How does it differ from a DHMO plan?
If you’re new to shopping for dental insurance coverage or you are looking for a new plan, you may not know which plan options will work best for you and your family. Just like regular health insurance, dental insurance offers different plan options to suit your coverage needs. From co-pays to annual maximums to your provider network, each plan offers its own advantages and disadvantages for cost and coverage options to suit your needs.
Dental PPO plans and DHMO plans are the two most popular types of dental insurance plans. Learn what a dental PPO plan is, how it differs from a DHMO plan, and how to find the PPO dental insurance plans that work best for your needs.
What is a PPO dental plan?
What is a PPO dental plan? It's short for a Dental Preferred Provider Organization plan. This is an indemnity insurance plan combined with a network of dentists under contract to the insurance company to deliver services for an agreed-upon set of fees1. Dental PPO networks vary in size from issuer to issuer, but PPO dental insurance plans typically offer a larger choice of dentists when compared to Dental Health Maintenance Organizations (DHMO) plans.
PPO dental insurance plans are also much more likely to offer reimbursement for services from an out-of-network dentist. That means if you have a dental PPO plan, you can visit any licensed dentist and still receive full or partial coverage for the covered services. However, if you visit a dentist that’s out of your insurance provider network, that dentist may have fees that are higher than your plan’s allowance, and you’ll be responsible to pay the difference. You’ll still save the most money if you see a dentist who’s in your provider network.
PPO dental insurance plans also don’t require you to choose a primary dentist or get a referral before visiting a dentist or specialist.
Dental PPO insurance plans typically also don’t involve any co-pays whatsoever. Dentists in your provider network typically will also file your claims for you, so you don’t need to waste your time filling out loads of paperwork.
You’ll typically pay more out-of-pocket for a dental PPO plan than you will for a DHMO plan – but you’ll get quality coverage as a result. PPO dental insurance plans usually require you to meet an annual deductible before they’ll cover your dental costs. They also typically involve annual maximums, which limit the amount the dental plan will pay in a year. After your annual maximum is reached, you’ll have to pay the remaining cost for your dental services at a discounted rate determined by your plan.
To sum up, dental PPO plans...
Have a larger network of providers
Allow you to visit a licensed dentist and still receive full or partial coverage
Don’t require referrals
Don’t charge a co-pay
Involve a deductible
Involve annual maximums
Have higher out-of-pocket costs
What is a DHMO plan?
A DHMO plan is short for a Dental Health Maintenance Organization plan. This plan works similarly to an HMO health insurance plan, and it’s also known as a capitation plan. Under a DHMO plan, contracted dentists are pre-paid an amount by the insurer for each patient that has elected or been assigned to that dentist. Dentists are then obligated to provide contracted services and covered procedures at the copay amount as listed on the schedule of Benefits2. Since the plan doesn’t typically reimburse the dentist or patient for individual services, patients usually must receive treatment at a contracted office to receive a benefit.
The most common advantage of DHMO plans is that participants enjoy lower out-of-pocket costs. Not only do DHMO plans offer discounted dental coverage, but they typically also have the lowest premiums of all dental insurance plans. If you have a DHMO plan, you’ll only have to pay your set co-payment at the office rather than receiving a bill from the dentist’s office weeks later.
DHMO plans rarely involve any annual maximums or deductibles you’ll have to meet before receiving coverage.
The main disadvantage of DHMO plans is that they typically limit which dentists you can see and still receive full or partial coverage for cleanings and other procedures. Because DHMOs typically have a much smaller network of dentists who offer low-cost dental care, it can be difficult to find a dentist near your home or work who satisfies your dental needs and will still be covered by your DHMO plan–and if you choose to visit an out-of-network dentist, you likely won’t receive any benefits at all.
To sum up, DHMO plans...
