In the United States, Participating Provider Network or PPO, also referred to as Preferred Provider Organization, is an organization governed by medical doctors, hospitals, other health centers, and medical care providers. This organization has an agreement with an insurer or the third party administrator to provide health insurance to the people associated with their client at reduced or low rates. Participating Provider Network plan may work similar to a DHMO while using an In-Network facility. However, a PPO allows Out-of-Network or Non-Participating Providers to be used for service. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified.

Different companies provide various percentages of coverage in these areas. For example, one insurance provider might cover 100% of the cost of Class I services while another might only cover 80%. Yet another plan might not provide Class IV or orthodontic coverage, but provide coverage in all other areas. It’s important that you understand what services are covered before signing up for a plan.
They provide discounts on your claims that average around 20.3% in addition to covering a percentage of your costs. Delta Dental Premier works with a network of dentist that offer lower costs on their services which equates to cheaper treatments for you. Dentist in this network are not allowed to bill you additionally after you pay your agreed co-payment or deductible.
Enhanced dental policies for seniorsSome dental insurance policies pay for part of the costs for services beyond routine exams and fillings. Some examples include (but aren’t limited to):Endodontics: Root canals, or the removal of a tooth’s decayed or diseased pulp, are the most common use of endodontics. Your family dentist can sometimes perform this repair, or he or she may refer you to a specialist.Periodontics: Periodontal disease comes in many forms and could end up destroying supporting bones around the teeth. Treatment may include the placement of dental implants and treatment for inflammation. A specialist is often required.Dentures: Being fitted for dentures typically requires many extractions, making it a major procedure, possibly involving several visits. Some family dentists now fit patients for dentures. Specialty offices are more familiar with the process and sometimes offer a faster turnaround.Implants: Some adults who have lost a small number of teeth due to an accident or decay might get dental implants. Implants may eliminate the need for a bridge since the implant looks, feels, and works like a regular tooth. An oral surgeon rather than your family dentist typically does this procedure.Orthodontia: This type of service involves braces to align crooked teeth. Most family dentists offer orthodontia.Cosmetic services: Bonding, whitening, and veneers are sometimes covered under certain dental policies. Many family dentists offer whitening.  Types of dental plansThere are two major types of individual dental insurance plans that may apply to seniors:Managed-care plans (often preferred provider organizations, or PPOs) negotiate fees with specific providers. These in-network providers request only your portion of the cost and file any necessary paperwork on your behalf. Procedures performed by out-of-network providers are sometimes covered, but often at a lesser amount.Indemnity plans often include a larger group of providers and you may be able to see the dentist of your choice. The drawback is that patients are often required to pay 100 percent of the bill up front and then file a claim for reimbursement for the covered procedure.You can get help choosing an individual dental insurance planDon’t wait until you feel discomfort to get dental insurance. Many seniors take daily medications that cause dry mouth, which can lead to cavities. Inadequate nutrition can also affect your dental health, reports the Columbia University College of Dental Medicine.Keep in mind that some health problems, like pneumonia and insulin resistance, may be triggered by poor dental hygiene. Research has even found a connection between gum disease and heart disease, Intellihealth News Service reports.If you’d like to explore your options for individual dental insurance plans in your area, just click the button on the right side of this page. You can also request our newsletter in the lower right side of this page if you want to stay up to date on with health and insurance-related updates.This article is for informational purposes only. Nothing in it should be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine. In addition, this information includes just some factors to consider when selecting insurance and may not reflect the provisions of any particular insurance product. Always carefully check the provisions of any insurance product you have or may consider purchasing. wp_cta_load_variation( '10789', '' )#cta_container{ border: 1px solid #dbdbdb; border-radius: 5px; } #wp_cta_10789_variation_0 #cta_container #content {background: transparent;}
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eHealth Insurance was started in 1997 and it was the first platform used to sell health insurance over the internet. eHealth has over 5 million customers in 50 states. The company doesn’t provide dental insurance themselves, but acts as an insurance broker or marketplace. They have partnerships with over 180 health providers and they sell over 10,000 different health insurance products online.
DHMO's are similar to HMOs in that their plans connect you with a network of dentists who give you care for a low monthly premium. With DHMO plans, you are required to go see dentists who are in their network, but in return you have lower costs, and no claim forms to fill out. DHMOs are great for preventative care and basic procedures. Some downsides include that there can be wait times if you need major or restorative dental care and some DHMOs don’t cover this types of treatment. You also need to go see your primary care dentist and get a referral to a specialist in order to get some specialized care.
Another option for dental care is Medicaid, which covers some kinds of dental procedures if you meet the requirements. Medicare does not provide dental coverage. The ADA Foundation has provided dental care to 5.5 million children since 2003. They will direct you to a dentist that is near you. Another option is the Children Health Insurance Program (CHIP). It provides health coverage including dental coverage to over 7 million children under 19 years of age.
The final kind of dental insurance is indemnity dental coverage. These plans allow you to visit any dentist and they will pay a fee for the procedures you have done. They calculate a set amount that they’ll pay for each type of procedure and any additional amount would have to be paid by you out-of-pocket. They also have an annual maximum which can sometimes be higher than other types of plans. One of the downsides is that you have to pay for all the services upfront and submit paperwork in order to get reimbursed.

