What’s the Difference Between In-network and Out-of-network Insurance?

Understanding your dental insurance can be tricky. Terms like out-of-pocket maximum, deductible, copay and coinsurance are not only vague, but their specifics often differ from plan to plan and insurer to insurer. But what about in-network versus out-of-network? If you’re wondering what the difference is between the two, here’s a closer look!

In-network Vs. Out-of-network Insurance

When it comes to your dental insurance, an in-network dentist is different from an out-of-network dentist. Dentists who are considered in-network are also referred to “participating providers” who are contracted within an insurance company because they’ve agreed to provide dental services at negotiated rates.

This means when you choose an in-network dentist, you’ll pay less for your care at the time of your service. Some in-network preventive care such as exams and cleanings may even be covered at 100 percent by your dental insurance. Furthermore, some plans offer 50 percent coverage for more complex restorations like dental crowns or bridges.

With in-network providers, it’s important to note that you may have less dentists to choose from, and you may still have a copay or deductible.

Conversely, with an out-of-network doctor you are free to choose any dentist you want, but they aren’t contracted with your dental insurance company and don’t have any pre-established rates. Generally, with a PPO plan your coverage for dental treatment can range from 100 to 50 to 40 percent, depending on the type of plan you choose. Although your fees may be higher, you can still use your dental insurance to get your money reimbursed directly, but you’ll spend more out of pocket because you need to pay upfront at the time of service.

Using Your Dental Insurance Benefits

With the holidays fast approaching and the end of the year right around the corner, now is the time to take advantage of your annual dental insurance benefits. Most plans will renew during open enrollment in November and reset on January 1. If you haven’t had your annual exam and cleaning, or have been putting off a treatment, be sure to schedule your appointment in the remaining months of 2025 before your benefits expire.

Remember, whether you choose an in-network or out-of-network dentist, your dental insurance was designed to help offset the cost of smile-saving oral health care. Don’t lose out on your benefits for 2025! Visit your dentist before the clock strikes midnight on December 31 and start the new year with a healthy grin!

About Dr. Morton

Dr. Roger Morton attended Southern Methodist University, followed by Eastfield College. He earned his doctorate at the University of Texas Health Science Center at San Antonio. He is a current member of the American Dental Association, Texas Dental Association, and the North Texas Dental Society to name a few. To schedule an appointment at Wylie Family Dentistry, please visit our website or call us today at 972-442-5599.