EPO Dental Plan

Compare the Different Types of Dental Plans

Exclusive provider organization (EPO) dental plans

Brief overview:

An Exclusive Provider Organization (EPO) is a network of participating dentists that have agreed to accept reduced fees (commonly called the negotiated fee) as payments for patients with EPO dental plans. It’s similar to a PPO but at a much lower premium cost. This lower cost is possible because you can only select a dentist that is a part of the EPO network.

If you have an EPO insurance plan and you visit an EPO dentist, you will only pay a set percentage of the fee. The rest of the negotiated fee is paid to the dentist by the insurance plan.

For sudden and serious emergency situations, out-of-network coverage is not an option under an EPO plan model. It’s important to fully understand emergency out-of-network coverage rules under an EPO plan so you are prepared to make decisions if the situation presents itself.

What you pay:

The percentage you pay (this is called ‘co-insurance’) will vary depending on the type of treatment you are having:

Restorative treatment, such as a filling, may be covered at 80%.
This would mean you only pay 20% of the fee.

Oral Surgery treatment, such as an implant, may be covered at 50%.
This would mean you only pay 50% of the fee.

EPO plans usually require you to pay your part of the fee first (the ‘deductible’) before they pay benefits.

Usually, for preventive treatment, you won’t have to pay the deductible.

Advantages Advantages:

The premium costs are much lower.

Dentists in the network have gone through a rigorous credentialing process to be considered for participation.

MetLife negotiates fee schedules with participating dentists to help reduce out-of-pocket expenses.

Advantages Be aware that:

You can only select an EPO network participating dentist. MetLife offers this option only in states where the law allows EPO plans.

With an EPO insurance plan you are fully responsible for all costs if you use an out-of-network dentist.

EPO plans usually include a maximum amount of coverage per year.

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