How do Blue Dental℠ plans work?
Who is this for?
Shopping for a dental plan, or a plan with dental and adult vision coverage? This explains how these plans work so you can choose the best one for you and your family.
Dental plans have some things in common with medical plans. They have deductibles, coinsurance and networks. In other ways they're different. For example, dental plans have an annual benefit maximum. Medical plans don't. If you understand how Blue Dental plans work, it'll be easier to choose a plan that fits your needs and budget.
Dental plan types
When you have a PPO medical plan, you get to choose the doctors you see. If a doctor you see is out of network, your plan still shares the cost. Blue Dental PPO plans work the same way:
- You can see any licensed dentist and your plan will share the cost.
- But you'll pay less when you see a dentist in our preferred network. That's called getting your dental care in network.
The more a plan pays for out-of-network care, the higher your monthly payments will be.
An EPO doesn't cover any care you get out-of-network. EPO stands for exclusive provider organization. It means a Blue Dental EPO plan only covers services from dentists in our preferred network. This reduces costs, so your monthly payments will be lower.
If you want the freedom to see dentists outside our preferred network, a PPO plan could be best for you. Want to know if a dentist is in our network? See How do I find a dentist?
Preferred, Blue Par or out of network?
Whether you choose a PPO or an EPO dental plan affects how much your monthly payment will be. Which one of dentists you choose determines how much you'll pay for services.
- Preferred network dentists. You'll save the most when you see an in-network, or preferred network dental professional: up to 20 percent. Remember, EPO plans only cover services you get from dentists in this network.
- Blue Par Select℠ dentists. Although not part of our network, you'll still save if you see one of these dentists: usually around eight to 10 percent. EPO plans don't cover services from Blue Par Select dentist.
- Out-of-network dentists. You pay the dentist in full. Then you file a claim and we reimburse you for the share of the cost your dental plan covers. If the dentist charges more than we pay for a service, you’ll need to make up the difference. EPO plans don't cover services from out-of-network dentists.
See How can I get the most out of my Blue Dental plan? for examples of what you can save by choosing a preferred network dentist.
Your out-of-pocket costs for dental care
When you get medical care, you and your plan share the cost, beginning with a deductible. That's the amount you pay for services before your plan begins to pay.
After you pay your deductible, you'll have coinsurance and copays. Your coinsurance is usually figured as a percentage of the total charge for the service. A copay is a fixed amount you pay for a service, usually when you receive the service.
When you have a Blue Dental plan, there are no copays for dental care. Whether or not you have to pay a deductible depends on the plan and the kind of dental care you get. But deductibles are very low compared to medical plans. And you'll never pay a deductible for preventive care if you go to a dentist in the preferred network.
Blue Dental plans do have coinsurance. Amounts vary from plan to plan. In general, the less you have to pay in coinsurance, the more your monthly payments will be.
You can see your out-of-pocket costs for dental care by looking on the benefits tab of our Blue Dental plans.
What's the difference between an out-of-pocket maximum and a benefit maximum?
An out-of-pocket maximum is the most you'll have to pay during a policy period, usually a year, for services you receive. Everything you pay for health care for everyone on the plan goes toward your out-of-pocket maximum. Once you reach your out-of-pocket maximum, your plan begins to pay 100 percent of the allowed amount.
Dental coverage works differently.
- Only dental care for pediatric members has an out-of-pocket maximum. Pediatric members are age 18 or younger when the plan starts.
- Nonpediatric dental coverage for members who are age 19 and older has an annual benefit maximum. That's the most your plan will pay during a policy period, usually a year, for dental care each adult on the plan receives. Once you reach your benefit maximum, you pay 100 percent for dental care.
What about Blue Dental plans that include adult vision care?
Your network is VSP, one of the nation's largest providers of vision care. Although your plan will still share the cost if you get your vision care out of network from an eye doctor that doesn't take VSP, you'll pay more.
Unlike dental care, you'll have a copay for some services. But you won't have a deductible for vision care.