Adding dental coverage to your health insurance package can be a pricey proposition.  If the additional coverage is coming out of your very own pocket, you might see the price difference between dental health insurance and dental plans and wonder why they’re so different.  Here’s a quick overview:
 
Dental health insurance is an actual PPO (preferred provider organization) insurance plan.   Here the insurance provider and the dental specialists agree on a set schedule of fees for the various services in exchange for being admitted into the network of preferred providers.  As with all managed care insurance, there are limitations to the services you can receive and there are deductibles (although they are small – usually $50 or $100).  Once the deductible is met, however, plan only covers a percentage of the remaining fees.
 
Most dental health insurance will cover 80-100% of the cost of preventive care such as cleanings, check-ups, protective dental sealants, x-rays and fluoride treatments. Basic oral care, which includes fillings, extractions and root canals, are generally covered for 80% of their cost. Crowns, caps, bridgework, full or partial dentures and periodontal care are considered major oral care and are often covered at 50%. In addition, many carriers have a yearly maximum amount that they will cover, and some of them set this ceiling as low as $1000. Obviously that doesn’t go far.  But the real beauty of dental health insurance is the PPO network and the commitment the specialists make to the prearranged price for services.  You are essentially getting a discount of as much as 50% off their normal rates just by flashing your insurance card.
 
Dental plans are first and foremost not insurance plans. They are designed to help policy holders budget more efficiently for the routine dental work we all need and often forget to budget on our own. These policies typically exclude certain treatments viewed as optional, such as dental sealants, even if these treatments would save the plan holder money on future care. Limitations vary from plan to plan, so be sure to read a plan carefully and consider all its limitations before you buy.  Any plan that doesn’t cover a procedure your dentist has recommended may not be worth considering.  Our advice would be to keep shopping.
 
As oral plans determine what portion of a oral treatment should be covered, they will refer to "usual, customary and reasonable" (UCR) procedures and pricing. UCR reimbursement levels are reached using different methods depending on the plan’s provider. The plan will then pay a percentage of the UCR level. The plan holder will be expected to pay the remainder.
 
Both dental health insurance and dental plans require patients to choose a dentist from a relatively limited list. If your current dentist is not on the list of a dental health insurance policy or oral plan you’re considering, ask him why not. Most often it’s because the dentist chose not to participate, and the reason he chose to pass on one plan or another may be very insightful.