This resource summarizes the information you need when shopping for an HMO dental plan including:
A Dental Health Maintenance Organization, or DHMO, is often the least costly type of a dental plan. In these plans, a network of participating dentists, provides broad and affordable care at a low monthly premium. Much of the work is fully covered, or provided at a reduced price. However 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 from the plans dental network. The size of the patient pool for the plan, and the number of dentists that service that pool could impact your ease of use. Your primary dentist may refer you to an in-network dental specialist, if so, you’ll also get a discount for their work. With a DHMO plan there are no waiting periods, calendar year maximums, deductibles or claim forms. Ready to shop for a Dental HMO plan?! Start your search at DentalInsurance.com today.
While a small part of the market compared to PPOs (PPOs have 86 market share),1 HMO dental plans are among the least expensive insurance options. Alongside their savings, HMO plans are known for broad coverage and affordable out-of-pocket costs.
HMO dental insurance is most often lower priced than PPO dental plans and indemnity dental plans with comparable benefits. The foundation of an HMO’s lower price rests in the way the plan is structured. An HMO dental plan (otherwise known as a DHMO) is a health maintenance organization. A health maintenance organization is a type of "managed care" where a primary care dentist is chosen by the enrollee. This primary care dentist Is prepaid an amount for the patient each month and the dentist is responsible for providing benefits under the plan and determining if a referral to a specialist is warranted.
Equally important to the primary care dentist model is the network of dental professionals associated with the HMO. Fewer dental providers are used by an HMO, giving these providers a greater share of the patients covered under the plan. Patients are strongly incentivized to receive dental care exclusively from in-network providers because out-of-network providers are normally not reimbursed by HMO insurance. The HMO's model of managed care produces both low premiums and out-of-pocket costs. Unlike PPO and indemnity dental plans, HMO out-of-pocket costs are often flat-fee copayments (as opposed to coinsurance fees based on a percentage of the total service cost).
Below are examples of how inexpensive HMO coverage can be. Your prices will depend on the cost of dental care in your region, whether you choose single or family coverage, etc.
Guardian Managed DentalGuard starting around $7.74
MetLife TakeAlong Dental HMO-Managed Care 350 (Low) starting around $8.20
Humana Dental Value Plan HI215 starting around $11.99
Dominion National Select Plan Basic starting around $24.58
A choice in dental insurance involves trade-offs. For HMOs, the most common trade-off is the dentist choice restriction of a narrow network versus the very low costs of HMO premiums and out-of-pocket costs. Another HMO trade-off concerns referrals. A referral to a specialty dentist must be made by the enrollee's primary care dentist for an in-network specialist or the HMO plan will not pay for the specialty service. If the primary care dentist does not believe the specialty dentist is necessary for the enrollee, a referral will not be provided even if the enrollee wants to see the specialist. On the subject care not provided by a primary dentist, when shoppers considering an HMO plan know they will need to have a special type of dental work performed, it is wise for them to review how many dental specialists participate in the HMO plan’s network.
One of the overlooked advantages of HMO plans is the common absence of waiting periods. If you need dental care quickly and enroll in an HMO plan, you are less likely to face coverage delays of three months, six months, or an entire year. In PPO and indemnity plans, waiting periods are frequently encountered.
A final consideration is emergency care. Before enrolling, find the plan's policy regarding emergency care needed during travel when the enrollee is outside the plan's network. This can be a major concern for people who frequently travel for business.
HMO Dental Basics: Challenges and Strengths
Some strengths and challenges of HMO dental plans include the following:
HMO Challenges:
HMO Strengths:
A Reputation Based on Trust
We do our best to provide you the best experience ever
Tell your friends and family
Very affordable plans and a wide range to choose from to fit your budget...Belle Chase, LA
Thank you for a pleasant experience
I got signed up for Dental Insurance and your Representative made it very easy...Grantville, GA
A choice in dental insurance involves trade-offs. For HMOs, the most common trade-off is the restriction of a narrow dentist network versus the very low costs of HMO premiums and out-of-pocket costs. Another trade-off concerns referrals. A referral to a specialty dentist must be made by the enrollee's primary care dentist or the HMO plan will not pay for the specialty service. If the primary care dentist does not believe the specialty dentist is necessary for the enrollee, a referral will not be provided even if the enrollee wants to see the specialist. On the subject care not provided by a primary dentist, when shoppers considering an HMO plan know they will need to have a special type of dental work performed, it is wise for them to review how many dental specialists participate in the HMO plan’s network.
