Although Managed Care Dental has been around for years, some employers and many of their employees don’t understand how it compares to other Dental options. We’ll help you compare and contrast available plans.
Managed Care Dental
Managed Care Dental plans, also known as MCD or Dental HMO (DHMO) plans, work in many ways like a Health Maintenance Organization (HMO) for medical care. An MCD or DHMO plan requires patients to select a primary care dentist, who manages care under the plan. An MCD or DHMO plans typically offers dental services at a low, pre-negotiated cost with minimal or no copayments for covered services through a pre-selected dentist or dental group.
Premiums for an MCD or DHMO plan are lower than for Dental PPO plans. Coverage usually includes preventive care like cleanings, exams, and X-rays, with no deductible, no set copayments, and no annual maximum on covered services. Basic and Major services may be covered up to specified limits. Some MCD or DHMO plans restrict the number of dental visits, treatments, and diagnostic tests. Another drawback to a DHMO or MCD plan is a smaller participating network of dentists. Referrals may be required from a primary care dentist for specialist care. There may be no coverage for out-of-network care.
Dental PPO Plans
The costs for a Dental Preferred Provider Organization (DPPO) plan are greater than for an MCD or DHMO plan. The premium is typically higher, the co-payments greater, and covered services are often subject to a deductible. There may also be an annual limit on covered services.
DPPO plans typically include diagnostic and preventive services, Basic services, endodontics/periodontics/oral surgery, and Major services.
A big plus for a Dental PPO is the increased flexibility it offers when receiving services at an in-network dentist, dental group, or specialist. Patients can self-refer to receive care from a specialist. There may be partial coverage (or reimbursement available) for out-of-network care, too. Dental PPOs offer a larger network of participating dentists from which to choose.
Finding the Right Coverage
Helping your clients decide what plan(s) they want to offer to their employees is easier when you have a broad array of products from which to choose. Word & Brown offers Dental from 30 carriers and administrators in California and more than 20 in Nevada. Both employer-sponsored and voluntary Small Group and Large Group coverage are available. Talk with your Word & Brown representative about your clients’ specific needs, so you can strategize to determine the best match to address those needs.
If you’re not already working with Word & Brown, our sales professionals throughout California and Nevada are just a phone call away. Call (800) 869-6989 to get started today. We’ve been a valuable partner to brokers for more than 35 years, and we can help you write more and earn more in 2022.
Managed Dental Care and Dental PPO – A Comparison Snapshot
|Feature||Dental PPO Plan||Dental HMO or Managed Dental Care Plan|
|Choice of dentist||Able to go to any dentist; increased savings (reduced out-of-pocket) using in-network provider||Required to see an in-network dentist to receive benefits|
|Plan costs||Higher premiums; annual deductible and plan copayments apply; covered services vary by treatment||Lower plan premiums; co-payments apply to each visit|
|Annual plan maximum||Dollar amount limits may apply to some plan services annually||Often no annual maximum|
|Specialist referral requirement||No; patient can usually self-refer to specialist; greater payment for in-network dentist||Yes; referral must be to an in-network specialist|
|Freedom to change dentist||Yes; may switch providers at any time; unlimited||Usually limited to one change per month|
|Emergency care out of home service area||Yes; able to visit a dentist in or out of network when away from home; benefits paid are greater for in-network dentist||Limited benefits available|