From cleanings to braces, dental plans help you and your family to control the costs of dental care.
There are three types of dental insurance plans:
A Dental Maintenance Organization (DMO®)* -- most often, this is a lower-cost insurance plan. You choose a primary care dentist. If you need to see a specialist, your primary care dentist gives you a referral. If your plan covers orthodontia, you do not need a referral to see a DMO orthodontist. You get peace of mind with no deductibles or annual maximums. To learn more, view the DMO video.
A Preferred Provider Organization (PPO)** or participating dental network (PDN) -- With these plans, you can visit any dentist you want. You never need a referral. But costs usually are lower if you choose a dentist who is part of the PPO or PDN. Deductibles and annual maximums may apply. To learn more, view the PPO video.
A dental indemnity plan gives you free choice of any dentist you want. There may be deductibles and annual maximums with these plans, too.
You can compare the three types of plans below. (Your options will depend on whether you're buying direct or being covered by an employer.)
|DMO||Dental PPO or PDN||Dental Indemnity|
|Plan description||A lower-cost dental benefits plan that gives you cost-effective care through a primary care dentist (PCD). You get the advantage of building a relationship with your PCD.||Visit any licensed dentist to receive benefits. You will typically enjoy lower costs if you choose a dentist who participates in our PPO/PDN network. There is never a need for a referral.||The freedom to visit any licensed dentist, anywhere in the country. No need to choose a PCD. There is never a need for a referral.|
|Plan options||Copay – you pay a set dollar amount at the time of service; or Coinsurance – you pay a percentage of covered expenses at the time of service.||Coinsurance – you pay a percentage of covered expenses at the time of service.||Coinsurance – you pay a percentage of covered expenses at the time of service.|
|Primary Care Dentist election||Yes – Call the dentist to ensure he or she is accepting new patients.||Not required||Not required|
|It’s easy to find a participating dentist. Just visit DocFind®, our online directory. Or call Member Services at 1-877-238-6200.|
|Office visit copay – the amount you pay each time you visit the dentist for any procedure.||$0 to $15 depending on your plan.||None||None|
|Deductible – the amount you pay before your plan pays.||None – There is just a copay to pay. You do not have a plan deductible.||Yes – There is a deductible for procedures not covered at 100%. That means you pay a dollar amount before the plan starts to pay.||Yes – There is a deductible for procedures not covered at 100%. That means you pay a dollar amount before the plan starts to pay.|
|Annual maximum – the maximum amount your plan will pay out in a plan year.||None – Aetna DMO plans do not have an annual maximum limit. The plan continues to pay benefits for covered procedures throughout the plan year.||Yes – There are limits to how much Aetna will pay in benefits for covered procedures in a plan year.||Yes – There are limits to how much Aetna will pay in benefits for covered procedures in a plan year.|
|Referrals – the primary care dentist directs you to seek dental care from another dental professional.||Referrals are required, except when you visit an orthodontist in our DMO network.||None required||None required|
|Procedures NOT covered by the plan||You are responsible for the cost of procedures not covered by your plan.||You are responsible for the cost of procedures not covered by your plan. And remember this: Participating PPO and PDN dentists offer discounts on procedures not covered by your plan.||You are responsible for the cost of procedures not covered by your plan.|
* In Illinois, DMO plans provide limited out-of-network benefits. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO.
** In Texas, the Preferred Provider Organization (PPO) plan is know as the Participating Dental Network (PDN).