Delta Dental PPO

When it comes to dental insurance, there are many options to choose from, but Preferred Provider Organizations (PPO) are the most popular, accounting for over 80% of dental insurance plans. PPO plans offer clear advantages that make them the popular and smart choice.

One key advantage of a PPO plan is that it can save you money. Insurance companies negotiate discounted fees with dentists who are part of their network, with the deepest discounts given to PPO network dentists. By visiting a dentist within the PPO network, you can maximize your savings and benefits and reduce your out-of-pocket expenses.

Another advantage of PPO plans is the flexibility they offer. You have the option to choose from a variety of dentists within the network, and you can even visit out-of-network dentists. However, to save the most money, it's recommended to visit a PPO network dentist who has agreed to lower fees.

At Delta Dental, our PPO plan allows you to visit any licensed dentist, anywhere, or keep the dentist you know and trust. You'll save the most by visiting a dentist within our PPO network, as they have agreed to reduced fees and won't charge you more than your expected share of the bill. Additionally, they'll handle your claim forms and help you understand your share of the payment

What Does Delta Dental PPO Cover

Dental insurance policies generally cover preventive care, such as regular checkups and cleanings, as well as basic and major procedures like fillings, crowns, root canals, and oral surgery. Some policies also cover orthodontics, periodontics, and prosthodontics like dentures and bridges. Most plans provide coverage for two preventive visits per year.

Individual policies may not offer coverage for periodontics and prosthodontics in the first year, and orthodontics may require an additional fee. Most plans follow a 100-80-50 coverage structure, covering preventive care at 100%, basic procedures at 80%, and major procedures at 50%, or a larger co-payment. However, some plans may not cover certain procedures, such as sealants, at all.

Every plan has an annual maximum, which is the cap on what it will pay during a plan year. About half of dental PPOs offer annual maximums of less than $1,500. Once you reach the maximum, you are responsible for all expenses above that amount, including costs for procedures like crowns, root canals, and oral surgery. There's also typically a separate lifetime maximum for orthodontic costs.

Delta Dental, like many other insurance companies, offers a variety of plans with different coverage levels and premiums. Woody's Insurance can help you determine which plan may be the most beneficial for you.

Delta Dental's PPO Plus Premier Coverage plan provides members with access to two of their national dental networks: Delta Dental PPO and Delta Dental Premier, which is the largest dental network in the country. This plan offers two levels of claims savings and considerable savings for members.

Delta Dental PPO Plus Premier Coverage offers members two national dental networks to choose from: Delta Dental PPO and Delta Dental Premier, which includes 96% of dentists in Massachusetts. Members have the greatest flexibility when choosing a dentist from the Premier network, which includes three out of four dentists in the country. On the other hand, members can get the greatest value by choosing a dentist from the PPO network, which includes 20% of dentists in Massachusetts.

The coverage for this plan includes diagnostic and preventive care, routine checkups, restorative care, and oral surgery. There are no claims forms to fill out when services are performed by participating dentists, and balance billing is not allowed. Services performed by non-participating dentists are covered at a lower benefit level.

Savings are generated through the plan's negotiated fees, claims processing, and utilization management program. There are also special plans for smaller businesses with 10-49 employees. The plan also includes Rollover Max, which allows a portion of a member's unused annual maximum to be carried over to the next year for greater value. However, limitations may apply, and this feature may not be included in some programs. Members are advised to refer to their benefit materials or contact customer service for more information.

Delta Dental PPO Orthodontics

Tooth alignment is essential for both function and appearance. Proper alignment makes it easier to talk and chew food. As a child grows, it is crucial to correct and guide tooth and jaw development for a healthy and functioning smile in adulthood. Orthodontic services, also known as "Ortho," are treatments and procedures used to correct malpositioned or misaligned teeth, such as braces, retainers, and other orthodontic appliances. The level of coverage for orthodontic services depends on the dental plan chosen by your employer or organization. Typically, orthodontic services are considered a Class IV benefit and are payable for eligible individuals up to age 19. However, the coverage is limited to a lifetime maximum per person, as specified in your Summary of Dental Plan Benefits.

Delta Dental PPO Cost

Delta Dental plan premiums vary by state and plan. According to its website, the plans are ranked from least to most expensive as follows:

  1. DeltaCare USA (HMO)
  2. Delta Dental Patient Direct
  3. Delta Dental PPO
  4. Delta Dental Premier
  5. Delta Dental PPO Plus Premier

Below is an example of sample quotes for a family of two adults aged 35 and 34 with two children residing in Chicago.

 Gold PlanSilver PlanBronze Plan
Office Visit Co-paymentNoneNoneNone
Plan Dollar Maximum Per Person, Per Year$1,500$1,000$500
Deductible$50 per person, per benefit year for all services$75 per person, per benefit year for all services$25 per person, per benefit year for all services
Annual Contract RequiredYesYesYes
Waiting PeriodsMay applyMay applyNone
Cost Per Month$125.46$105.27$61.93