There are some differences between managed care plans and indemnity dental plans. Mostly they differ in choice of providers, amount of out-of-pocket costs, and payment methods. We’ll go over some of those differences here.
Typically, an indemnity plan offers a wider choice of dentists than a managed care plan. Indemnity plans pay their share of costs after they get the bill. Managed care plans have agreements with dentists to give services to plan members at a certain cost. In general you’ll get less paperwork and lower costs from a managed care plan, and a greater choice in providers if you select an indemnity plan.
Managed care plans are PPOs, POSs, and dental HMOs. A dental PPO provides care through a network of dentists that offer discounts on their services. You can use an out-of-network dentist, but you’ll only be reimbursed the discounted amount, leaving you responsible for the balance. A DHMO provides services through a network through prepayment. If you use an out-of-network dentist, you may end up footing the entire bill. A dental POS allows a member to use a network dentist or not. Members choose their dentist, and most pay more for out-of-network care.
An indemnity plan is also known as a fee-for-service plan. If you choose this type of plan, you have the option to visit any dentist you wish. You don’t usually need a referral, but some plans may require you to precertify for certain procedures. Most indemnity plans make you pay a deductible. After that, they pay a percentage (up to 80%). Most plans have an out-of-pocket maximum, and once you reach it they pay 100%. Most of these plans also have a waiting period before they cover you.
Related posts:
