Dental PPO vs. dental HMO insurance plans
Dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) are the two most common dental insurance plans. While one option isn’t better than the other, each type has its advantages and limitations. Read on to learn more about the difference between PPO and HMO dental insurance and their pros and cons.
What's the difference between PPO dental insurance and HMO dental insurance?
Take a look at the table below to compare the differences between PPO vs. HMO dental plans.
| Dental PPO | Dental HMO | |
|---|---|---|
| Overall | Best for more control and flexibility | Best for affordability |
| Premiums | Higher premiums |
Lower premiums |
| Network size | Broad (out-of-network costs may be partially reimbursed) | Smaller network of covered providers |
| Out-of-network coverage | Yes, but it will likely cost less if you see a network provider |
No |
| Primary care dentist (PCD) required | No | Yes |
| Specialist referral required | No | Yes |
| Annual maximum | Yes | No |
| Co-pay | Sometimes | Yes |
What is dental PPO Insurance?
A dental preferred provider organization (DPPO) plan is a type of insurance that offers members broad access to pre-selected providers. These dentists and specialists have already agreed to participate in the insurance company’s network, which usually makes it cheaper and easier to see providers within that network.
Pros of dental PPO plans:
- Greater flexibility in choosing your dentist: With these plans, you have the freedom to visit network or out-of-network providers. PPO plans generally offer broad networks of care, giving you more options to find the right provider or facility for your needs.
- Save money with lower costs for services: While you’re able to see any provider, you’ll receive deeper discounts when you choose care within your network.
- No referral required to see a specialist: You can usually go directly to a specialist without a referral from your primary care dentist. This convenience could help save you time and address issues more quickly.
- Could receive partial reimbursements for out-of-network services: Depending on your plan, you may receive partial reimbursements for the costs involved with seeing a provider that’s not within your network.
Cons of dental PPO plans:
- Higher premiums: Compared to HMO plans, the amount you pay monthly for your plan will be higher in exchange for flexibility and increased options in receiving care.
- Your insurance plan will require you to meet a deductible: Your deductible is a set amount that you’ll be expected to pay for your dental care before your insurance benefits starts to pay. This amount resets every 12 months.
- Higher coinsurance: Like deductibles, coinsurance (a percentage of the cost of a procedure) is a way to share the costs of care with your benefits company. These costs tend to be higher with PPO dental plans than with HMO plans.
Is PPO dental insurance right for you?
A PPO dental plan is a good choice if you want more flexibility in choosing a provider and the ability to see a specialist without a referral. If you know you’ll be needing more care in the coming year and can budget for higher premiums, a PPO dental plan might be right for you.
What is dental HMO Insurance?
A dental health maintenance organization (DHMO) is budget-oriented plan that is designed to help lower the cost of care. These plans emphasize preventive care and prioritize regular check-ups with a primary dental facility or provider.
Pros of dental HMO plans:
- Lower monthly premiums: Since they work with a network of providers at reduced rates, dental HMO plans are usually more affordable with lower monthly premiums and out-of-pocket costs.
- Usually, there is no deductible or annual maximum: These plans focus on preventive care and routine procedures, which means they typically don’t require a deductible to be met before services are covered.
- Fixed copays: You’ll pay a predetermined flat rate listed in your benefits for covered services. This predictability makes it easy to budget and plan for dental expenses.
Cons of dental HMO plans:
- Restricted network of dentists: You’ll select a primary care dentist from a smaller network of covered providers.
- Out-of-network care isn’t covered: Outside of your HMO’s network, costs for care won’t be covered.
- You’ll need a referral for specialists: To see a specialist, your primary care dentist will need give you a referral for care. Without a referral, your dental services may not be covered by your insurance plan.
Is HMO dental insurance right for you?
If flexibility and frequent specialist care isn’t a top priority for you, an HMO dental plan could be your best bet. DHMO plans are a great option if your primary concerns are affordability and keeping dental costs low. These plans work best for people who want to stick with a primary dentist to coordinate their care and are comfortable with obtaining referrals for specialist care.
Looking for a dental plan?
Choose from plans that include a range of benefits to cover your dental care needs.
