Dental insurance helps you pay for certain costs associated with dental work. There are several types of coverage: indemnity plans without a network, PPOs, and HMOs.
The plan you choose will depend on your needs. You can usually find price quotes online by specifying how many people will be covered.
They’re More Managed
If you enroll in a dental HMO plan, the insurance provider will assign you a Primary Dentist who manages your dental care. The dentist will then refer you to other providers for your services, such as specialist referrals. Dental HMO networks are often smaller than PPO networks.
Preferred Provider Organization (PPO) plans offer more flexibility as they don’t require you to use a select network of dentists. However, that freedom comes at a cost, as your out-of-network benefits are typically less than the in-network fees that dentists are contracted with the insurer to accept.
Dental PPO plans also have a much more extensive selection of dentists than HMO plans and, in many cases, are slightly less expensive. However, PPO plans have a higher monthly premium and a different payment structure. Most dental PPO plans will pay a percentage of the dentist’s allowed charges for covered services and will have an annual maximum.
Moreover, HMO dental insurance in California offers a network-based approach to dental coverage, providing affordable options and access to a specific set of dentists and specialists for comprehensive oral health care.
These are a few of the more popular options available. Unlike the HMO and PPO types of dental plans, indemnity plans don’t have a network. Instead, the plan pays a set percentage of the “usual and customary” fees for the given procedure. Like other dental plans, indemnity plans also have a maximum deductible and annual benefit.
They’re Less Expensive
HMO dental plans have a lower cost structure and prioritize affordability over provider choice. You’ll save money by staying in-network because they require you to select a primary dentist within the network and coordinate all care through that office. But, it’s important to note that DHMO networks tend to have fewer providers than PPO plans, so you may have a concise list of dentists to choose from.
For example, the DHMO plan has only about 175 providers in California compared to the PPO plan, which covers about 285 dentists nationwide. And since DHMOs reimburse dentists for only a pre-determined percentage of a procedure’s usual, customary, and reasonable (UCR) charge, you’ll typically pay more when visiting an out-of-network provider.
PPO dental insurance is different because it offers more excellent dental choices and coverage for out-of-network services. This makes it a better option if you prefer flexibility and want to avoid paying a deductible or annual maximum.
However, it’s important to note that PPO plans typically have higher monthly premiums and out-of-pocket costs compared to DHMO dental insurance. It’s also worth noting that not all dentists accept PPO plans, as they often must agree to discounted rates set by the insurer.
In addition, many dentists won’t take on a PPO patient unless they accept the assignment of benefits, which means that the dentist will submit claims directly to the insurance company and be reimbursed for services provided.
They’re More Flexible
The most significant trade-off with Dental HMO plans is that you must use dentists in the plan’s network. This can be difficult in some areas where few or no Dental HMO providers are available. However, these plans typically have lower monthly premiums than PPO plans, and they often do not include deductibles or annual maximums, which can be crucial to some consumers.
While HMO plans have many advantages, they are only suitable for some. If you want a more extensive choice of dentists, then a PPO dental insurance plan is the way to go. These plans also allow you to see out-of-network dentists, but they will typically cost more.
Alternatively, fee-for-service dental plans (indemnity) let you choose any dentist and are usually less expensive than PPO plans. However, they may cover fewer procedures or provide the same level of coverage.
Dental PPO and Dental HMO are both options for consumers in California who want to enroll in a family dental insurance plan. Consumers can choose a dental plan that works best for them, which allows them to select the number of people they need to be covered and then filter out the plans unavailable in their zip code. However, consumers should keep in mind that only dental plans available are eligible for subsidies from the federal government.
They’re More Popular
The dental insurance market needs to be more precise for many, and the technical terms used to describe plans may be challenging to understand. The most important thing to remember is that each program offers different benefits and costs. If you’re considering a dental insurance plan, it’s best to consult a licensed agent to help you make the right decision for your family’s needs.
Most plans offer a network of dentists who agree to set pre-negotiated rates with the dental insurance carrier for services provided. Visiting a dentist outside the network will often result in higher out-of-pocket expenses. These types of dental insurance plans are called managed-care plans.
DHMO (Dental Health Maintenance Organization) plans are similar to health insurance HMOs in that you’re assigned a Primary Dentist who coordinates referrals to Specialists for the care you need. They tend to have lower costs but less flexibility with provider choices compared to PPO plans.
DPPO Dental Plans are an excellent option for affordable dental coverage with flexibility and choice. The DPPO network includes more providers than the traditional HMO, and most dental insurance companies allow you to visit any dentist that accepts the DPPO network. However, if you choose to see an out-of-network dentist, you’ll pay more for services and may have to wait longer for certain services, such as braces.