PPO Dental Insurance Review: Is It Better Than HMO?

PPO Dental Insurance Review: Is It Better Than HMO?

Choosing the right dental insurance plan is about knowing the pros and cons of your choices and considering your individual needs and those of your family. One of the most common dental insurance plans is PPO dental insurance.

Below, we’ll help you better understand this dental plan to help you pick the best one for your and your family’s needs and avoid costly, unplanned medical bills.

 

Key Takeaways

  • PPO insurance involves a group of medical facilities and providers under contract with an insurance company to provide low-cost services.

  • A PPO plan covers all healthcare services offered by medical facilities and practitioners within the network.

  • PPO subscribers aren’t required to choose their primary care provider or have referrals to receive treatment.

  • PPO dental insurance plans cover costs of primary care, major restorative dental care, and preventive services.

  • PPO insurance offers subscribers access to a more extensive network of dentists and other healthcare specialists.

  • You’ll find higher premiums, deductibles, and copayments in a PPO than in an HMO dental plan.

  • No waiting period in PPO dental insurance plans means patients can receive different dental treatments on the exact same day.

 

What Is PPO Insurance?

PPO (preferred provider organization) is a type of health insurance plan that involves a national network of medical providers (doctors, hospitals, etc.) contracted to a health insurance firm to provide affordable treatment

A PPO is a type of managed healthcare insurance plan that’s similar to a health maintenance organization (HMO), point-of-service plan (POS), fee for service (FFS), high-deductible health plan (HDHP), and exclusive provider organization (EPO). 

If you get treated by an in-network dentist, you’ll pay less [1]. You can use a dentist outside of the network at an extra cost.

You will likely have to pay an annual deductible before the insurance provider starts paying your medical bills. Moreover, you may need to copay for some treatments or pay a certain fraction of the total cost of your medical bills.

 

What Does a PPO Plan Cover?

A PPO plan covers all the treatment provided by dentists within the PPO network. Referrals aren’t required to see a network dentist, and subscribers are encouraged, rather than required, to choose their primary care provider. Subscribers can receive dental insurance coverage out of the network, but it typically costs more.

Summary

PPO insurance covers all types of dental treatments provided by dentists in the PPO network at a discounted price. You don’t need to choose your primary care provider or have a referral to get treatment. PPO also allows you to receive treatment out of the network, but you’ll have to pay more.

 

What Does PPO Dental Insurance Cover?

PPO dental insurance covers the costs of preventive care services such as oral exams, certain X-rays, and routine cleanings. It also covers basic care procedures like fillings, non-surgical extractions, and emergency treatment for pain relief. Preventive dental services have no waiting periods.

  • Preventative dental care: This typically covers oral tests, teeth cleanings, fluoride treatments, sealants, and specific types of X-rays. Age restrictions and restrictions on how many preventive dental services a network dentist can render per year may apply.
  • Fillings, extractions, root canals: For these essential dental care services, you pay a deductible and then a percentage of the costs covered by your dental plan up to an annual maximum.
  • Dentures, bridges, crowns, etc.: Major restorative dental care services such as dentures, bridges, crowns, gum grafts, and oral surgery procedures are often covered up to a specific amount. Check your PPO dental plan for more information.
  • Braces and additional orthodontic care: Some PPO dental insurance plans offer coverage for braces and other orthodontic treatments. These plans may have age limitations, too.

Before you sign up for any PPO dental plan, be sure to go through the details of the plan’s coverage, like out-of-pocket costs, limitations, exclusions, annual maximum, and potential waiting periods.

Summary

PPO dental insurance provides coverage for preventive, primary, and major restorative dental services. These services come with different limitations, costs, and possible waiting periods.

 

What Is PPO Good For?

PPO offers subscribers a broader network of dental facilities and dental specialists. This plan doesn’t restrict you to one primary care dentist, meaning you can see a dentist without a referral [2].

Therefore, PPO is a great option for those who want extra flexibility when selecting their dentists, those who need to visit dentists regularly because they suffer from chronic dental problems, or people who travel often.

