What is Dental HMO? Which one is better: DHMO or PPO?

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DHMO refers to the Dental Health Maintenance Organization plan. A person who is a participant of a DHMO plan can visit a dentist within the DHMO network and can receive discounted health coverage, be it preventive visits or restorative care.

Whereas, a DPPO refers to the Dental Preferred Provider Organization plan. It has a broader network of dentists that one can visit and still receive at least partial coverage. An important and interesting fact about DPPO is that it is more likely to offer reimbursement for services from an out-of-network dentist. 

Now that we briefly know about both the plans, let’s understand which one is better to enroll in. But before that, we need to understand the pros and cons of both plans.

Advantages of DHMO : 

  1. Low cost: A great advantage of a DHMO is that it comes with a lower cost. They offer the lowest premiums with zero deductibles to meet before you receive coverage. With DHMO, you’ll only need to pay your set co-payment at the office for most dentist visits and procedures.
  2. Coverage: A DHMO plan will offer discounted dental services to the participants within the DHMO network. Be it routine visits or more extensive tooth procedures like root canal or extraction; a DHMO plan will take care of all end to end processes at a more affordable range. This plan also de-shoulders the participant’s responsibility of filing claims as it is well taken care of by their dentist network.
  3. No annual maximum limit: The participants of a DHMO plan rarely have an annual maximum limit for the number of dental services covered in a year.

Now let’s look at the disadvantages that makes DHMO a less desirable plan.

Disadvantages of DHMO:

  1. Limited coverage: The main disadvantage of a DHMO plan is its limitation to the number of dentists’ visits in a year to receive full or partial coverage for cleanings and other big procedures.
  2. Limited Dentist Options: Because of its narrower network of dentists offering low-cost dental care, it can sometimes be difficult to find a nearby dentist who offers good dental care and at the same time is covered under the DHMO plan.

Now let’s discuss the advantages and disadvantages of the PPO plan in detail. Let’s start with the advantages first. 

Advantages of the PPO plan: 

  1. Visit any dentist: One of the biggest advantages of PPO plans is visiting any dentist and receiving full or partial coverage for their services. But it is advisable to visit a dentist within the PPO network as it will save you the most money.
  2. No Referrals: The participant under the DPPO plan need not choose a primary dentist or doesn’t need to get a referral before visiting a dentist or specialist. 
  3. No Co-Pay: The participants of a DPPO won’t have to pay a co-pay for visiting a dentist. On visiting the dentist in the DPPO network, they’ll file all the claims for the participant. But in case a participant chooses a non-network dentist, they will probably have to file their own claim. 

Now let’s look at the disadvantages. 

Disadvantages of a PPO plan: 

  1. Higher costs: A disadvantage of a DPPO plan is that the participants pay an annual deductible for their routine dental services. 
  2. Coverage: After meeting the deductible, the DPPO will cover most of the dental costs. But these plans pay less if one visits dentists outside the plan’s network.
  3. Annual maximum: Post the annual maximum, the participant has to pay the remaining cost for the dental services but at a discounted rate determined by the standard plan.

Now that you are well aware of the advantages and the disadvantages of both DHMO and PPO, it will be easier to decide which plan is best suited to your needs. Before deciding on a DHMO or DPPO plan, a participant must evaluate their expectations from an ideal dental care plan. 

If a participant moves frequently moves from one city to another or lives in a large city for some time before settling, the participant would want to weigh several options and a DPPO plan will suit better. But if the participant is more of a prioritizer of a low out-of-pocket cost, then a DHMO plan could be the most suited plan. 

Therefore, both plans are devised, keeping in mind the benefits for a larger audience, it is advisable to evaluate all your best bets and choose the best plan for your dental health.