This article provides the most important facts quickly so you can get back to shopping and find the best coverage for your needs. In this article, you'll learn:
PPO and HMO both refer to the type of dentist network associated with the insurance plan. PPO is an acronym for "Preferred Provider Network" and HMO stands for "Health Maintenance Organization." Today about eight-in-ten private dental plans in the U.S. are PPOs while less than one-in-ten are HMOs. HMOs pay their dentists a set monthly amount for each enrollee regardless of the services they use. A PPO reimburses a dentist based on services rendered.
Typically, an HMO dental insurance plan has a narrow network of participating dentists and services received from out-of-network dentists won't be paid for by the dental plan. A PPO dental insurance plan, in contrast, offers coverage for dental care received outside its network but it comes higher out-of-pocket costs for the plan enrollee. A PPO plan also does not require a referral before going to a dental specialist while an HMO plan will require such a referral from the enrollee's primary care dentist.
Neither HMO nor PPO dental plans have standardized benefits. However, HMO plans in the market seem less likely to offer very limited benefit coverage. Instead, many HMOs provide comprehensive insurance that covers preventive, basic, and major dental services. This is not to say that individual HMO plans always cover more expensive services such as crowns or dental implants, but that that they frequently do.
Among dental plans the network acronyms often have the letter "D" in front of them so instead of PPOs and HMOs, there are DPPO and DHMO plans. Don't worry. The "D" stands for "dental” and the guidance regarding the two network types still applies.
Dental plan premiums vary by several factors:
With that said, PPOs often have higher premiums than HMOs because PPO enrollees have more freedom with respect to dentist choice and the use of dental services. With respect to the latter issue, instead of a primary care dentist within an HMO deciding whether a specialist referral is necessary, the enrollee in a PPO can make that decision without need of a referral. HMOs not only restrict referrals to the judgment of a primary care dentist, there is also a tendency among these plans to have fewer in-network providers (i.e. a narrow network).
While the differences between dental HMO plans and dental PPO plans are not especially complicated, the wrong choice can have negative consequences for either your wallet or your oral health. Learn what the two biggest concerns are when choosing between a dental PPO and HMO on the second page of this article.
HMO plans usually have fewer dentist options than PPO plans. This small pool of provider options is sometimes referred to as a “narrow network.”
Out-of-pocket expenses vary by dental plan, whether PPO or HMO. PPOs often have cost-sharing fees that are based on a percentage of the plan’s negotiated price for dental care while HMOs, in contrast, have a predetermined dollar amount charged as a copayment.
When considering PPO dental plans against HMO plans, it's important to note that PPOs typically involve a deductible of $50 to $100 an enrollee while HMOs often have no deductible. With a deductible, an enrollee must pay (out-of-pocket) the deductible amount of covered dental treatments before his or her insurance begins to assist with costs.
It is not customary for an HMO dental plan to have a maximum limit, which is the maximum amount the insurance will pay for covered dental procedures in a year. Most PPO plans have such a limit.
A dental payment plan is at the discretion of your dentist. In a dental payment plan, a patient is allowed to pay off an expensive procedure in smaller amounts over time rather than in a lump sum. Normally there is a contract defining how much is owed by the patient, what the installment payment amount is, how long the installments must be paid, and what fees or interest will be charged alongside the original cost of dental care.
It is possible, though not common, for an HMO dental plan to place restrictions on the number of covered dentist visits and treatments per year.
Yes. However, an enrollee in an HMO plan must pick a new primary care dentist from the plan’s in-network choices.
Our knowledgeable customer service team will assist you with any questions you may have prior to enrolling in a dental plan. They can guide you through the process of choosing coverage that matches your needs as well as your budget.
