As 2025 comes to an end, you likely have countless things to wrap up, from planning your holiday dinner menu signing up for a new dental insurance plan either through your work or the marketplace. As you begin your search, it’s important to find the plan that best fits your needs, and in order to do that, you need to know what factors to consider! Read on to find out what you should be looking into as you search for the perfect dental insurance plan for you.
Is It a PPO or HMO Plan?
As you search the marketplace or you determine whether it’s worthwhile to sign up for your dental plan through your employer, the first question you should ask yourself is whether it’s a PPO or an HMO plan. PPO stands for “Preferred Provider Organization,” while HMO stands for “Health Maintenance Organization.” If you absolutely love the dentist you currently go to, it’s best to stick with a PPO plan, as this will allow you to continue seeing them and still make sure your benefits to go towards your treatments.
On the other hand, HMO plans are stricter about who you can see. This is fine if you already see a dentist who accepts HMO plans, but if you ever need to see a specialist, you’ll need to be referred to one that accepts your plan. This can make emergencies and other situations more frustrating to navigate.
What’s the Annual Maximum?
If you’re in need of dental work in the new year, like a dental crown or denture, you should consider your plan’s annual maximum and whether it would cover the cost of your needs. This is a capped-off amount that your dental insurance company will pay out for your treatments over the course of the year. After you reach it, any additional costs will be your responsibility to pay. Most dental insurance plans have an annual maximum of about $1,500.
Does It Have a Waiting Period?
In short, it’s not recommended to choose a plan with a waiting period if you can help it because it’s inconvenient and can leave you in a bind if you’re in need of certain services before that time is up. This is a set amount of time that your insurance company determines you need to wait before you begin receiving coverage for certain services, allowing the dental insurance company to deny coverage for treatment for pre-existing issues. That means that if you need a dental crown before your waiting period is over, you’ll likely need to pay for it out-of-pocket even though you’re insured.
Dental insurance can feel impossibly complicated and frustrating to navigate, which is what can make searching and signing up for a new plan feel like a big task. However, one of the big takeaways that you should get from this blog is that if you love the dentist you’re currently seeing and don’t want to change, it’s best to stick with a PPO dental insurance plan. That way, your dental office can continue helping you get the most out of your benefits!
About the Practice
At DuPont Family Dentistry, our team is extremely helpful when it comes to navigating patients’ dental insurance benefits and minimizing their out-of-pocket expenses. We accept virtually all PPO dental insurance plans, including BlueCross BlueShield, Aetna, Delta Dental, and Cigna, as well as a variety of military dental plans. Our financial coordinators always do their best to provide patients with accurate cost estimates as well to minimize the chances of receiving a surprise bill. To learn more about how we handle insurance, visit DuPont Family Dentistry’s website or call 253-964-7000.