Ppo dental insurance blue cross blue shield

Who is this for?

Ppo dental insurance blue cross blue shield

Shopping for a dental plan, or have coverage through your employer? This explains how Blue Dental plans work so you can choose the best one for you and your family.

Dental plan types

A Blue Dental PPO plan works similar to how medical PPO plans work with in-network and out-of-network coverage. With a Blue Dental PPO plan:

  • You can see any licensed dentist and your plan will share the cost.
  • You'll pay less when you see a dentist in our PPO network.
  • You’ll pay more when you see a dentist outside our PPO network.

Blue Dental EPO stands for exclusive provider organization. Blue Dental EPO plan only covers services from in-network PPO dentists and doesn't cover any out-of-network care. This increases savings, making your costs lower.

The more a plan pays for out-of-network care, the higher your costs will be. If you go out-of-network, you could be charged for the difference between what Blue Cross pays and what your dentist charges.

If you want the freedom to see dentists outside our PPO network, a Blue Dental PPO plan could be best for you. If you want the most savings by only seeing a PPO network dentist, a Blue Dental EPO plan could be better for you.

Want to know if your dentist is in-network? Just use our online search.

Choosing a dentist

Whether you choose a PPO or an EPO dental plan affects how much your monthly payment will be. The dentist you choose determines how much you'll pay for services.

  • PPO in-network dentists You'll save the most when you see a PPO dentist who participates in-network. Network discounts average 40%. If you have an EPO plan, you can only see dentists in this network. 
  • Blue Par Select℠ dentists Although they're not part of our network, you'll still save if you see one of these dentists. EPO plans don't cover services from Blue Par Select dentists.
  • Out-of-network dentists You pay the dentist in full. You may need to file a claim after the service, if the dentist didn't submit on your behalf 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.

Your out-of-pocket costs for dental care

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. Blue Dental deductibles are very low when compared to medical plans and you'll never pay a deductible for Class I preventive care like exams or cleanings.

Blue Dental plans do have coinsurance and the amounts vary from plan to plan.

If you purchase your dental plan directly from Blue Cross, you can see your out-of-pocket costs for dental care by looking on the benefits tab of our Blue Dental plans. If you purchase your dental plan through your employer, please refer to your human resources or benefits department for more information on coverage and costs.

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, which only applies to services provided by PPO dentists. Pediatric members must be 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.

Did you know that comprehensive dental care can help detect other health problems before they become more serious? That’s why we offer several dental plans to meet your financial and coverage needs.

To get dental coverage for you and your family, you can choose from our three dental plans:

  • BlueDental Preferred
  • Dental HMO
  • Preferred Dental

Our dental plans cover a comprehensive range of dental services including no charge oral exams, cleanings and X-rays. And your acceptance is guaranteed.

Pediatric dental coverage is also included in all CareFirst ACA medical plans through age 19.

For additional information, contact us Monday-Thursday 8 a.m. to 5 p.m. or Friday 10 a.m. to 5 p.m. at 855-503-4862, or visit our dental page for a quick and easy quote.