The Two Biggest Concerns When Choosing Between PPO & HMO Dental Insurance Plans

By Insurance Industry Expert & Author
Updated on

Dental PPO Plans versus Dental HMO Plans - Part 2

The two biggest concerns when deciding between PPO and HMO dental plans concern costs and dentist choices. HMOs generally have cheaper premiums, lower copays, and no annual limit on what the dental plan may spend on your dental care. PPOs advantages focus squarely on dentist choice. They typically have wider networks than HMO plans and also allow for out-of-network dentists (as long as they are licensed). The material below will provide a more detailed exploration of these issues.

Why Choose an HMO Dental Plan?

If the lowest cost monthly premium is your top priority, then a HMO plan may be right for you. The HMO plan may also have a $0 deductible and/or lower out-of-pocket costs for covered services like fillings, sealants, and crowns. However, HMOs may have a smaller network of dentists, which means you have fewer from which to choose as an enrollee. If you have a preferred dentist, you should confirm his or her acceptance of the HMO plan before enrollment. There are some exceptions to HMO in-network restrictions. Certain types of dental emergencies can qualify for coverage of out-of-network care. Additionally, state law may also have some requirements pertaining to out-of-network dental services.

Most HMO plans lack a limit on annual dental care spending but you should not assume this is the case. Coverage conditions are always specific to the plan itself. A HMO plan may also have restrictions on the number of times care is used in a year (e.g. teeth cleanings, x-rays). Be certain to review these restrictions before enrollment.

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Why Choose a PPO Dental Plan?

If you worry about the range of dentists who might be available, as well as the number of specialists such as oral surgeons, a PPO may be a better option for you. If you decide to use an out-of-network dentist with a PPO, you may need to file the claim to the insurance company yourself. If you remain in-network, the dentist should file the claim for you. If you do consider a PPO remember that most PPO plans have a maximum annual benefit. A maximum annual benefit is the limit what the insurance plan will pay for your dental care in a year.

Similarly, PPOs are more likely than HMOs to have waiting periods before certain types of expensive procedures will be covered by the dental plan. While these waiting periods are plan-specific, they are an important point of comparison when evaluating the value of a PPO vs a HMO dental policy. If you need a dental procedure immediately and your insurance plan has a waiting period for it, you will pay 100% of the costs if you receive the care prior to the expiration of the waiting period.

I always warn ”Insurance is only as good as the doctors and hospitals that accept it.” This applies to dental coverage too. In other words, a HMO or PPO is only as good as the dentists who will accept it.

Before enrollment, check out the dentists who accept the dental plan. Do they receive good ratings from third-party sources such as Healthgrades, the Better Business Bureau, and Yelp? Have any of your friends or relatives used dentists from the plan’s network? Would they recommend them?

The choice between a DHMO and DPPO is a critical piece in determining what dental plan to select, but it is not the only piece. Plans that provide access to the quality dental practice of your choice must be evaluated against one another for their breadth of benefits (see our article Dental Insurance 101) and the price they charge for those benefits.

The following link will return you to the first page of the Dental HMO vs PPO article or you can review dental plan options in your area here.

Need help choosing a plan? Call us at 800-296-3800

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.

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