One question.Three systems.
PPO, HMO, and Medi-Cal cost different amounts, cover different things, and let you go to different dentists.Below is what each one actually means when you walk into the dentist’s office.
At KYT we work with PPO. If you have HMO or Medi-Cal, we can still talk through your options.
Dental plans differ in reimbursement, network rules, covered services, and administrative requirements. Those differences can affect how many patients an office needs to see per day and how much chair time is realistic per visit.
The type of insurance plan by itself does not determine the skill of the dentist or the quality of treatment — plenty of excellent dentists work in every kind of system.
What matters is whether the plan you have fits the kind of dentistry you actually need.
Insurance does not decide how long your teeth last. Good dentistry does.
Different plans cover different services and administrative requirements, which shapes what kind of visit fits each system best.
PPO is the system KYT is built around, because it fits the way we plan and sequence treatment.
Each plan was built for a different kind of patient and a different monthly cost.
What matters is whether the plan you have fits the kind of dentistry you actually need.
Free or very low cost. For members with applicable full-scope Medi-Cal Dental benefits, covered services can include exams, X-rays, cleanings, fillings, extractions, anterior and posterior root canal treatment, crowns, periodontal care, dentures, and — under applicable program criteria — dental implants.
Eligibility, coverage, authorization requirements, and available provider networks depend on the member and the specific service. Some members may have restricted-scope eligibility rather than full-scope benefits.
Current benefits should always be verified with Medi-Cal Dental for your specific coverage before scheduling major treatment.
Lower monthly cost. You’re assigned to a single dental office and have to use them.
Switching offices or seeing a specialist usually needs approval first.
Fine for routine care if you like your assigned office. Hard if you want to choose where you go or get a second opinion.
Higher monthly cost, but you choose your dentist.
Many PPO plans cover preventive services at a higher percentage and major restorative services at a lower percentage. Deductibles, annual maximums, covered percentages, exclusions, downgrades, waiting periods, and implant benefits vary significantly by plan.
Best if you want to pick your own office, plan major work, or expect to need more than just basic care.
Original Medicare doesn’t cover most dental work. The dental benefits people usually mean come from Medicare Advantage plans, which you have to sign up for separately.
Medicare Advantage plans behave differently depending on which one you pick. Some work like an HMO (locked to one office). Some work like a PPO (pick your own). If you’re on Medicare and not sure what your dental coverage actually does, ask us and we can help sort it out.