What is the real difference between a PPO Dental Insurance plan and a DHMO Dental Insurance plan?
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 lower cost with set copayments with a pre-selected primary care dentist or a dentist facility with multiple dentists. (less choice of 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 premiums 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, on a PDF with a list of Dental codes. These codes are the only items covered on that DHMO and most DHMO plans do not have exclusions for pre-existing conditions or missing teeth. (Dentist can balance bill client)
The problem usually arises with the narrow network of dentists available that take these plans. Most of these Dentists will pick and choose which codes they will take, and balance bill the client for the remaining cost of the procedures. All DHMO Plans only cover the least expensive fix available. You cannot upgrade.
Also, you need to be on the lookout for Dentist that use high pressure scare tactics to sell you on these expensive fixes with care credit. Please get only your preventative treatment; cleaning, exam and x-rays and ask for a treatment plan and walk out the door call your agent for advice.
If you choose to enroll in a DHMO plan, you are required to select a primary dental facility, usually a group plan like Western Dental or Bright Now 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. The Specialist may or may not take the DHMO plan. If Specialist does not take plan, you will be responsible for the entire cost. 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:
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
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. Do your homework, talk to your neighbors. Before you enroll in either, though, make sure to do research to understand the out-of-pocket costs (including premiums, copays, coinsurance, 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. Most Dentist that owns their own practice do not accept DHMO dental plans
Call your agent for advice or examples of Dental work and comparisons.
Ask your agent about POS Point of Service Dental which is added to your Medicare Advantage plan at no extra cost to you. These are reimbursement for your dental work go to any dentist.
Tamie Mongold (951) 795-1943