan. HMO plans are health-managed organization plans, meaning you will only be covered when seeing providers working within the plan network.

Some other benefits of choosing a PPO plan include not having to stick with a single primary care dentist if you don’t like them, and you can also see any specialist without getting a referral from your general dentist first. You will often pay a monthly premium for the PPO plan, which may be deducted from your paycheck or paid directly to the insurance company. Most PPO dental plans have an annual maximum of how much the insurance will pay for a year, and you will be responsible for any costs above this amount.

Out-of-Network Dentists

Unlike an HMO plan, which limits you to only visiting dentists who are part of its network, most PPO plans give you a choice of many different dentists and specialists from which to choose. The insurance company negotiates with these professionals to offer discounted fees paid in full or partially by the plan. Depending on the type of procedure, these fees can be less than what the provider typically charges.

Most PPO dental insurance plans have no annual deductible and will cover most of the costs of your care, even after the annual limit has been reached. There may be out-of-pocket expenses, such as copays or a yearly maximum of the coverage your insurance will provide in a given year. Some of these plans also have special allowances for orthodontic procedures like braces.

Indemnity dental plans typically have a smaller network of providers and do not pay dentists directly but rather reimburse their clients. Indemnity plans also require patients to pay a portion of the service cost and usually have higher copays and deductibles than PPO dental insurance policies. Most indemnity plans also have an annual maximum for the coverage they will provide for a specific procedure. Some of these plans also include coverage for oral surgery.


When choosing a PPO plan, compare the total cost of care. The deductible is essential, but looking at the plan’s care agenda and how the insurance carrier will help reduce costs is critical.

Generally, dental plans require that members pay a fixed amount, called a deductible, for services before the insurance plan begins to cover expenses. Most deductibles are based on a calendar year, and once they’re met, the plan pays for preventive services, essential services, and primary services.

Some dental insurance plans don’t have a deductible, but these are often paired with an indemnity plan that limits contracted dentists to a maximum allowable charge for procedures. Other plans offer a “reasonable and customary” fee, an average of what most dentists in a given area charge for a particular service.

The main reason to choose a PPO is its more extensive network of providers, which means lower out-of-pocket costs. The provider networks have agreements with the insurer to provide care for a set rate, usually less than the provider’s usual and customary rates. Another benefit is that the PPO plan’s network providers file the claim for members, reducing the administrative burden on members. Many PPO plans also don’t require members to choose a primary dentist or get a referral for specialty care.

Maximum Benefits

Unlike HMO plans, most PPOs come with an annual maximum benefit, which limits how much the plan will pay for covered services in one calendar year. Consumers are responsible for any expenses that exceed the total amount.

Some dental PPOs have maximum benefits adjusted annually to reflect inflation. Others remain static. Consumers need to know the full benefits of their plans so they can plan accordingly.

While any licensed dentist can take advantage of a PPO plan’s discounts, insurance companies develop lists of preferred providers that offer the most cost savings to members. These providers have agreed to charge less for their services to be included in the insurance carrier’s network. The list changes regularly as insurance companies negotiate with new preferred providers or existing ones leave the network.

Understanding the basics of a PPO dental insurance plan can help consumers shop smarter for individual or family coverage during open enrollment this fall. This information can make it easier for small business owners to compare dental PPOs and HMOs and decide which plan best meets their workforce’s priorities. Direct Benefits offers a variety of dental PPO plans to fit every budget and preference. Our licensed insurance agents are non-commissioned and focus on assessing your needs to help you find the right plan.


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