Offer no-cost or reduced-cost services to patients
Involve a much smaller network of dentists
Have lower out-of-pocket costs
Rarely offer benefits for dentists outside of the network
Charge a co-pay for every service
Don’t involve a deductible
Don’t involve annual maximums
How to find the best dental PPO plans for you
Most PPO dental insurance plans offer a lot of great benefits, like a large dental network, no co-pays, and the freedom to visit virtually any dentist and still receive coverage. However, PPO dental insurance plans vary greatly from one provider to the next. To find a dental PPO plan that best fits your needs, it’s important to shop around with different providers and look for these 4 common key things:
A large dental network. While these plans usually allow you to visit any dentist and still receive full or partial coverage, you still can save the most when you visit a dentist in your provider network. Make sure there are in-network dentists conveniently located near your home or work.
Comprehensive coverage. Good dental insurance subject to applicable waiting periods and annual maximums, typically covers preventative care such as cleanings at 100%, basic procedures such as fillings at 50-70%, and major procedures such as root canals at 30-50%. Take a close look at your policy to determine how much your policy will pay out. If you’re looking to have specific procedures done in the near future, such as getting adult braces or wisdom teeth extractions, make sure your policy covers them.
A premium you can afford. Having good dental insurance coverage is important, but your dental insurance should help support your finances instead of straining them. Make sure you’re able to comfortably afford your monthly premium so you never experience a lapse in coverage.
Manageable out-of-pocket costs. Your monthly premiums aren’t the only costs you’ll have to take into account – calculate the additional costs you’ll typically have to pay, including coinsurance, deductibles, and costs outside of your annual maximum to make sure you’re comfortable with the level of coverage your policy provides.
Guardian Direct offers dental PPO plans that check all the boxes, with a network of over 100,000 dentists to choose from, affordable premiums starting at $20 per month in most states, comprehensive coverage, and fair out-of-pocket costs. Costs vary by state and available plan type selected.
PPO dental plans for individuals
Many Americans receive dental coverage through their employers. But if you’re self-employed or your current employer doesn’t offer adequate dental benefits, you can still get a dental PPO plan. Individual PPO dental insurance plans are available to enroll in online, directly from an insurance provider.
When you’re purchasing individual dental insurance, you have the freedom to choose the plan that’s the best fit for your budget and your coverage needs. But even once you’ve settled on a dental PPO plan, the freedom continues – each person in your family can choose their own dental provider and still enjoy the same level of coverage.
If you’re ready to start shopping for dental PPO plans for individuals, get a free quote here.
If you think a DHMO plan might be a better fit for you, you can also enroll in a Guardian Direct DHMO plan on the dental exchange here.
Which plan is better: DHMO or Dental PPO?
Which is better, DHMO or dental insurance PPO plans? There isn’t just one answer to this question – the best dental plan for you will depend on your budget and your coverage needs
Deciding whether a DHMO or dental PPO plan is best for you depends on what matters most to you for your dental care.
If you have a favorite dentist who you or your kids can’t live without, a dental PPO plan can allow you to keep that dentist and still receive at least partial coverage for your routine cleanings and other dental procedures.
A dental PPO plan could also work better if you move often, if you live in a larger city where you’d rather explore several dentists’ offices before you stick with one, or if you desire the best dental coverage available.
But if you’re not picky about your dentist and would rather prioritize keeping your out-of-pocket costs low, a DHMO plan could be the best bet for you.
We’ve compiled a bank of resources to help make an informed decision when choosing a dental insurance plan that works best for you and your family.
Looking for full coverage dental insurance? Learn how to find the best comprehensive dental insurance for you and your family.
How much should you expect to pay for a dental PPO plan? Learn how much dental insurance typically costs.
Does dental insurance cover all dental services? Learn what procedures and treatments dental insurance covers.
Do I need individual dental insurance? Learn what individual dental insurance is and how to get it.
Is dental insurance worth it? Learn whether dental insurance could pay off for you in your stage of life.
How does a self-employed person get dental insurance? Read our self-employed guide to individual dental and vision insurance.
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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.05/22)