What's the Difference between PPO and DHMO Dental Plans? - Capline Dental Services

What’s the Difference between PPO and DHMO Dental Plans?

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With so many dental benefit plans, you have heard this a time or two from your patients. What insurance plan should I choose to reduce out-of-pocket costs on dental care? What are the different types of dental insurance plans on the market? That is where it gets woozy, and you help your patients make informed decisions in selecting their dental insurance plans.  

What is a PPO Dental Plan? 

A PPO (Preferred Provider Organisations) is a flexible indemnity insurance option, where the patient can choose and receive care from an in/out-of-network dentists listed under the insurer. Dentists deliver the rendered services at set fees. Patients have the freedom to choose any dentist they would like to see for their dental care. The contracted dentists under this plan have had to accept the maximum allowable fee, whereas the non-contracted dentists can receive money either higher or lower as per the plan allowance.  

What is a DHMO Dental Plan?

Under DHMO (Dental Health Maintenance Organisation) patients are allowed to contracted dentists from a specific list identified by the insurer to provide contracted services at reduced or no cost. Also known as a capitation plan. Here, the contracted dentists have remunerated a certain amount basis each patient and not for the individual services. Hence it limits the choice of dentists as very few offices work with this kind of plan. On the contrary, some providers rush through dental services for payouts. Hence, before enrollment, inform the patients about the dental insurance plans that the office accepts- an accessible alternative that does not limit the treatment and services. 

Difference between PPO and DHMO Dental Plans

Let us take a closer look at PPO and DHMO dental plans to know the key differences that will be a bonus to your practice. In this article, let us compare the plan’s basis deductible, maximum amounts, coinsurance, waiting period, in/out-of-network requirement, types of services rendered, and primary dentist requirement.

Usually, patients have common questions about the benefits of each insurance plan like, is there any low deductible under my insurance plan? Does my dental insurance plan have a coinsurance benefit? What are my dental insurance plans premiums? Since these features of the dental plan vary from PPO to DHMO. 

  • DHMO has the lowest premiums of all the dental insurance plans. Let say if the patient opts for the PPO dental plan, they have to pay higher premiums with annual deductible benefits. The maximum amount of $1000 yielded against the claim that covers 80% of the staple restorative care like extractions, root canal, and fillings, and 50% of substantial restorative care like bridges, crowns, dentures, et al. 
  • Unlike DHMO, PPO allows patients to opt-out of the network dentists at less coverage and higher quality care.
  • For DHMO, the coinsurance shares a percentage of the costs depending on the services rendered. Whereas PPO dental plans, coinsurance will come into existence once the deductibles pay off. 
  • PPO dental plan practitioners paid by the insurance company once the service exhibits. On the contrary, DHMO plan dentists receive regular money based on the number of patients assigned. 
  • For beneficiaries with expensive treatments such as oral surgeries, braces, and other orthodontic care, they have to choose the plan that begins to share the cost.
  • DHMO plans demand a primary dentist for the initial dental care. In case of substantial procedures, they will refer the patient to a dental specialist in the network of the plan. On the other hand, the PPO dental plan will permit an individual to choose any licensed dentist in-or-out-of-network to be covered. 
  • DHMO works best for people who are cost-conscious and prefer dentists within the plan of the network. Whereas, PPO dental plan offers adaptability in seeing a practitioner. 
  • Individuals and families turn to PPO dental insurance plan for better service offers and fewer limitations. Despite this flexibility, they have tedious claim forms to receive reimbursements. DHMO plan works on predetermined rates preferred by businesses to provide their employees with dental benefits.

Waiting Period of Dental Insurance Plans

Whether your patient buys a dental insurance plan from their workplace or through their own by an individual carrier, still insured individuals have to wait to receive reimbursement. Some insurance companies have longer waiting periods before the insurance covers them. Unfortunately, this discourages people from getting insurance coverage benefits on the treatment once the policy expires. Preventive services such as oral exams, teeth cleaning, x-rays, sealants, and fluoride treatments are covered at 100% by both PPO & DHMO dental plans with a minimum of 3-6 months of the waiting period. 

It ensures that the patient does not drop the plan, especially with complex procedures that have six months to a year waiting period. The status of waiting periods is also dependent on the provider, type of service, and dental insurance plan. Amongst other benefits, every insurance provider offers a different waiting period with diverse insurance plans.