MAC vs. UCR Dental Plans: What's the dental difference?

What do these terms mean? How do they work? How do I explain MAC and UCR to a client? Our SecureCare team often receives questions about the dental insurance terms PPO MAC and PPO UCR. Here's a brief overview to help make sense of these two important dental benefits terms.

The terms MAC and UCR are dental plan abbreviations for:

1. MAC: Maximum Allowable Charge

2. UCR: Usual, Customary and Reasonable

When do we use the terms MAC and UCR?

Both terms, MAC and UCR, are used to describe how PPO dental insurance plans reimburse non-contracted or out-of-network dentists for covered services performed. 

The UCR and MAC terms are not used when referring to how contracted or in-network dentists are reimbursed, because these dentists are already contracted at a specific reimbursement fee schedule. 

PPO MAC Dental Plans 

PPO MAC Dental Plans pay non-contracted or out-of-network dentists according to a fixed reimbursement fee schedule determined by the dental insurance company. 

This MAC reimbursement fee schedule is typically lower than standard UCR reimbursement schedules. The MAC reimbursement schedules will vary by dental insurance company.

PPO MAC Pro : Lower average monthly premiums than UCR Plans. Increases in-network dental provider utilization.

PPO MAC Con : Higher average *balance billing for out-of-network services than UCR plans, which can mean higher patient costs for out-of-network services.

PPO UCR Dental Plans

PPO UCR Dental Plans pay non-contracted or out-of-network dentists based on the actual fees charged by dentists in the area (ie. zip code) where a member has dental services.

For example, a UCR dental plan may pay non-contracted dentists based on what 90% of the dentists are charging for a particular service (ie. crown, implant) in the area where a member’s dentist is located. 

As a result, UCR non-network payments to the dentist from the dental insurance company are generally higher than on a MAC dental plan.

PPO UCR Pro: Lower to no *balance billing for out-of-network services than PPO MAC Plans; higher out-of-network dentist reimbursement than PPO MAC Plans on average.

PPO UCR Con: Higher average monthly premium than MAC plans.

*The difference between what the dental plan reimburses and what the dentist charges.