Dental HMO vs. PPO dental insurance: what's the difference?
You’ve probably encountered Dental Health Maintenance Organization (DHMO) and Preferred Provider Organization (PPO) dental insurance plans before. What exactly are they? How do they work? Is one better than the other?
If you’re asking any of these questions, you’ve come to the right place.
What’s the Difference Between DHMO and PPO Dental Insurance?
DHMO and PPO plans have one key difference. DHMO insurance plans typically cover dental services at a low cost and minimal or no copayments with a pre-selected primary care dentist or a dentist facility with multiple dentists. PPO dental insurance plans, on the other hand, offer a balance between low-cost care and dentist choice.
These two types of plans have unique features, benefits, and limitations that are attractive to different people. In order to understand the difference between DHMO and PPO dental insurance, let’s take a closer look at how each plan operates:
Dental HMO Insurance Plans
A DHMO provides lower cost coverage with a focus on preventive care. DHMO plans are designed to encourage regular dental visits and check-ups while minimizing spending. Any out-of-pocket costs are clearly defined, and most DHMO plans do not have exclusions for pre-existing conditions or missing teeth.
If you choose to enroll in a DHMO plan, you are required to select a primary dental facility to manage and coordinate your oral health needs. If a treatment by a specialist is necessary, the primary dental facility or dentist will first need to submit a referral. You’ll need to use in-network dentists in order to obtain coverage under a DHMO plan.
Here are a few benefits and limitations to consider when evaluating a DHMO plan:
Benefits
- Lower premiums than PPO plans or other types of dental insurance plans
- No deductible
- Set copayments; often minimal or no copayment for diagnostic and preventive care
- Typically, no annual maximum for covered benefits
Limitations
- Smaller dentist network size
- Referral required by primary care dentist in order to receive specialist care
- Does not cover costs for out-of-network dental care
- May be restrictions around the number of visits, treatments, or diagnostic tests allowed
PPO Insurance Plans
PPO dental plans entail higher out-of-pocket costs than DHMO plans – but they also offer a greater degree of flexibility when choosing a dentist or dental facility.
A PPO dental plan will typically have a larger network of dental providers, and you’ll be able to switch dentists or see a specialist without a referral from a primary care dentist. In fact, you aren’t required to designate a primary care dentist when enrolling in a PPO dental plan.
If you are considering a PPO dental plan, keep in mind that you’ll pay a higher premium and will likely be required to meet a deductible. In addition, most PPO dental plans have an annual limit on the amount of coverage
Benefits
- Greater flexibility overall when selecting a dentist or dental facility
- Referral not required in order to receive treatment from a specialist
- Depending on the plan, you may receive partial reimbursement for treatment by an out-of-network dentist
- Larger network of dentists from which to choose
Limitations
- Higher premiums than a DHMO plan
- Typically involves a deductible
- In most cases, PPO dental plans have an annual limit on coverage
- Copayments may be higher with a PPO dental plan than with a DHMO plan
Every insurance plan comes with its own advantages and limitations. No one plan is necessarily better than the other - it all comes down to choosing the best plan for you and your family.
Deciding between a DHMO and PPO dental insurance plan doesn’t have to be difficult. Before you enroll in either, though, make sure to do research to understand the out-of-pocket costs (including premiums, copays, and deductibles) as well as the specific limitations of each.
In addition, contact your existing dentist to find out what kind of coverage their facility accepts prior to selecting an insurance plan.
Generally speaking, DHMO plans are more cost effective, while PPO dental plans offer greater flexibility. There’s no way of saying that one plan is better than the other – it just comes down to which will meet your unique needs.
Are you ready for a new DHMO or PPO dental plan? Or you can compare two plans side by side on our individual dental insurance page.