When looking for the best dental insurance plans, you want the right balance between covered services and reduced dental costs.
In your search for this balance, you have likely come across two types of dental insurance plans: dental HMO insurance (DHMO) and dental PPO. Which type is the best, and does not sacrifice dental care quality for affordability?
DHMO dental insurance plans are cheaper than other options, such as PPO plans.
This type of dental insurance has lower premiums, no deductibles, and no annual maximums.
Like HMOs, there is a focus on prevention and maintenance.
PPO plans allow for treatment by out-of-network dentists, but with less coverage.
A dental PPO also offers a wider range of covered treatments at a higher price.
A Dental Health Maintenance Organization (DHMO) is a prepaid dental insurance plan that aims to minimize out-of-pocket costs. They provide in-network dental coverage, meaning you can only choose from dentists who have decided to sign up with the insurance company.
A DHMO plan focuses on dental health maintenance. They nudge customers towards prevention and treatment of less serious issues now, rather than waiting for them to become severe problems later. For this reason, you will see basic care fully covered, while dental coverage drops sharply for advanced treatment.
In many cases, the same insurance company will offer different types of dental insurance. You can compare DHMO and PPO plans by cost and covered services together, as their advantages and disadvantages meet different needs.
DHMO dental insurance plans provide cost-effective dental care from a limited range of in-network dentists.
Each DHMO plan will cover a number of dental care services that vary by insurance company. For example, DeltaCare prioritizes preventative care like other DHMOs, so teeth cleanings, X-rays, and examinations are covered from the first day. In the case of DeltaCare, waiting periods apply to some other services, such as fillings, crowns, or root canal.
Aetna Dental, used by some employers such as Princeton University, offers complete coverage for prevention, diagnostic tests, and basic services [1]. Crowns, implants, and other services classified as “major” are 60% covered. Orthodontic care is 50% covered, meaning you would have to pay half of the fees out-of-pocket. You also need a referral to see a dental specialist.
Cosmetic procedures, however, are not usually covered by dental insurance, including DHMO plans. Pre-existing conditions and some specialist treatments, such as braces, are often left out too.
DHMO plans cover a wide range of dental health services, but basic services such as prevention are prioritized.
A DHMO is a prepaid dental care plan, where you are assigned or choose an in-network dentist, and can receive coverage for a predetermined list of dental procedures. In-network dentists have been contracted with the company you receive dental insurance from. If you require a dental specialist, you can access referrals through your primary care provider.
Like other health insurance plans, you enjoy reduced out-of-pocket costs, and pay a pre-specified copayment that you will find on your Schedule of Benefits. This also makes it easier for you to budget for the remainder of your dental care costs.
There is no need for an annual deductible, and there is no annual maximum or need to file a claim on your own. Instead, your primary care dentist or other treating provider will file the claim for you.
DHMO insurance plans are similar to other types of health insurance, where you pay to access significant discounts on a range of services. However, you are limited to providers in the network.
A DHMO is, in essence, a dental HMO. While an HMO covers medical care, a DHMO focuses only on dental health.
Like a typical HMO insurance plan, a DHMO offers lower-price care with a focus on prevention. This makes it easier for you to afford checkups and other maintenance care, lowering the risk that you will develop serious dental problems later and cost your insurance company more.
A DHMO is specific to dental care, while an HMO covers medical expenses.
Dental HMO insurance plans have lower premiums through their prepaid structure. You either select, or are assigned to, a primary dentist if you decide that DHMO plans are the best option. If you don’t like your primary care dentist, you can change them, but only in-network dentists are available.
PPO stands for Preferred Provider Network (Organization), and they make up the vast majority of private dental plans. You can choose care from an out-of-network dentist, but additional costs will likely be higher. Additionally, you do not need a primary dentist.
A dental PPO will often cover a wider range of treatments than DHMOs, as your dentist receives payment based on services provided, instead of a set monthly amount. For this reason, they are often more popular among dentists. Whether or not you need a waiting period before certain treatments depends on your plan.
Your PPO dental insurance plan will likely work with what is known as 100-80-50 coverage. Here, you can expect to have all of your preventative care and diagnostics covered, and 80% of basic treatment such as fillings or root canals. Major procedures, including bridges, crowns, and covered surgeries, will only be 50% covered under this type of plan.
Dental care from a DHMO is aimed at helping you cut costs, while a dental PPO provides more flexible treatment options at higher premiums.
When choosing between dental plans, the most important factors are individual to you.
On one hand, DHMO plans provide you with lower-cost coverage. For routine, standard dental care such as teeth cleanings, where you expect to stick with one primary dentist, a DHMO may be best for you.
They have no annual limit either, so you can be assured of using your benefits for covered dental services all year even if you are on a family plan for children. Adding to their cost-effectiveness is the lack of deductibles, a specific payment you must make before your insurance company will give you coverage.
On the other hand, PPO dental insurance plans are often preferred by both patients and dentists. There is a greater choice of dentists, thanks to the out-of-network coverage and more extensive participation. More extensive funding also allows for a wider range of covered services and higher benefits.
There have been some reports of dentists being dissatisfied with the DHMO plan they signed up for, due to lower profits. Whether your dentist is satisfied with being a participating provider is an important factor, because it can determine your chance of remaining as their patient.
PPO dental plans are often sold to dentists as a method of filling up treatment rooms, so you are less likely to have an overworked primary care dentist. However, there are still complaints of dental services lacking coverage, and some PPO plans do not pay their providers enough despite the higher premiums [2].
While DHMO plans are cheaper and more convenient, PPO dental insurance plans provide for more treatment options with an out-of-network dentist chosen from a wide network of dentists.
What are the most important things to know about a DHMO?
The best dental plan for you depends on your budget and preferences. If you expect to rely on prevention and maintenance, and regularly use dental services, a DHMO is likely right for you, especially if you have children. For advanced care, greater choice of providers, or both, a PPO could be more fitting.
There is no “best” option for you as a patient, but a DHMO can provide significant savings while still accommodating the needs of most people.