One of the overlooked advantages of HMO plans is the common absence of waiting periods. If you need dental care quickly and enroll in an HMO plan, you are less likely to face coverage delays of 3-months, 6-months, or a year. In PPO and indemnity plans, waiting periods are much more prevalent.
A final consideration is emergency care. Before enrolling, find the plan's policy regarding emergency care needed during travel when the enrollee is outside the plan's network. This can be a major concern for people who frequently travel for business.
Some strengths and challenges of HMO dental plans include the following:
HMO Challenges:
HMO Strengths:
Our agents can:
Interested to see if DentalInsurance.com has any HMO options available in your region? Just visit our page for dental insurance quotes. As mentioned earlier, HMO plans comprise less than 10 percent of dental insurance market so DentalInsurance.com cannot guarantee they will have HMO options available in every territory. However, if they do not have any HMO options in your area, they will present alternatives such as PPO plans, indemnity plans, and/or dental savings plan.
In most cases, no. HMO plans achieve their low costs through restricting enrollees to their network of dentists.
They often are less expensive with respect to monthly premiums and out-of-pocket charges for covered dental services. However, if you use an out-of-network dentist, the HMO would not pay for the expense while a PPO plan would (though at higher out-of-pocket costs than if you used an in-network PPO dentist).
Yes, HMO dental plans do have specialists. However, in order to see a specialist, a plan enrollee must first obtain a referral from his primary care dentist. If the primary care dentist does not believe a specialist is justified, a referral will not be given.
There is not a standard HMO network size. The number of dentists and dental specialists (e.g. oral surgeons, endodontists, orthodontists, etc.) vary by HMO plan.
In our Learning Center, we provide a dental insurance guide called “Dental Insurance 101.” This guide provides concise explanations of what are your typical dental plan options are, how a plan decides which services for which it will pay, the big principal concern about dentist networks, waiting periods, premiums, and out-of-pocket costs. By using this guide, you'll gain a solid understanding of your coverage options and be better equipped to choose the right one for your circumstances.
While benefits are not standardized in HMO plans, many have broad coverage that extends to major dental care treatments. Examples of such treatments include root canals, crowns, dental implants, and apicoectomy. In an HMO, the cost-sharing for major dental services is a flat fee copayment (e.g. $674 for a crown as opposed to 20 percent of the cost).
The most common basic dental care treatments in an HMO plan are fillings and tooth extractions. A filling may be a traditional (amalgam) filling or a white (composite) filling. A tooth extraction is the removal of a tooth due to damage, gum loss, or other reason.
X-rays are also (used outside of preventive care) as another form of basic dental treatments covered by an HMO. Basic dental care treatments address minor problems and seek to prevent more serious dental problems from developing.
Preventive care includes routine exams (yearly or twice a year) to address oral care problems before they develop into more serious conditions. At the same time as the routine exam, a dental office will likely provide professional teeth cleaning to preserve good oral health and prevent gum disease. Children may also receive fluoride treatments and/or sealants as part of preventive care. These treatments are intended to prevent cavities and strengthen teeth.
For non-emergency office visits under the dental value plan, the fee is $15.
Preferred provider organization (PPO) dental plans, indemnity dental plans, and dental discount programs are all alternatives to HMO plans.
No, there are many insurance companies across the United States and DentalInsurance.com attempts to do business with the best of them. However, DentalInsurance.com does not offer every insurance company or every insurance plan type available in the country.
Most HMO plans allow for direct online billing to a credit card. Some may allow you to pay by mail or by phone. Paying your premiums for the dental value plan can be done in several convenient ways.
See the section above labeled “<a href="#hmo-dental-plans">HMO Dental Plans in Your Area</a>.”
Visit our page for dental insurance quotes page and enter your zip code and other information to review your local dental plan options. When the quote page displays with your different insurance options, you will see a link labeled “Dentist Search” on each plan. Click this link for the plan(s) that interest you.
HMO dental plans normally lack a maximum benefit limit on what the insurance company will spend for an enrollee’s covered dental services each year. Maximum benefits are commonly observed for PPO dental plans and indemnity dental plans.
While waiting periods are possible, they are less frequently observed in HMO plans than PPO or indemnity dental plans.
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.
