What are Dental Health Maintenance Organization Plans?

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A Dental Health Maintenance Organization plan or DHMO plan is one of the two most renowned dental health insurance plans available. The other one is the Dental Preferred Provider Organization (DPPO) plan. Similar to an HMO health insurance plan, a Dental HMO plan provides discounted dental care through a network of dentists. Although there are multiple dental insurance plans available such as Dental Exclusive Provider Organization (DEPO), Dental Point of Service (DPOS), and Dental Indemnity plans, the article will specifically talk about the DHMO plan in detail including how it works, pros and cons, and what patients should know!

What is a DHMO Plan?

A DHMO plan is a type of managed care plan that offers comprehensive and less expensive dental care to individuals and families through a network of qualified dentists. A DHMO plan, also called a Capitation plan, is considered the least expensive dental insurance plan available. 

Patients can choose a primary care provider, commonly known as PCP, from the network who is supposed to be the first point of contact for them in case they need a referral, wish to see a specialist or change to a dentist. 

The best part about a DHMO plan is that it has no annual maximums also known as calendar year maximum, no deductibles, or claim forms. The dentist or PCP files and claims on your behalf. 

How DHMO plans work?

Under DHMO plans, all the in-network dentists receive a fixed amount as a pre-paid fee from the plan for certain dental services, treatment, and procedures. When you, as a plan member, visit a dentist within the network, you receive dental care at either no cost or reduced costs. 

Usually, preventive care such as cleanings, routine treatment or check-ups, and routine X-rays have no co-payments. The plan premium you pay includes all the preventive care. However, if you are looking for extensive care, treatments, or procedures, you may need to pay a co-pay. 

Pros & Cons of DHMO plans

Every dental insurance plan has a set of pros and cons. So is the case with DHMO plans. Let’s take a look at some of the advantages & disadvantages of DHMO plans.

Pros Cons
A DHMO plan usually has no annual maximum. So, you just pay low monthly premiums to receive dental care at minimal costs.  You are required to choose a primary care provider (PCP) to get covered dental care. 
It allows you to enjoy dental care at low out-of-pocket costs by offering a network of qualified dentists.  You would need the referral of your PCP if you wish to see a specialist or seek some extensive treatment. 
The plan has no deductible. You just need to pay a copayment to your dentist during your visit.  A DHMO plan usually does not cover out-of-network dentists. You may need to bear the extra cost if you visit an out-of-network dentist. 
The plan affordably covers restorative procedures such as root canals and extractions.   You will have to wait for a set time between dental visits.
The plan allows you to know the cost of the treatment up front.  If a treatment is not spelled out in the plan’s summary of benefits, the plan may not cover it. 

Other things to know about DHMO plans

  • You would know the cost of the treatment before you visit your dentist because DHMO plans have copays. 
  • The cost of dental care is not paid by the coinsurance. 
  • Most services apart from regular routines would require you to pay a copay.
  • You should know about the average time plan members have to wait between their dental visits. 
  • If you need a specialist to treat you, it’s a good idea to know how many dental specialists are available in the plan. Your primary care provider can refer you to a dental specialist.
  • Also, knowing all the details including the rules of your DHMO plan, especially rules about emergency dental care if you are travelling or are away from home, will allow you to reap the maximum benefits.