Another option for dental care is Medicaid, which covers some kinds of dental procedures if you meet the requirements. Medicare does not provide dental coverage. The ADA Foundation has provided dental care to 5.5 million children since 2003. They will direct you to a dentist that is near you. Another option is the Children Health Insurance Program (CHIP). It provides health coverage including dental coverage to over 7 million children under 19 years of age.
DentalPlans.com is one of the leading online marketplaces for finding dental savings plans. The company has been in business since 1999 and is affiliated with more than 30 dental plan companies and has over 100,000 participating dentists around the country. The benefit of using DentalPlans.com is it allows you to access the number of different dental plans to find out which is the best deal for you.
Spirit Dental is the online storefront for Direct Benefits, a company started in 2001 by Tom Mayer, who wanted dental coverage to be affordable for all Americans. While Direct Benefits serves as a broker for employee benefits and consultants, Spirit Dental is meant for online consumers who can buy coverage right on the website or talk to one of their many agents and providers nationwide.
We understand that individuals and families are looking for dental insurance solutions to fit their specific needs. Our dental insurance plans include options for any budget and tailored coverage options offering dental care choices for individuals or families. With choices for higher maximum benefit amounts with more coverage if needed, options if your child needs braces, and immediate coverage on most services, we have a dental insurance plan for you. Discover more about our dental insurance plans below:
Another benefit is that you have more flexibility when it comes to choosing what type of plan you want. When you work for an employer, they choose which plan they believe would be right for the majority of their workers. But you might not need the same type of coverage as the person who works in the cubicle next to you. By buying an individual plan, you're able to customize and purchase exactly what you need. For that reason, your coverage can actually be less expensive than if you had an employer-sponsored plan – especially if you had to pay for part of your premiums.
Dental savings plans are different than dental insurance. Dental savings plans provide you with a list of dentists who will give you a discount because you’re a member of the savings plan. Usually, these are quite generous discounts and can save you a significant amount of money on your dental care. Sometimes the discount can be well over 50% for things like preventative care, but it tends to be a little less for other types of care.
DentalPlans.com isn’t an insurance company, but they work with dental service providers to reduce the cost to see an out-of-network dentists. In this way the company gives access to some of the same dental benefits offered by employers through typical group insurance, but more closely resembles a prescription discount card. For example, the estimate we received for a 6-month checkup was only $15. The annual cost for the plans range from $100 – $175 depending on the location and number of people covered.
Spirit Dental is the online storefront for Direct Benefits, a company started in 2001 by Tom Mayer, who wanted dental coverage to be affordable for all Americans. While Direct Benefits serves as a broker for employee benefits and consultants, Spirit Dental is meant for online consumers who can buy coverage right on the website or talk to one of their many agents and providers nationwide.

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One example of a plan that is offered through eHealth is the Dominion Dental Services PPO Discount plan which has no deductible. They provide 100% coverage on most preventative and diagnostic procedures and 45% to 60% coverage on all other procedures including children’s orthodontics. They have no maximum annual benefit and they have no waiting period for things like cleaning, extractions, x-rays, and oral surgery but they have waiting periods but you have to use a dentist within their network.

Yes. Plans vary by state and not all discount or low-cost senior dental plans cover the same services. Some have limited services or only pay so much per year before they max out on benefits. Some may not cover routine care, such as cleanings. It is important to compare dental plans and look for value rather than just for lower monthly premiums. Your goal is always to find the best plan that fits your dental needs and budget.


A carrier recently told us that many seniors expect to carry over their dental coverage from their employer. Yet, that rarely happens. What does happen is that about 90% of seniors on Medicare don’t have proper dental coverage (American Dental Association). After filling out the Medicare paperwork, most seniors put dental insurance on the back burner.  (And vision and hearing, too…we’ll get to those later.) And, why not? Your teeth are not hurting yet and they feel pretty good.

Preventive care may seem optional if you have healthy teeth and good oral hygiene, but it saves money in the long run. I went without dental insurance for three years in my twenties, and did what most of my peers did in that situation – simply didn’t visit the dentist. Then I enrolled in a graduate program which required students to have medical and dental coverage. At my first dental visit, I had numerous cavities. Getting them all filled required nine or ten appointments in the nine months of my academic year.
PPO Plan B has slightly lower premiums and still covers many basic services. The annual deductible is $100 with an annual maximum of $1,000. Keep in mind you are trading in the lower deductible for a higher one but you are also receiving a lower monthly premium. You have 80 percent coverage for three dental cleanings and exams per year and coverage is available for major services including implants, crows, bridges and dentures after one year of continuous coverage. You can visit any licensed dentist but save more by choosing a preferred in-network provider.

Dental insurance almost always picks up 100 percent of the bill for routine checkups and cleanings. Coverage for common procedures like root canals and fillings are typically covered at 80 percent, although policies with higher premiums cover up to 90 percent. You are then responsible for the remaining 10 to 20 percent of the cost, called coinsurance. Most plans cover higher-priced and more involved procedures at 50 percent, so you should have some savings set aside for what your insurance does not cover. Still, with relatively low premiums, having dental insurance is far less expensive on average than paying cash for all dental procedures.


Most independent dental insurance plans will only pay for your dental services if you go to a contracted and participating in-network dentist. Find out if you are required to go to a participating dentist or if you can choose your own. If the plan requires that you see an In-Network Dentist, ask for a list of the dentists in your area with whom they are contracted so you can decide if they have a dentist you would consider seeing.
Most Medicare or Medicare Advantage Plans provide no dental coverage or only provide minimal dental coverage. Those that do provide coverage, usually only cover preventive services so many seniors find the need to buy a dental insurance policy. Some top considerations for seniors purchasing a dental insurance plan include in-network providers, types of services covered, deductibles and co-pays. We done some comparisons and come up with some of the best dental insurance options for seniors in 2018.
Once you purchase a dental insurance plan and start paying your premiums, most preventive care like cleanings and check-ups are covered immediately. For more serious procedures, after you meet your deductible, you’ll only be responsible to pay your percentage of the cost. And we’ll pay the rest. Also, some dental plans have an out-of-pocket maximum to protect you from high costs throughout the year. On some plans, if you reach this maximum, we’ll pay the full cost of any additional care until your annual maximum benefit is met. 
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