HMO and PPO Dental Plans

Choosing the right dental plan entails understanding the type of plans available for you to choose from. There are differences between an HMO dental plan and a PPO dental plan.

Are you one of the millions of Americans who don’t have dental insurance? Are you now considering obtaining a dental health plan for you and your family? It is important that you understand the type of plans available to you, and learn how you can use it without exposing yourself to out-of-pocket expenses. There are two main categories in which dental insurance plans fall: a health maintenance organization or HMO dental plans, and a preferred provider organization or PPO dental plans.

HMO Dental Insurance

HMO stands for Health Maintenance Organization and refers to an insurance policy that restricts members to choosing and using dental health professionals from within its network of providers. When you choose an HMO dental plan, you will need to seek treatment or have procedures done only from and by dentists in the organizations list of approved providers. In case you need to see a specialist, your primary care dentist will refer you to one, but this may require preauthorization.

Typically, dental HMO plans do not impose deductibles or maximums; rather, you will need to pay a fixed amount for the dental services you receive, which is called a copayment. Diagnostic and preventive services usually do not require a copayment. However, in the event that you visit a dentist from outside of the network of providers, you will need to pay for the entire bill.

PPO Dental Insurance

PPO stands for Preferred Provider Organization and refers to an insurance policy that offers members with the flexibility of choosing their own dentist. However, you may need to make a larger copayment towards treatments or procedures performed by a dentist outside of the network affiliated with the dental insurance company.

The percentage you will need to pay may vary based on the type of dental services you get, such as diagnostic and preventive services or major dental work. For instance, you may need to pay 20 percent for preventive services while the plan shoulders 80 percent of the cost, while you may only be covered for 50 percent of the cost for crowns and bridges. In addition, you may be required to meet a deductible and have an annual maximum amount of coverage for PPO dental plans.

Choosing Between an HMO and PPO Dental Plan

It is important that you compare dental insurance plans before you make your choice. Review the differences between your options. Think about whether you’re comfortable with being limited in your choice of dentists or specialists to see, or if you would rather have a wider network of dental professionals with which to choose from.

An additional consideration would be your location of residence. HMO dental plans are more likely to be available in major cities, while PPO dental plans may be more ideal for those in rural areas so they can get dental services of a provider near them, whether or not they belong to the network.