In-Network vs Out-of-Network Dental Care

In-Network vs. Out-of-Network Dental Care

Dental insurance can help reduce your out-of-pocket costs for dental care, including preventative cleaning, basic services, and major services. It can help support your health at a reduced cost. Dental insurance plans work in different ways, but insurers often have their own network of dentists that you can (or must) use for a better price. With some plans, you can still choose your own dentist who is outside the network, but it may cost more. Understanding how in-network vs. out-of-network dental care works can help save you money and pick the best plan for your needs.

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Key Takeaways

In-network vs. out-of-network refers to the insurance provider’s network of approved dentists.
Dental health maintenance organizations (HMOs) typically require you to go to in-network providers, while dental preferred provider organizations (PPOs) can offer more flexibility and allow you to choose out-of-network providers.¹
Aflac offers network dental insurance plans for individuals and families with various coverage levels that can help you save on dental care, so you can select a plan that’s best suited to your needs and budget.

What does in-network mean for dental insurance?

Insurance companies have a network of dentists that policyholders can receive treatment from. With an HMO plan, you usually have to see an in-network provider to receive coverage.¹ Even if it’s not required by your plan, seeing an in-network dentist can usually reduce your out-of-pocket costs because your insurer has negotiated reduced service rates and will cover more of the cost.

What does out-of-network mean for dental insurance?

Out-of-network dental providers are simply those who are not in the insurance company’s network. With an HMO plan, your insurance company may not cover services by out-of-network dentists. A PPO plan, however, may allow you to visit out-of-network dentists, but potentially at a higher out-of-pocket cost.

Factors to consider when choosing between in-network and out-of-network dental care

While you can always choose to see an out-of-network dentist, your plan may require you to pay for the entire visit yourself. This is why it’s so important to understand how your dental plan treats in-network and out-of-network care. Before choosing a dentist, consider these factors:

Cost of care and savings

In-network services will typically be less expensive than out-of-network ones. That said, not all dental services are the same. The average cost of a dental cleaning without insurance is $104, which may not feel like too much to spend if you have a strong preference for an out-of-network dentist.² A root canal, however, could cost more than $2,000, so your out-of-pocket expenses may be less by using an in-network dentist.³

Provider choice and flexibility

Dental PPOs can offer greater provider choice and flexibility than HMOs. That’s important to many people because it’s not easy for everyone to find a dentist they like. It’s your oral care, so if you really like your dentist, learn what insurance networks they’re a part of or look for a PPO plan so you can continue seeing them.

Coverage limits and balance billing

Some insurance providers have coverage limits and practice balance billing for out-of-network care. A coverage limit is the maximum amount that the insurer will pay for out-of-network care before you have to pay out-of-pocket. Balance billing occurs when a provider bills a patient for the difference between the cost of the service and the amount the insurer agrees to pay.⁴ Both can have a significant impact on how much you pay for out-of-network care.

Convenience and paperwork

Some insurers may require you to submit paperwork to get approved for out-of-network care. It can be a hassle and is at least worth considering when weighing in-network vs. out-of-network care.

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How to find in-network dentists with your dental insurance

Finding an in-network dentist is a straightforward process. There are a few ways to do so:

Using the insurance provider’s website: Many insurance providers offer a web portal where you can search for nearby providers.
Calling customer service: Your insurance provider’s customer service agents can help you find an in-network dentist near you.
Asking the dental office directly: If you like your current dentist, or there’s a dental office near you, you can always ask what insurance networks they are a part of.

Get a dental insurance quote today

The differences between in-network and out-of-network care are important to understand. Depending on your plan, your provider may not cover any costs at an out-of-network provider, which is something you don’t want to discover when checking out. Planning ahead and understanding coverage before making a choice is essential. Aflac network dental insurance for individuals and families can help you save on dental care while having flexibility to choose your provider. Chat with an agent today to learn more and get a quote.

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