A dental health maintenance organization (DHMO) is a structured type of dental plan. In this type of plan, a set group of dentists provides broad and affordable care at a low monthly premium. The dentists who work with DHMOs receive a fixed fees each month. Most of the work is done at no cost or for a reduced price. You may need to make a copayment for some types of work.
If you get a DHMO plan, you will need to choose a primary dentist to work with. And you must let the plan provider or carrier know if you want to change your dentist. There are no waiting periods, calendar year maximums, deductibles, or claim forms when you have a DHMO plan.
To help you master a few of the basics, here are definitions of twenty of the most frequently used terms you’re likely to see if you’re in the market for dental insurance.
This type of plan, which is also called a “capitation plan,” is most often the least costly type of dental insurance plan that you can buy. Not that dentists need it, but DHMO plans do give them even more reason to help keep you well. When you stay well, they can avoid doing more free work.
DHMOs and You: What to Consider
Many people look to a DHMO plan when they need work to be done in the next month that they can’t put off until the waiting period on their PPO or Indemnity plan can be met. Also, with a DHMO, it is easy for you to know the cost of the work you need to have done before you go in to have it done. This is because DHMO services have copays. The cost of the work is not paid through coinsurance.
Other than office visits, exams, x-rays, and cleanings, the work you have done through a DHMO most often requires a copay for services. As a rule, work that is not spelled out in the plan’s summary of benefits is not covered.
If you think you may want to buy a DHMO plan, it’s a good idea to be alert to some key details. For instance, those who get a DHMO plan should look at the average time people on the plan have to wait between their dental visits. Also, ask about the size of the patient pool for the DHMO plan and try to learn how many dentists serve that pool.
If you know you will need to have a special type of work done, it is also good to learn how many dental specialists take part in the plan. Your main dentist can refer you to a dental specialist, and you’ll get a discount for the work they do.
Lastly, get to know all of the plan’s rules about emergency dental care for when you travel or are away from home.
Summary of DHMO Challenges and Strengths
- Other than office visits, exams, x-rays, and cleanings, most work usually requires a copay
- Most often, plans do not cover treatments that are not spelled out in the plan’s summary of benefits
- You will have to wait a set time between dental visits
- The size of the patient pool for the DHMO plan and the number of dentists who service that pool could impact ease of use
- For work to be covered, you have to choose a primary care dentist
- DHMOs are good for those who need work done in the next month but who can’t wait for another plan’s waiting period to be met
- You’ll know the cost of work up front
- Provides broad and affordable care from a set group of dentists
- Dentists provide work at either no cost or a lower price
- Dentists have an added incentive to keep you well
- Most often the least costly of dental plans
- There are no waiting periods, calendar year maximums, deductibles, or claim forms
- Your main dentist can refer you to a dental specialist, and you’ll get a discount for their work
Shop for DHMOs
DentalInsurance.com offers DHMO plans from the following carriers: