If you’re new to shopping for dental 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.
Two of the most common dental insurance plans are DPPO plans and DHMO plans. 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. Here are the pros and cons of DPPO plans and DHMO plans so you can choose the option that works best for you and your family.
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.
Participants of a DHMO plan can see a dentist within the DHMO network to receive discounted health coverage, from preventive visits to restorative care.
Pro: lower costs
A big advantage of a DHMO plan is that you’ll enjoy lower out-of-pocket costs. DHMOs have the lowest premiums of all dental insurance plans and have no deductible you’ll need to meet before you receive coverage.
For most dentist visits and procedures, you'll only need to pay your set co-payment at the office. You won't have to expect a bill from your dentist’s office weeks later.
A DHMO plan will provide discounted (and sometimes free) dental services to plan participants if you receive the services from a dentist inside the DHMO network.
From routine cleanings, exams, and X-rays to bigger restorative procedures like root canals and extractions, a DHMO plan will make all your dental care more affordable.
Plus, you won’t have to worry about filing claims yourself — your network dentist will file them for you.
Pro: no annual max
DHMO plans rarely have an annual maximum for which dental services you can be covered for in a year.
Con: limits on coverage
The main disadvantage of a DHMO plan is that it limits which dentists you can see and still receive full or partial coverage for cleanings and other procedures.
Con: restriction on dentists
Because DHMOs 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.
What is a PPO plan?
A DPPO plan is short for a Dental Preferred Provider Organization plan.
Unlike a DHMO, a DPPO has a much wider network of dentists you can visit and still receive at least partial coverage for. A DPPO is also more likely to offer reimbursement for services from an out-of-network dentist.
Pro: visit any dentist
One big advantage of PPO plans is that you can visit almost any dentist and still receive full or partial coverage for the services. But you’ll save the most money if you see a dentist who’s in the DPPO network.
Pro: no referrals
Another pro is that a DPPO plan doesn’t require you to choose a primary dentist, or get a referral before seeing a dentist or specialist.
Pro: no co-pay
You won’t have to pay a co-pay when you visit your dentist. Once you see a dentist in the DPPO network, they’ll file all your claims for you. If you receive care from a non-network dentist, you’ll probably have to file your own claim.
Con: higher out-of-pocket costs
A disadvantage of a DPPO plan is its higher out-of-pocket costs.
A DPPO plan usually requires for you to pay an annual deductible for routine dental services. This means your DPPO plan won’t cover your dental costs until you meet the deductible.
Once you meet your deductible, your DPPO will cover most of your dental costs. But these plans pay less for the services you receive from dentists outside your plan’s network.
Con: annual max
A DPPO plan may limit the amount of coverage you can receive in a year through an annual maximum for dental services and procedures.
When the annual maximum is reached, you’ll have to pay the remaining cost for your dental services — but at a discounted rate that will be determined by your plan.
Which plan is right for you?
Deciding whether a DHMO or DPPO 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 DPPO plan can allow you to keep that dentist and still receive at least partial coverage for your routine cleanings and other dental procedures.
DPPOs could also work better if you move often, or if you live in a larger city where you’d rather explore several dentists’ offices before you stick with one.
But if you’re not picky about your dentist but would rather prioritize keeping your out-of-pocket costs low, a DHMO plan could be the best bet for you.
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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.10/21)