HMO vs. PPO Dental Plans

 

As you shop for the right dental insurance plan, you’ll come across some terms that might be a little confusing if you’ve never heard of them before. A couple of examples are PPO and HMO. What do these abbreviations stand for? And what are the levels of coverage that these two options provide? 

To help you navigate the world of dental insurance more easily, we’ve compiled some information on HMO vs. PPO dental plans. Once you understand what these mean, you’ll be able to make smarter choices when browsing policies. 

The difference between HMO and PPO dental plans 

HMO stands for Health Maintenance Organization, while PPO stands for Preferred Provider Organization. You might also see these written as DHMO and DPPO to specify that they’re dental policies rather than medical policies. 

What does PPO mean in dental insurance?

Let’s start by going over what a PPO dental plan typically features:

  • If you’re worried about being able to see a dentist of your choice, a PPO plan is the better way to go. That’s because these policies let you see any dentist, without needing to worry about selecting one who’s in-network. However, if you select an in-network provider, you’ll be able to save more money, so that’s something to consider.
  • You likely won’t be required to choose a primary dentist with this type of plan. And you’ll also have more flexibility when it comes to specialists because you won’t need to get a referral to see one.   
  • With this type of dental policy, you might have an annual deductible, which is an out-of-pocket cost that you’re required to meet before certain types of coverage will be provided by the insurance. 
  • There may be an annual maximum amount that the insurance is willing to pay for dental services that you need in a year. If you surpass this amount, you’ll be required to pay for the rest of your care out-of-pocket. 

What does HMO mean in dental insurance?

When it comes to HMO plans, here are some of the main features:

  • In terms of choosing a dentist, an HMO is more restrictive, as coverage is only provided if you see an in-network dentist. However, there might be some situations, such as emergencies, when you might receive coverage if you need to see an out-of-network provider. 
  • You’ll likely be required to select a primary dentist. And you usually need to get a referral if you need to see a specialist. 
  • Oftentimes, HMO dental policies don’t have an annual deductible that you’ll need to worry about paying, so this may be helpful if you’re on a tight budget. 
  • When it comes to annual maximums, an HMO policy may not have one, so you won’t need to worry about hitting a limit if you need expensive dental care.

 HMO or PPO dental: what’s covered?

Generally, dental HMO plans and dental PPO plans will provide coverage for the following services:

  • Preventive care is often covered completely. This means the insurance will take care of 100% of the cost of things like exams, cleanings, sealants, fluoride treatments, and X-rays.
  • Basic services, such as fillings for cavities, extractions, and root canals , will also be covered, but details vary between HMOs and PPOs. For example, with a PPO, you might be required to reach your deductible, and then you might need to cover a percentage of the cost of treatment. With an HMO, you might only be required to pay a fee.   
  • Major services, such as bridges, crowns , dentures, implants, and oral surgery, are also often covered by PPOs and HMOs, but you will be required to cover some part of the cost. 
  • Orthodontic coverage isn’t something that comes with every dental plan, so if you want it, narrow your options to those policies that include it. You might be required to pay a portion of the cost, and there might be limits on coverage as well. 

Keep in mind that different plans might categorize services differently. And they also might have limits on the amount of care you can receive for each category. Therefore, it’s important to read the details carefully before signing up for a plan. 

Is PPO better than HMO?

For some patients, a PPO dental insurance plan is better than an HMO. For others, the opposite is true. It depends on your expectations, needs, and budget. 

Dental insurance HMO vs. PPO

Generally, HMO dental insurance might be a better option if you want to keep costs down. These plans typically come with lower monthly premiums and affordable copays, and they may not have a deductible or annual maximum to worry about either. Just keep in mind that, despite the savings, you may face more restrictions when it comes to how many treatments you can receive in a year, as well as which dentist you can use. Also, if you really want to see a dentist who isn’t in-network, your insurance won’t help cover the cost.  

Why would a person choose a dental PPO over an HMO, even though it’s pricier? Well, if you prefer a plan that gives you more flexibility, thanks to a bigger network of providers and the ability to get at least some coverage for out-of-network dentists, a PPO might be more appropriate. However, these plans may come with higher premiums and copays, as well as deductibles and annual limits. 

 

Take your time when searching for the ideal dental plan

Now that you understand the basics of DPPOs vs. DHMOs, you can shop smarter when you’re ready to enroll in a plan for yourself or your family. Remember to check the specific details of any plan you’re interested in. That way, you’ll be aware of all of the requirements, from waiting periods to coinsurance. 

If you’re ready to browse the insurance options available in your area, you can begin by using the Direct Benefits Marketplace . There, you’ll find plenty of PPO dental insurance plans, as well as HMO options, that will suit your needs.