7 Differences Between DHMO Dental vs PPO Dental

By Deborah Pinnock on Dec 2, 2020 @ 10:05 AM

Dental insurance is a great way to save money on dental procedures and maintain good oral health. However, with so many different plans available, it can be overwhelming to choose the right one.

Say you've finally narrowed down your dental benefit choices and decided to choose a dental HMO or dental PPO plan. And this is where it gets foggy. What's the difference between these two types of dental plans? Which is the best plan for you right now? You've probably been talking with co-workers, friends, or family members, trying to find someone to break it down. To help, here are seven differences between DHMO and DPPO dental plans that will allow you to confidently pick the plan that's right for you and your family.

1. Premium Cost

DHMO insurance plans use a pre-paid design, meaning their premiums are typically the least expensive of all dental insurance plans.

DPPO plan premiums are based on a fee schedule the provider and the dental insurance company agreed to, meaning they tend to be more expensive.

2. Primary Care Dentist

DHMO dental plans often require you to select and be assigned to a primary care dentist. You can switch dentists once a month by calling your dental insurance company. Transfers are usually effective the following month; however, even though the transfer may be effective, some offices may only see you once your name appears on their roster. All of these plans are different, though. Some have an open-access network (like Solstice plans) that allows you to choose any in-network provider or dental specialist.

DPPO plans don't require you to be assigned to a primary dentist. They allow you to find dentist services and visit any provider you want. You can switch dentists anytime without calling the insurance company or waiting for your name to appear on an office roster.

3. Provider Access

Dental insurance plans have networks of dentists that you can visit. If you have a preferred dentist, you must ensure they are included in the plan's network. If you don't have a preferred dentist, ensure the network comprises a range of qualified providers.

DHMO plans mean you are only eligible for coverage if you visit an in-network provider for covered services. An in-network provider is a dentist contracted with your dental insurance company. To find out if a dentist is in-network, you can call the insurance to verify or use their online portal to locate in-network dentists near you.

In the battle of dental plans, DPPO insurance allows you to be covered whether you visit an in-network or out-of-network dentist. But even though you can go out-of-network, it doesn't mean you should every time. Using an in-network provider on this plan will save you money compared to seeing an out-of-network provider.

4. Payment

DHMO plans mean you'll pay the specific fee (copayment) listed on your Schedule of Benefits to the dentist for covered services. A Schedule of Benefits is a document that lists all the procedures your plan covers and what you pay for each procedure; it's similar to a menu.

DPPO plans, as mentioned above, are based on a fee schedule. This is an agreement with your dental insurance company to charge up to a certain dollar amount for covered services, whether routine cleaning or a root canal. So, you pay a coinsurance, which is a percentage of this negotiated fee, and the insurance company pays the rest of that negotiated fee.

When you use an out-of-network dentist, your coinsurance is higher because that dentist does not have an agreement with the dental insurance company and will, therefore, charge their usual fee for all procedures.

5. Claims

DHMO plans are convenient since you shouldn't worry about filing claims. Your network dentist will file them for you. The out-of-pocket costs can be more predictable, depending on the service. If you ever have a claim issue, call your insurance company's customer service line; they can help!

DPPO plans are trickier when it comes to claims. If you use a network provider, they will file claims for you. But you may have to file your claim if you receive care from an out-of-network dentist.

6. Deductibles

DHMO plans don't have any deductibles. The deductible is a specific dollar amount you must pay before the dental insurance carrier will pay toward your claims. You are simply responsible for your copayment at the time you receive services.

On DPPO plans, you do have to pay an annual deductible. The out-of-pocket costs vary between insurance companies and specific plans. Be sure to check with the dental insurance company or your insurance broker to identify your deductible before choosing a plan.

7. Maximums

DHMO plans have no annual calendar maximums. The maximum amount a carrier will pay for dental care in the calendar year is the maximum. Members can use their benefits throughout the year to their advantage. Just read any limitations or exclusions that may apply to out-of-pocket costs.

DPPO plans do have an annual calendar maximum. Like deductibles, this amount varies between dental insurance plans and by plans. So, ensure you understand your calendar maximum and can get the dental care you need without exceeding it to maximize your savings.

Picking dental insurance that works for your family's needs and budget is essential. If you want additional help understanding before you buy, click the image below for a free consultation with a Solstice team member - we will help you pick a plan for you and your family!