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Dental Health Maintenance Organizations (DHMOs) Defined

A dental health maintenance organization (DHMO) is an organized system of dental health care in which a network of highly qualified dentists, who receive fixed monthly fees, provides comprehensive and affordable care for individuals or families at a low monthly premium with services at either no cost or a reduced price. Some services may require a copayment .

DHMO plan subscribers must select a primary dentist and must make any change to the primary dentist by contacting the plan provider or carrier. However, there are no waiting periods, calendar year maximums, deductibles , or claim forms.

This type of plan, which is also referred to as a “capitation plan,” is typically the least expensive of dental insurance plans . DHMO dental insurance plans provide an incentive to dentists to provide quality dental care that keeps patients in good dental health in order to minimize the number of free procedures those patients require.

DHMOs and the Patient: What to Consider

Consumers should consider DHMO plans when they need services done within the next month but cannot wait for the waiting period on their PPO or Indemnity plan to be satisfied. In addition, with a DHMO, customers will know the cost of their procedure before having it done, because services are subject to copays vs. coinsurance .

Depending on the plan, most treatments usually require a copayment for services other than office visits, exams, x-rays, and cleanings. Treatments that are not specified in the plan’s summary of benefits are usually not covered.

Patients considering purchasing a DHMO dental insurance plan should be alert to several important details. For example, purchasers of a DHMO dental insurance plan should be aware of the average time plan participants are required to wait between dental appointments. They also need to determine in advance the size of the patient pool for the DHMO dental insurance plan and the number of dentists servicing that pool.

It is also worthwhile to learn the number of dental specialists participating in the DHMO dental insurance plan, especially for those patients who have special needs. (Plan subscribers can receive a referral for a dental specialist from their primary dentist and receive a discount for specialty services from participating specialists.)

Finally, potential participants in a DHMO dental insurance plan are well advised to familiarize themselves with those stipulations in the plan relating to emergency dental care and treatment for patients who are traveling or otherwise away from home.

Summary of DHMO Challenges and Strengths

DHMO Challenges:

  • Depending on the plan, most treatments usually require a copayment for services other than office visits, exams, x-rays, and cleanings
  • Treatments that are not specified in the plan’s summary of benefits are usually not covered
  • Participants are required to wait a specified time between dental appointments
  • The size of the patient pool for the DHMO dental insurance plan and the number of dentists servicing that pool could impact dentist availability
  • For services to be covered, a primary care dentist must be assigned

DHMO Strengths:

  • Good for those who need services done within the next month but who cannot wait for their PPO or Indemnity plan waiting period to be satisfied
  • Customers know the cost of their procedure in advance
  • Provides comprehensive and affordable care through a network of highly qualified dentists
  • Dentists provide dental procedures at either no cost or a reduced price
  • Provides dentists with added incentives to provide quality dental care to their patients
  • Typically the least expensive of dental insurance plans
  • There are no waiting periods, calendar year maximums, deductibles, or claim forms
  • Subscribers can receive a referral for a dental specialist and receive a discount for specialty services from participating specialists

If the dental insurance purchaser determines that these and related provisions of the DHMO dental plan are satisfactory and the dental plan appears affordable, a DHMO may be a good dental insurance option.

Shop for DHMOs

DentalInsurance.com offers DHMO plans from the following carriers:

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