Your employer may ask you to choose among several types of dental insurance plans. Two of the most common types are the preferred provider organization and the dental health maintenance organization. A PPO plan consists of a network of dentists who partner with the insurance company to offer you discounted rates. DHMO plans contain a network of dentists who agree to provide many services at low or no cost. Under a PPO plan, you will have more flexibility in choosing a dentist, but your out-of-pocket costs may be higher.
Coverage
A DHMO plan will cover your routine exams, X-rays and cleanings. These types of services help dentists discover problems and prevent new ones, such as cavities and gum disease. You may need to pay a co-payment for fillings or extractions. Under a DHMO, the co-payment is usually small and you pay it when you receive treatment. A PPO plan may require that you pay an annual deductible for routine treatments. This means that the plan will not cover the costs until you meet the deductible. Once you meet your deductible, a PPO will cover a percentage of the costs.
DHMO Pros and Cons
A big advantage of a DHMO is that it will probably cost you less money. For most procedures, you'll need to pay only your co-payment. You won't have to worry about a bill from the dentist's office showing up a few weeks later. A dentist who is within the HMO network cannot refuse to treat you. You will have to choose a primary dentist and get referrals from him for special procedures. The number of dentists you can choose from may be small and you will have to pay full treatment costs if you see a dentist out of the network.
PPO Pros and Cons
PPO plans are more lenient when it comes to letting you choose a dentist. You may receive treatment from any dentist. Your costs will be lower when you seek treatment from a dentist in the PPO network and higher when you go out of network. A PPO plan does not require that you select a primary dentist or get referrals before seeking treatment. The major disadvantages of a PPO dental plan are its higher out-of-pocket costs and billing paperwork. A PPO plan may also limit the amount of coverage you can receive in a year.
Patient Costs
You will not pay any out-of-pocket costs for routine check-ups, X-rays or cleanings with a DHMO. A PPO may cover a percentage of these treatment costs once you meet your deductible. For example, a PPO may require a $50 annual deductible. If the cost of your first check-up and cleaning is less than $50, you will pay the full cost. The insurance will kick in for costs that exceed your deductible. If your PPO coverage is 80/20, the plan will pay 80 percent and you will pay 20 percent. The average monthly premium for a DHMO is between $5 and $15, while the premium for a PPO is between $20 and $25, according to iDental Hub.
References
- dentalinsurancehelper.com: What Are HMO Dental Insurance Plans?
- dentalinsurancehelper.com: What Is Individual PPO Dental Insurance Plan?
- Aetna: Dental PPO Benefit Summary FAQs
- DentalPlans.com: Dental Insurance Decisions
- Health Insurance Finders: Dental Health Maintenance Organization (HMO) Plans
- iDental Hub: Comparative View of Different Dental Plans
Writer Bio
Helen Akers specializes in business and technology topics. She has professional experience in business-to-business sales, technical support, and management. Akers holds a Master of Business Administration with a marketing concentration from Devry University's Keller Graduate School of Management and a Master of Fine Arts in creative writing from Antioch University Los Angeles.