 

PPO Pros

What We Like

  • Broader network of dentists, unlike in DHMO plans, for instance
  • Higher flexibility overall when picking a dental facility or dentist
  • No referrals are required to visit dental providers, unlike a dental HMO plan
  • Freedom to visit out-of-network dental facilities or dentists
  • You can get a partial dental insurance reimbursement after getting treated by an out-of-network provider, depending on your plan, by filling out claim forms

PPO Cons

What We Don't Like

  • Higher monthly premiums than an HMO dental plan
  • Typically includes higher annual deductibles than a dental HMO plan
  • Can have higher copayments than an HMO dental plan

Summary

PPO is an excellent choice for people who want added flexibility when picking their dentists, those who regularly travel, and those who regularly need dental treatments due to long-term dental issues.

 

Why Is PPO More Expensive?

Preferred provider organization insurance typically has higher monthly premiums and out-of-pocket expenses, such as deductibles. You generally have to sort out both copay and coinsurance as well. 

This is the price you pay for the flexibility provided by PPO, which allows you to use dental specialists both within the PPO network and outside of it without requiring referrals.

The cost of deductibles and coinsurance may differ for services provided by out-of-network and in-network dentists. Without a primary care dentist, some people may find it overwhelming to be more responsible for their own care. 

Summary

Due to higher monthly premiums, out-of-pocket costs, copayments, and coinsurance, PPO is more expensive than other insurance plans, including a DHMO plan.

 

What Is PPO Dental Insurance No Waiting Period?

A PPO dental plan with no waiting period refers to patients not having to wait for coverage for primary, preventative, or major dental services—and occasionally even orthodontic treatments. 

PPO dental plans with no waiting period are ideal for people postponing dental care because of the cost involved or someone who needs to undergo a major dental treatment.

Summary

No waiting periods in PPO plans are best for people who need major dental treatments or those putting off dental treatment.

 

What Is Better: HMO or PPO?

DPPO and dental HMO insurance plans have their key differences and pros and cons, so your decision largely depends on your or your family’s healthcare needs. Here are some critical facts that can help you decide between the two insurance plans:

  • More people have a DPPO insurance plan than a DHMO plan.
  • In 2020, 47% of insured employees had DPPO plans, compared to only 13% of employees with DHMO plans, according to the Employer Health Benefits Survey conducted by Kaiser Family Foundation [3]

Generally speaking, a DHMO dental plan might be the right option if lower premiums matter the most to you, you want to save money, and you don’t mind having a primary dental care provider. However, make sure first to review the covered services since some might be limited.

On the other hand, if you want to continue seeing out-of-network dentists, then a PPO could be a better option. 

Summary

There’s no better option between a DPPO and DHMO plan. When choosing between the two, what matters most is your or your family’s specific healthcare needs. 

 

FAQ

PPO is quite a common term when it comes to dental health insurance. Here are some of the most commonly asked questions about PPO dental insurance.

 

What Does Dental PPO Mean?

Are DPPO and PPO the Same?

Does PPO Have Copay?

Is a PPO Worth It?

 

PPO Dental Insurance: Conclusion 

Different dental insurance plans come with different kinds of coverage. A key feature of each plan is the ability to access a countrywide network of participating dental specialists. One popular network plan is PPO (participating provider organization). 

Before you choose any PPO plan, be sure to find out the specific restrictions of that plan in addition to out-of-pocket costs (such as premiums, deductibles, and copays). Moreover, talk to your primary care dentist to know what type of coverage is accepted in their facility before weighing up different PPO dental plans.

 

References:

  1. Sonomacounty.ca.gov. 2022. Delta Dental PPO. [online] Available at: https://sonomacounty.ca.gov/administrative-support-and-fiscal-services/human-resources/divisions-and-units/benefits/retiree-benefits/medical-dental-vision-and-life/dental-retirees/delta-preferred-option-for-retiree [Accessed 10 August 2022].
  2. 2022. [online] Available at: https://www.ers.texas.gov/active-employees/optional-add-on-benefits/state-of-texas-dental-choice-plan-delta-dental [Accessed 10 August 2022].
  3. KFF. 2022. 2020 Employer Health Benefits Survey - Summary of Findings. [online] Available at: https://www.kff.org/report-section/ehbs-2020-summary-of-findings/ [Accessed 10 August 2022].

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