--- title: UCR vs. MAC in DPPO Plans | Broker Guide description: Learn the difference between UCR and MAC pricing in DPPO dental plans. This broker guide teaches you how to explain dental costs with confidence. image: https://blog.solsticebenefits.com/hubfs/Blog%20Images/AdobeStock_456362951.jpeg --- [![Solstice Logo](https://blog.solsticebenefits.com/hs-fs/hubfs/Vonazon/solstice-benefits-broker-blog-template1-logo-216x76.png?width=216&name=solstice-benefits-broker-blog-template1-logo-216x76.png "Solstice Logo")](https://www.solsticebenefits.com/) # Insurance Broker Blog ![A set of hands on a table using a calculator and writing on a clipboard with a large tooth display in front of them comparing dental plan pricing models](https://blog.solsticebenefits.com/hubfs/Blog%20Images/AdobeStock_456362951.jpeg) # UCR vs. MAC: What Brokers Should Know About DPPO Plans By Brooke Ellis on Apr 15, 2026 11:12:00 AM As a dental insurance broker, you work with many industry terms—DHMO, DPPO, MOOP, CYM, and more. It’s no surprise that employers and employees have questions about what these terms mean and how/if they affect costs, like [the differences between DHMO and DPPO plans](https://blog.solsticebenefits.com/solstice-broker-blog/what-is-a-dental-ppo-plan-7-things-a-broker-should-know). When brokers can break down complex concepts in an uncomplicated way, it builds trust and leads to better benefit decisions. One common area of confusion is how **DPPO (Dental Preferred Provider Organization)** plans handle out‑of‑network claims. DPPO plans are popular because they give members flexibility to visit both in‑network and out‑of‑network dentists. In fact, PPO‑style plans make up [most of the private dental coverage](https://www.newmouth.com/oral-health/dental-insurance-statistics/) in the U.S., accounting for roughly 80–90% of employer‑sponsored and individual dental plans. Unlike DHMO plans, DPPO plans typically do not use fixed copays. Instead, members pay **coinsurance**, which is a percentage of the covered amount. That covered amount depends on whether the plan uses **UCR** or **MAC** pricing when care is received out of network. Understanding that difference helps brokers explain why costs can vary so much between providers.    **Key Takeaways:** ![Pretty young lady taking a decision with scale above her head](https://blog.solsticebenefits.com/hs-fs/hubfs/Pretty%20young%20lady%20taking%20a%20decision%20with%20scale%20above%20her%20head.jpeg?width=780&height=504&name=Pretty%20young%20lady%20taking%20a%20decision%20with%20scale%20above%20her%20head.jpeg) **What’s the Difference Between UCR and MAC?** A common broker question is whether a DPPO plan processes payment based on **UCR** or **MAC**—and what that means for members. **UCR** stands for *Usual, Customary, and Reasonable*. UCR amounts are based on what providers in a specific geographic area typically charge for a service. Insurers often rely on third‑party benchmarks, such as [FAIR Health](http://www.fairhealth.org/), or their own claims data to set these values. The goal is to reflect local market pricing rather than a single negotiated fee. **![what is an open access dental network](https://blog.solsticebenefits.com/hs-fs/hubfs/what%20is%20an%20open%20access%20dental%20network.jpg?width=780&height=521&name=what%20is%20an%20open%20access%20dental%20network.jpg)** **How Does a UCR‑Based Plan Work?** Here’s a simple example. A member visits an out‑of‑network dentist for a root canal. The plan covers the procedure at **50%**, and the insurer’s UCR amount for that service is **$1,500**. If the dentist charges **$2,000** (above UCR): This difference highlights why provider choice matters in UCR‑based plans. Regional pricing allows flexibility, but higher charges can increase member costs. **![AdobeStock_249468811](https://blog.solsticebenefits.com/hs-fs/hubfs/Blog%20Images/AdobeStock_249468811.jpg?width=780&height=520&name=AdobeStock_249468811.jpg)** **What About MAC‑Based Plans?** **MAC** stands for *Maximum Allowable Charge*. In MAC‑based DPPO plans, reimbursement is tied to the insurer’s **in‑network negotiated fee**, even when a member goes out of network. These negotiated rates are agreed upon between the insurer and participating dentists. When a member sees an out‑of‑network provider, the insurer still uses the in‑network rate to calculate payment. **How Does a MAC‑Based Plan Compare?** Using the same root canal example: In this case: Because MAC‑based plans rely on negotiated fees, staying in network often results in lower out‑of‑pocket costs. **![Smiling charismatic speaker giving public presentation in conference hall](https://blog.solsticebenefits.com/hs-fs/hubfs/Smiling%20charismatic%20speaker%20giving%20public%20presentation%20in%20conference%20hall.jpeg?width=780&height=520&name=Smiling%20charismatic%20speaker%20giving%20public%20presentation%20in%20conference%20hall.jpeg)** **Advantages of Each Plan Design** **MAC‑Based Plans** **UCR‑Based Plans** Both designs have value. The key is to help clients understand the tradeoffs before claims are submitted or processed. **![two-happy-people-having-a-conversation-3874038](https://blog.solsticebenefits.com/hs-fs/hubfs/two-happy-people-having-a-conversation-3874038.jpg?width=780&height=520&name=two-happy-people-having-a-conversation-3874038.jpg)** **Frequently Asked Questions ** **What does UCR mean in dental insurance?** UCR stands for Usual, Customary, and Reasonable. It refers to payment amounts based on typical charges in a specific geographic area. **What is MAC pricing in a DPPO plan?** MAC pricing uses the insurer’s in-network negotiated fee to calculate payment, even when care is received out of network. **Is UCR or MAC better for dental insurance?** Neither is universally better. UCR offers more pricing flexibility, while MAC often results in lower premiums and stronger incentives to stay in network. **Why do out‑of‑network dental visits cost more?** Out‑of‑network dentists do not agree to insurer fee limits, which can result in higher costs for members. **How can brokers explain UCR vs. MAC more clearly?** Using real‑world examples and setting expectations around provider choice helps clients understand potential cost differences. **Final Thought for Brokers** UCR and MAC pricing can feel complex, but they play a big role in how dental benefits are experienced day to day. When brokers set clear expectations early, employers and employees are better prepared—and fewer surprises show up later.   [![keys-to-effective-coms-with-client-CTA](https://no-cache.hubspot.com/cta/default/215049/interactive-183024458288.png) ](https://blog.solsticebenefits.com/hs/cta/wi/redirect?encryptedPayload=AVxigLJR4F0cbh1fmTNSLAMcQ4HE7hDyCTTXgrI3SC5yuSS9JvXD6UmeycmF8KyRtSjxpowjRFzTBCfdGh0zJ0A93f9FZsokzdE3rlNGvWuKYbTa0dpfOAJlr0d4ovAwNHbtoXTB2K7CjhoDPpSckq4kASfIepEYZ6kmY0keniXhdqcmr1kR%2FGTHfiRaTBzgpk%2BS1LNxsiQ8MJ6zjZclXvMP2PNpiQIl9jATz9GYKQHkvRrvBl1N1TAmyUUJXsAS4Q%3D%3D&webInteractiveContentId=183024458288&portalId=215049)     Bonus: Feel free to use this practical guide to explain dental and vision benefits with clarity—before confusion shows up in claims.   Already working with Solstice? 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