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HMO Dental Insurance

A dental health maintenance organization or DHMO is a type of “managed care.” With this type of coverage, a network of highly qualified dentists provides comprehensive and affordable care for individuals or families. Consumers choose a dentist from the network, and they pay a low monthly premium to receive services at either no cost or a reduced price (some services may require a copayment). The participating dentists receive fixed monthly fees.

HMO Dental Overview: What is a dental health maintenance organization?

A dental health maintenance organization (DHMO) is a structured type of dental plan. With these plans, the plan’s approved dentists provide broad and affordable care for a low monthly premium. Most of the work is done at no cost or for a reduced price. In addition, you may need to make a copayment for some types of work.

How HMO Dental Plans Work

With a DHMO plan, you will need to choose a primary dentist to work with. You must also 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.

This type of plan, which is also called a “capitation plan,” is most often the least costly type of dental plan 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.

HMO Dental Plans 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 work you need to have done before you go in for care. 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.

HMO Dental Basics: Challenges and Strengths

Some strengths and challenges of HMO dental plans include the following:

DHMO Challenges:

  • 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

DHMO Strengths:

  • 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