My only problems are my wisdom teeth are crowding my front teeth and a plaque is starting to build. The dental insurance costs 8 annually and is for my wife and I.

Annual Deductible*
Individual
Family 0
Preventive Service Covered Percent 100%
Basic Service Covered Percent 80%
Major Service Covered Percent 50%
Annual Benefits Maximum 0
Office Visit Copay N/A
Orthodontic Services Not Covered
Orthodontic Deductible N/A
Orthodontic Lifetime Maximum N/A
*The deductible applies to Basic and Major services only.
Partial List of Plan Provisions Indemnity
Preventive
Oral examinations* 100%
Cleanings, including scaling and polishing* (Adult/Child) 100%
Fluoride* 100%
Sealants (permanent molars only)* 100%
Bitewing X-rays* 100%
Full-mouth series X-rays* 100%
Space maintainers 100%
Basic
Root canal therapy, with X-rays and cultures
Anterior teeth/Bicuspid teeth 80%
Amalgam (silver) fillings 80%
Composite fillings (anterior teeth only) 80%
Stainless steel crowns 80%
Scaling and root planing* 80%
Gingivectomy 80%
Incision and drainage of abscess 80%
Uncomplicated extractions 80%
Surgical removal of erupted tooth 80%
Surgical removal of impacted tooth (soft tissue) 80%
Major
Root canal therapy, molar teeth, with X-rays and cultures 50%
Osseous surgery* 50%
Surgical removal of impacted tooth (partial bony/ full bony) 50%
General anesthesia/intravenous sedation 50%
Inlays 50%
Onlays 50%
Crowns 50%
Full and partial dentures 50%
Denture repairs 50%
Pontics 50%

So I’ve been researching dental insurance in my area. (S. Florida Metro - Ft. Lauderdale/Miami/Palm Beach)

I’ve received a quote from a dental HMO that provides the following;
Individual Premium per month - 11.95$
No Wating Period
No Plan Maximum
No Deductable.
As examples of coverage;
Cleanings are no charge.
Fillings for one surface are 25$ for composite fillings. Standard silver fillings are no charge.
Crowns run between 245$-300$
Endodontics/Root Canals run between 110$ and 345$
Periodontic services run between 110$ and 300$ for surgical services.
Non surgiacal periodontic services run between 38$ and 65$
Dentures and bridges are fairly priced between 300$ and 425$
Extractions run between 30$ and 100$
The only place they really get you is with orthodontics.

Now let’s look at a PPO.

Individual Coverage is between 30$ and 42$ a month for basically the same services between plans, with large waiting periods, tiny plan maximums, and really not that great of coverage.

(Cont.)
My boyfriend needs a 3 fillings and a root canal and possibly a crown in the future. They cover 50% of the root canal, which would stick us with a 500$ bill. They cover 50% of a crown, which would stick us with another 500$ bill and we’ve reached our plan maximum of 1,000$, which is the largest plan maximum I’ve found.

Am I basically paying an obscene amount and tiny maximums with a PPO to go to a larger network of dentists? What’s the difference? Why should I pick a PPO over a HMO?
When it comes to orthodontics, which may also be something we consider in the future, the PPO isn’t able to provide a significant advantage over a HMO. The HMO’s charge around 1,000$ flat for orthodontic treatment. PPO’s either don’t cover orthodontics at all or only pay 25%.

Can anyone shed any light on the differences and why they exist?
So basically, I’m correct in that all I’m paying for is a larger network of dentists? There’s plenty of HMO providers in the area which are accepting patients. There’s nearly a dozen within 5 miles of my home.
And by the way, idiots need not reply. Christ you people are stupid.
Could a dentist possibly imput their .02 on this issue? Why do you choose to go with a HMO network? Why do you choose to go with a PPO network?
Up until recently, I’ve shared the same feeling, that in general, PPO insurance is better than HMO insurance.

It seems to me like this applies only with health insurance. I still feel the same way, go with PPO for health. But with Dental insurance, there is an amazing discrepancy. I was SO blown away at the differences.

This is simply an individual dental coverage plan with no bearing on my medical insurance. I have Tricare/Humana through my father and United Healthcare through my office. United Healthcare’s dental is the PPO I outlined, and I actually have only a 750$ per calender year with my office’s dental plan, and they cover NO major dental work, not even extractions. That’s NOTHING.