How to choose your dental benefits plan

| November 17, 2008

It’s open enrollment time of year……

It’s that time of year again when patients begin asking which plan they should choose during their employers open enrollment period.  So we thought we would define the different flavors of dental benefit plans out there.

There are probably 50 to 100 different dental benefits providers in the Columbus Ohio area.  And within those plans there are even more different flavors of the plans that were negotiated between your employer and the Insurance company.   A Metlife plan at company A isn’t the same plan as the Metlife Plan at company B.

Dental Plans typically fall into these categories.  If you are having difficulties figuring out your plan choices, fax us(486-2608) a copy of the pages from your benefits handbook.

PPO Plans

  • You are free to choose any dentist
  • If you choose a dentist from a list, the patient is given financial incentives.  How great are the financial incentives?  That’s hard to determine without a defined fee schedule from your plan.  In our office we’ve seen the difference in cost for a cleaning be nothing.  On average the difference is between $5 and $15 per cleaning.
  • Think about this: Does choosing a dentist on the list save me money, or my insurance company money?
  • The PPO Plan pays all or part of the dentist’s fee to the extent that it does not exceed the UCR fee for that service.


  • Under these plans you must choose a dentist from a list to receive any benefit.
  • If you do not choose a dentist on the list the entire cost of the dental visit will be your responsibility

My plan says I will be covered up to 80% or up to 100% so I’ve got a great plan, right?

Many plans tell their participants that they will be covered “up to 80% or up to 100%” but do not clearly specify the plan UCR fee schedule, allowance, annual maximum or limitations.  The UCR fee schedule is what they will pay 80% of, not the fee your dentist charges.  (See post on how insurance companies calculate the UCR fee)

By the way, your dental office has no idea what the UCR fee schedule is for your particular plan with your insurance company.   We don’t know for certain what your insurance company will pay until we receive the claim back.  Based on our experience, it is realistic to expect dental insurance to cover about 50% for major restorative services like crowns, large fillings, and root canals.

The good news is that most dental benefit plans pay the majority of the fee for your dental maintenance such as cleanings and x-rays.  And coming in for professional dental cleanings on a regular basis can help us keep small problems from becoming major restorative stuff.

So which should you choose if you are a Grandview Dental Care Patient?

You need to decide what dental plan to choose based on your needs.  If you choose a plan where you are allowed to choose any dentist(typically a PPO) you will receive dental benefits to help you pay for the cost of the dental work you have done.

Cigna, Metlife, Anthem, UHC, etc, as long as you can choose any dentist, you will have a certain level of coverage from the insurance company and a certain level of out-of-pocket depending on your plans fee schedule.  Remember, you get what you pay for.  If you pay $10 per month for dental coverage for your entire family, you are going to have some out-of-pocket expense for your dental care.