What is The Difference – PPO vs. DHMO Dental Insurance

Today, businesses, families, and individuals have multiple choices to reduce out-of-pocket dental care costs. These options include Dental Preferred Provider Organizations (DPPO) and Dental Health Maintenance Organization (DHMO) dental insurance plans. You may also consider dental savings plans — an affordable alternative to traditional dental insurance plans.  

Let’s take a closer look at both dental savings plans and dental insurance plans. 

What is DPPO Dental Insurance?  

• You can choose any dentist you want to see in-network, and often can choose to see an out-of-network dentist. You will save more if you stay within your network. 
• You do not have a primary dentist assigned to you and may not need referrals to see specialists. 
• A DPPO plan may be more flexible when it comes to what specialists you can see and when/where you can get dental treatments. 
• DPPOs are often more expensive than DHMOs.  
• Many PPO plans have an annual maximum limit of $1000-$1500, when you exceed the limit, you pay out of pocket until your insurance resets at the end of the plan year.  

What is DHMO Dental Insurance?  

• A DHMO doesn’t offer out-of-network coverage. If you see a dentist out of network, you will likely pay out of pocket.  
• Your insurance provider typically assigns you a primary dentist, who manages all of your dental care, including referrals to specialists. 
• A DHMO does not typically have an annual spending limit but may restrict when and how often you can get certain types of dental procedures.  
• DHMO plans tend to be less expensive than PPOs.  

PPO Dental Insurance: pros and cons

If you’re interested in a PPO plan, it’s essential to understand both its benefits and drawbacks.  

Benefits  

Dental PPO insurance plans — also known as dental preferred provider organizations or DPPOs — are a popular dental insurance option due to their flexibility in allowing insured members to choose their dentists and dental specialists. DPPO dental insurance plans are widely accepted, and if you choose a plan from a major insurance company with a large provider network, you’ll typically have no problem staying in-network. You can go out of network, but you’ll pay more for your dental care. Your preventive checkups and cleanings are almost always covered at 100% – that means no additional cost for you for these essential services.  

Drawbacks  

Despite their flexibility, PPO dental insurance plans have some limitations as well. In addition to the higher premiums usually associated with dental PPOs, you’re responsible for paying the deductible before receiving any reimbursement.  

In addition, you have to make a coinsurance payment – a percentage of the cost of your care – to the dentist since most dental PPO insurance plans only cover a portion of the dentist’s fee. And you may have to wait for months before your plan pays for expensive restorative dental care.  

DHMO dental insurance: pros and cons 

DHMO dental insurance plans are another option to consider. Here are the benefits and drawbacks.  

Benefits  

DHMO dental insurance plans are usually much far less expensive than PPO dental insurance plans. DHMO plans have dentists under contract who offer dental services to insured members at predetermined rates. There’s no deductible to meet before the plan starts covering treatment, and typically no long waiting periods before you qualify for restorative care. These plans are less expensive than a comparable DPPO plan. 

Drawbacks  

DHMO plans have been known to impose strict restrictions on insured members. For example, the DHMO won’t provide reimbursement if you see a dentist that’s not in their network. If you have a DHMO plan, you must select a primary dentist from a pre-approved list. Plus, all referrals to dental specialists must be provided by the primary dentist. Provider networks may be smaller than a DPPO network, which may be inconvenient.  

DPPO vs. DHMO: what’s the best option for you?  

Choosing between a DPPO and DHMO dental insurance plan depends on your needs, budget, and lifestyle. If you prefer flexibility and freedom in choosing your dentist or specialist, a DPPO plan may be better for you. On the other hand, if you’re on a budget and don’t mind picking from a select group of dentists and specialists, a DHMO plan might be more suitable for you.  

However, another option you can use with or without dental insurance is a dental savings plan. Dental savings plans, a trusted alternative to dental insurance, provide individuals, families, businesses, and other groups with affordable access to dental care. Dental savings plans provide savings on most dental procedures from a nationwide network of more than 140,000 dentists and specialists. Dental savings plan members report saving an average of 50%* on their dental care. And, unlike dental insurance, savings plans don’t have annual spending limits, deductibles or copays.

To learn more about dental savings plans, call us at 1-833-735-0399. Our job is to help you get the best dental care, at the best value. Want a quick peek at how much you can save at the dentist? Use our calculator below.

*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.