Dental HMO and PPO Insurance Plans offer similar dental benefits. HMOs are a low-cost solution for in-network dentists, while PPOs usually cost more but offer greater flexibility.
If you are shopping for a dental insurance plan, knowing the differences between dental health insurance plans will help you pick the best one for your needs. A dental health maintenance organization (DHMO) vs. a dental preferred provider organization (DPPO) plan differs in cost, flexibility, and defined networks. Here, you can find everything you need to know about dental HMO vs. PPO plans to find the best fit for your family.
Key Takeaways
- Both dental HMO and PPO Insurance Plans offer dental coverage to reduce your out-of-pocket costs.
- Dental HMOs require you to see an in-network dentist, but there’s no deductible and lower monthly costs.
- PPOs allow you to choose from a larger network or go out of network with reimbursement. However, PPOs usually have higher monthly costs.
What Is a Dental Health Maintenance Organization (DHMO) Plan?
A dental HMO plan or DHMO offers no annual maximum covered benefit, and any out-of-pocket costs are usually predetermined. This can help you control dental spending and save more overall on coverage. With a DHMO, you can access a network of dentists under contract with the insurance company. If you choose an out-of-network dentist, you'll have to pay out of pocket.
Advantages of a Dental HMO Plan
Dental HMOs are great for families happy with an in-network dentist and like to control costs. Here is a summary of the pros of a DHMO:
- No deductible
- No annual maximum
- Lower premiums than a DPPO
- Set co-payments for covered services
- Little or no co-payment for diagnostic and preventive care
Disadvantages of a Dental HMO Plan
While a Dental HMO offers a lot of advantages, like low cost and good coverage, here are the disadvantages to consider:
- You usually have to choose a primary care dentist from a preapproved list
- A smaller network of dentists
- You may need a referral from your primary dentist to visit a specialist
- You'll pay 100% of out-of-network costs
What Is a Dental Preferred Provider Organization (DPPO) Plan?
A dental PPO plan or DPPO is a good solution if you want the flexibility to choose your dentist without the limitations of a small network. With a DPPO, you'll usually have higher out-of-pocket costs and a deductible, but you can choose your dentist or remain with your long-term dentist. You also usually do not need a referral to see a specialist.
Like DHMOs, DPPOs have a network of dentists under contract with a dental insurance carrier. But with one key difference: You can choose to see dentists in the insurer's network or choose dentists or specialists out of network. Usually, in-network dentists' costs are less, allowing you to save more.
Advantages of a Dental PPO Plan
If you've got a dentist you love that isn't in a DHMO plan, a DPPO offers many benefits. Here are some other key pros to DPPOs:
- A larger network of dentists from which to choose for in-network care
- Visit any dentist or dental facility without limits
- No referrals to visit a specialist
- You don't have to designate a primary care provider (PCP)
- Receive partial reimbursement for covered services from out-of-network dentists (varies by plan)
Disadvantages of a Dental PPO Plan
While a DPPO offers a lot of advantages, there are a few disadvantages to consider, including:
- Higher premiums than DHMO plans
- Deductibles on most coverage, meaning out-of-pocket costs may be higher than DHMO plans
- You can only use coinsurance after the deductible is met
- Annual coverage limits vary by provider but can be lower than your needs
- Choosing DPPO coinsurance or co-payments may cost more
- To receive reimbursement for an out-of-network dentist, you'll need to file claims, and there may be a waiting period
DHMO vs. DPPO Insurance Plans: What Are the Similarities?
At their core, both DHMO and DPPO plans aim to provide excellent coverage and minimal out-of-pocket costs. They're designed to adapt to your family's unique needs.
Both types of plans have networks of dentists under contract with the dental insurance company, which can help reduce your out-of-pocket dental expenses. DHMO and DPPO plans can be purchased by individuals or offered as an employee benefit. Similarities include:
- Coverage: Both plans provide dental coverage and may include up to 100% coverage for preventive care.
- Network: Both plans have a network of dentists from which customers can choose.
