What’s the Difference Between Dental Insurance PPO and HMO?
Numerous dental insurance plans, such as preferred provider organizations (PPOs) and health maintenance organizations (HMOs), are available on the insurance market. Preventive, basic, and rehabilitative care are covered by both kinds of insurance, but their costs and levels of flexibility vary. It’s crucial to comprehend how each dental insurance plan operates and how effectively it may meet your wants for dental treatment before signing up for an HMO or PPO.
Dental PPO Plans
Dental PPO plans, also called DPPOs, make up 86% of the commercial dental market, according to the National Association of Dental Plans.
These plans charge higher premiums than HMOs but offer more flexibility when choosing a dentist or specialist.
PPO Protection
Preventive care including x-rays, cleanings, and examinations are usually included under PPO plans. Additional services including fillings, crowns, root canals, and gum disease treatments may also be covered by the PPO, depending on the plan.
According to Peter Pinto, CEO of Deering Dental in Miami, Florida, waiting periods are a major drawback of PPO plans.
According to him, a waiting period is a time when only essential procedures like cleanings, examinations, and occasionally fillings are covered. These blackout periods often last six months to a year. “Until the waiting period is over, your plan will not cover anything else you need.”
PPO Expense
PPOs often have premiums that are greater than those of DHMOs. Individual DPPO plans run around $35 a month, according to the NADP.
For preventative care, you usually receive 100% cost coverage. You will have to pay a deductible each year, which is a sum of money (usually between $50 and $100) that you have to pay before your plan starts to cover further treatments.
Either a fixed payment or a portion of the total cost, such 50% or 60%, will be covered by the insurer.
Typically, PPO dental plans have a $1,000 or $1,500 annual coverage cap.
The plan makes no more payments for the remainder of the year once your insured claims have reached this sum.
Covered HMO Services
Similar to PPOs, DHMOs typically pay for any preventative care provided by the in-network dentist of your choice. Other conventional procedures like crowns, implants, and fillings are also covered by the insurance. According to Pinto, these plans usually don’t have a waiting time for any services.
However, some procedures and costs, such tooth whitening or upgrades to gold or porcelain for molar restorations, could not be covered by your DHMO. Or the frequency of your dental care may be restricted by your dental HMO.
If you require the care of a certain expert for certain or more complex dental procedures, DHMO restrictions on non-network providers may be difficult to navigate.
Cost of an HMO
According to Pinto, “dental care is very affordable with HMO plans because they are usually less expensive and have small co-pays.”
DHMOs have no deductible and premiums are only about $14 a month on average.
You must pay a fixed copay for treatments under an HMO. Most of the time, preventive care is covered in full, but sometimes you have to pay a set amount, like $65.
All other treatments, including fillings, have a copay of $28. If you don’t like the thought of maxing out your coverage, dental HMOs can be a suitable option for you because they seldom have a plan limit.