Dental Indemnity Insurance: How Does It Compare to HMO and PPO Plans?

What Is Dental Indemnity Insurance? Pros, Cons and Comparisons

When searching for dental insurance, you want the most cost-effective plan. This doesn’t only involve the services covered, but also who you can visit and still be eligible for coverage. 

If you’re tired of dental plans that provide less coverage, or none at all, for your preferred dentists, dental indemnity insurance might just be the right choice for you.

 

Key Takeaways

  • Dental indemnity insurance plans are fee-for-service models that don’t bind your dentist to the insurance company contract.

  • Dental benefits are the same regardless of which dentist you visit.

  • There is no need to choose a primary provider.

  • No referrals are required to see a specialist.

  • You pay for treatment first and the insurance company will reimburse you later.

 

What Is Indemnity Dental Insurance?

Dental indemnity insurance is also known as traditional dental insurance. It is a fee-for-service plan and was once the most common type of dental insurance plan. Unfortunately, the Affordable Care Act marketplace does not sell these dental policies, but you can get them from independent brokers. 

 

What Is an Indemnity Dental Insurance Plan? 

Your dentist is charged per service, with no contractual obligation to reduce their fees for members like HMO plans. 

Most indemnity insurance plans will reimburse you for 50-80% of your treatment costs. However, you can expect to get full reimbursement for diagnostic services such as X-rays and routine dental care, including cleaning. 

Dental indemnity plans have a structure of tiered coverage. Routine care may be 100% covered, but you may pay 50% of the fee for crowns as out-of-pocket costs. Like other types of dental insurance, you pay an annual deductible before the dental coverage kicks in. Your level of coverage is determined by the “usual, customary and reasonable” (UCR) rates. 

Before starting any treatment, you must have your dentist file a predetermination plan to estimate the costs. A pre-claim will be sent back to you, so you can see the remaining costs after dental coverage. Your coverage is based on the UCR rates, not your dentist’s fees. 

Summary

Dental indemnity insurance is a traditional fee-for-service model that currently makes up a small minority of available plans. 

 

What Is the Difference Between Indemnity and PPO Dental Insurance?

Difference Between Indemnity and PPO Dental Insurance

 

Unlike an indemnity plan, a PPO dental insurance plan has a list of in-network dentists. The dentists agree to certain fee structures, which makes using them more cost-effective than visiting out-of-network practices.  

PPO dental insurance plans will cover you after seeing any dentist, but you receive more coverage when visiting an in-network dentist. 

However, the one advantage that PPO plans have is that you save on dental services right away. Indemnity insurance requires you to wait for reimbursement after first paying for the entire treatment cost. 

Summary

PPO plans have provider networks, but reimburse you immediately instead of requiring you to pay upfront first. 

 

Indemnity Dental Insurance Cost and Prices

Indemnity plans can cost double that of dental HMO or PPO plans. There may be a yearly cost of $780 as opposed to, say, $350, but you could have an annual maximum of $2,500 instead of $1,000-1,500. However, you must ensure that major services such as wisdom teeth removal and root canals are covered, as they may only cover common dental procedures. 

Here are some examples of indemnity plans offered by three major US providers: 

The Aetna Dental Indemnity Plan has a $50 deductible and a $1,250 yearly maximum per covered person. If you are receiving preventive or diagnostic services, such as routine examination or sealants, you are 100% covered with no deductible. Basic care including fillings, root canals, and crown repairs are 80% covered; inlays, implants and other major services are 50% covered. 

Cigna indemnity insurance has a $25 deductible, and you only pay 20% of the costs for a wide range of services once dental benefits kick in. These include fillings, root canal and crowns, but not orthodontic care. However, the annual maximum is $1,500, so you may still find treatment expensive if you need major procedures.  

The Delta Dental indemnity insurance plans pay 80-100% of your diagnostic and preventive services, such as cleanings and sealants for children. Procedures including extractions, fillings and root canal are 80% covered, while major restorative care, orthodontics and TMJ treatment are only 50% covered by the Enhanced plan. 

Summary

Dental indemnity insurance is more expensive but can provide coverage for more services. Levels that cover orthodontics and restorative treatment are available too. 

 

Indemnity Dental Insurance: Pros and Cons

There are several advantages and disadvantages to choosing dental indemnity insurance over other plan types: 

 

Pros of Indemnity Dental Insurance

What We Like

  • You can choose any dentist you want, and receive the same level of coverage
  • In many cases, no referrals are required to see a specialist
  • Some plans make it easier to access emergency dental care when necessary
  • You do not need to choose a primary care dentist, unlike HMO dental plans

Cons of Indemnity Dental Insurance

What We Don't Like

  • You must pay for dental services upfront
  • There may be a waiting period, especially for major treatments and if you have recently signed on.

Summary

Dental indemnity insurance is the type of plan that offers you the most freedom overall, with few requirements, but costs may be higher. 

 

FAQ

What are the most important things to know about dental indemnity insurance? 

 

Where Can I Find Indemnity Dental Insurance No Waiting Period?

Which Is Characteristic of Dental Insurance Indemnity Policies?

What Is a Cigna Indemnity Plan?

What Is a Delta Dental Indemnity Plan?

 

Conclusion

If you want the freedom to choose your dentist, and sometimes a wider range of covered services, dental indemnity insurance may be right for you.

Indemnity plans are similar to other types of dental insurance plans in that they cover more procedures with higher premiums, and impose a waiting period for major services. However, you are required to pay for treatments upfront, which may not suit everyone.


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