- Offerings: Employers can offer either type of plan as an employee benefit. You can also purchase either plan individually. You can also get a dental insurance plan as a self-employed professional.
- Waiting periods: Both HMO and PPO plans may have a waiting period, although you can find plans with no waiting period.
DHMO vs. DPPO Insurance Plans: What Are the Differences?
While the basics of DHMO and DPPO plans are the same, there are also some major differences, including:
| Features | Dental HMO | Dental PPO |
| In-network requirement | Must be in-network | Can be reimbursed for covered out-of-network care |
| Out-of-network coverage | Out-of-network visits are not covered | Can choose an out-of-network dentist or specialist |
| Cost | Lower monthly premiums than comparable PPO plans | Higher premiums than comparable HMO plans |
| Deductible | No deductible | Have an annual deductible. Some plans waive the deductible for in-network preventive services |
| Coinsurance | DHMO plans may base benefits on coinsurance percentages (some don't) | DPPO plans base benefits on coinsurance percentages |
| Copay | Set co-payments. Usually, minimal or no co-payment for preventive and diagnostic care. | Depends on the service. |
| Annual maximum | No annual maximum | Stated annual plan maximum |
| Waiting period | ||
| Primary dentist requirement | Primary dentist required | No primary dentist is required |
| Network size | Smaller network size | Large network size (and can go out of network) |
| Specialist referrals | Requires specialist referrals | No specialist referrals are required |
| Claims process | No claims necessary | Must file claims for out-of-network dentists |
| Preventive care | 100% Covered (depending on plan) | 100% Covered (depending on plan) |
| Basic restorative care | Covered with a flat fee (depending on plan) | Covered (depending on plan) |
| Major restorative care | Covered (depending on plan) | Covered with a deductible (depending on plan) |
Find the Best Dental Insurance Companies From Benzinga’s Top Providers
If you want better coverage or to switch plans, you can find the best dental insurance from Benzinga's trusted providers here.
- Best For:No annual maximumsVIEW PROS & CONS:securely through Careington Dental's website
- Best For:Young adults and families with children and teensVIEW PROS & CONS:securely through Guardian Dental Insurance's website
Choosing Between a DHMO vs. DPPO
DHMO and DPPO plans can minimize out-of-pocket dental costs to help you access affordable dental care. If you're on a tight budget and want good dental coverage without additional costs, a DHMO plan is probably right for you. On the other hand, if you need to see specialists and want the freedom to go out-of-network with a deductible, choosing a DPPO is a great option.
In either case, carefully compare costs, coverage limits, and provider offers to choose a plan that protects your family while helping you save more. To get started, check out average dental costs, compare dental insurance, including full coverage insurance, and then find our review for the best dental insurance providers. You can also compare dental savings plans or find dental plans in the Government's Healthcare Marketplace.
Frequently Asked Questions
What is the difference between a dental HMO and a dental PPO?
With a dental HMO, you must visit a primary care dentist within the DHMO network, while a DPPO will let you visit any dentist and get a reimbursement for covered costs.
Can I keep my current dentist if I switch from a dental PPO to a dental HMO?
You can keep your current dentists when you switch to a DHMO as long as that dentist is within your DHMO’s network.
Can I receive coverage for orthodontic treatment under both dental HMO and PPO plans?
Yes, you can receive coverage up to your plan limit for orthodontic treatment under both HMOs and PPOs. PPOs often cover up to 50%, while HMOs may not cover treatments or only certain treatments with in-network providers.
Dental Insurance Methodology
To determine the best dental insurance providers, we pored through all United States carriers. We winnowed the list by only including companies that have a wide coverage area and product offering. To further break down the list to the true best dental insurance providers, we gave weight to carriers that offer discounts, are available in all states and have multiple payment plan options.
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About Alison Plaut
Alison Kimberly is a freelance content writer with a Sustainable MBA, uniquely qualified to help individuals and businesses achieve the triple bottom line of environmental, social, and financial profitability. She has been writing for various non-profit organizations for 15+ years. When not writing, you will find her promoting education and meditation in the developing world, or hiking and enjoying nature.