Delta Dental PPO Enhanced Vs Standard

THE SHORT VERSION

Standard keeps your premium low. Enhanced pays more when you need fillings, crowns, bridges or dentures. If you mostly need cleanings, Standard usually wins. If you expect major work, Enhanced usually wins, even at the higher monthly price.

Preventive care. Exams, cleanings and routine X-rays are usually covered well on both tiers, often without a deductible.

The dentist networks. Both tiers typically use the same Delta Dental PPO and Delta Dental Premier networks, so upgrading does not give you more dentists to choose from.

How claims work. In network, the dentist files the claim and you pay your share. See how the Delta Dental deductible fits in before your coverage starts paying.

Waiting periods still apply. Upgrading to Enhanced does not usually remove waiting periods for major services. If you need a crown next month, a higher tier may not help until the waiting period ends, so check that before paying more.

1. Add up a year of premiums. Multiply the monthly premium by twelve.

2. Add the deductible. Most plans charge one before basic and major coverage starts.

3. Add your share of the work you expect. Ask your dentist for estimates, apply each tier’s coverage percentage, and remember anything above the annual maximum is yours to pay.

THE RULE OF THUMB

Cleanings only: Standard almost always wins. A crown, bridge or dentures this year: Enhanced usually wins. If you are unsure, compare both tiers with a real treatment estimate in hand. Our guide to the cost of Delta Dental insurance covers typical premiums.

➤ What is the difference between Delta Dental PPO Enhanced and Standard?

The Enhanced tier generally costs more each month and pays more when you need care, usually through a higher annual maximum and higher coverage percentages for basic and major services. The Standard tier has a lower premium but pays less for fillings, crowns and dentures and usually has a lower yearly cap. Exact benefits depend on the Delta Dental company and plan in your state.

➤ Is Delta Dental PPO Enhanced worth the extra cost?

It is usually worth it if you expect basic or major work in the next year or two, such as crowns, a bridge or dentures, because the higher annual maximum and coverage percentage can more than cover the extra premium. If you only need two cleanings a year, the Standard tier is often the better value.

➤ Do both Delta Dental PPO plans cover preventive care?

Yes. Both tiers typically cover preventive care such as exams, cleanings and routine X-rays at a high level, often with no deductible. The differences between Enhanced and Standard show up mainly in basic and major services.

➤ Can I see any dentist with a Delta Dental PPO plan?

You can usually see any licensed dentist, but your costs are lowest with a Delta Dental PPO network dentist. Dentists in the Delta Dental Premier network have also agreed to Delta Dental’s fees, while a non-network dentist can bill you for the difference between their charge and what the plan pays.

➤ Do Delta Dental PPO plans have waiting periods?

Many individual Delta Dental PPO plans have waiting periods for basic and major services, while preventive care is often covered right away. Waiting periods differ between plans and states, and some plans reduce them if you had prior dental coverage, so check the plan summary before you enroll.

➤ Does Delta Dental PPO Enhanced cover implants?

Some Enhanced plans include implants as a major service, while many Standard plans exclude them. Because coverage varies by state and plan, confirm implant coverage, the coverage percentage and the annual maximum in the plan summary before you buy.

➤ What is the difference between Delta Dental PPO and Delta Dental Premier?

Delta Dental PPO is a narrower network with lower negotiated fees, so you usually pay the least there. Delta Dental Premier is a larger network whose dentists have also agreed to Delta Dental’s fees, giving you more choice of dentist with somewhat higher costs than PPO dentists in many plans.

➤ Can I switch from Delta Dental PPO Standard to Enhanced?

Many Delta Dental companies let you change plan tiers, but the timing rules and any new waiting periods depend on your state and plan. Ask before you switch whether moving to the Enhanced tier restarts waiting periods for major services.

➤ Can I have Delta Dental with Medicare?

Yes. Original Medicare does not cover routine dental care, so many people on Medicare buy an individual Delta Dental plan to fill that gap. You can usually enroll at any time of year, separately from Medicare enrollment periods.