There are several ways to reduce your out-of-pocket dental costs. The options include HMO dental insurance plans, PPO dental insurance plans, dental indemnity insurance, and dental savings plans, which are a cheaper and simpler alternative to most dental insurance.
Cost is the first thing most people notice, but there are other differences worth understanding before you sign up for anything.
Before we get to the differences between HMOs and PPOs, we need to be clear about what a ‘provider network’ is. The term means a group of healthcare providers whose services are contracted by an insurance company at a discounted rate for the people and businesses it insures.
In dental terms that means general dentists and specialists, along with the labs and X-ray facilities they work with.
Understanding What Referrals Mean
Networks set their own rules about whether you can approach a specialist yourself, or whether it has to go through your primary care provider, sometimes called your ‘gatekeeper’.
- Making an appointment is easy enough, but if your plan requires a referral first, it won’t cover the cost of that appointment without prior approval.
- Once you have the approval, the plan pays its share and your costs come down.
What Are HMO Plans?
HMO, or Health Maintenance Organization, is a network of providers who have agreed to reduce their rates for network members. Cover applies inside the network only. Go outside it and the plan will usually pay nothing, leaving you with the whole bill.
- HMO members choose a gatekeeper, or primary care provider, who is the one authorized to refer them on to specialists in the network. The gatekeeper checks for problems and points you to the right person.
Sometimes the primary care provider treats the problem in their own practice, with no referral needed. - HMO plans suit people who want one central provider making the decisions on their behalf.
People who are often away from home can be at a disadvantage, because they may not find a network provider where they are. - Most people choose HMO plans for the low monthly premiums and the low or non-existent deductibles.
- The biggest drawback of an HMO is the waiting time. Some patients wait weeks, and sometimes months, for an appointment.
- One clear advantage of a dental HMO is that members don’t have to file claims themselves, because the primary care provider files on their behalf.
- Dental HMOs don’t have annual maximums, which is the cap on what a carrier will pay towards your dental bill over a given period. Members can use the benefit throughout the year. DHMO plans are mostly bought by businesses for their employees, but families and individuals can use them too.
What Are PPO Plans?
A PPO, or Preferred Provider Organization, is a network that gives you more freedom when choosing a dentist or a specialist. Choosing a primary care provider is optional, although your rates are lower if you pick a dentist from inside the PPO network.
- Patients don’t need a referral to make appointments with their providers, though they may pay more for the visit.
- PPO dental plans are generally reckoned to offer a better standard of service with fewer limits than HMO plans, but the premiums are higher. Plenty of families pay the difference for that flexibility.
- On top of the higher premiums, PPOs tend to come with claim forms that take a long time to complete, and members wait a while for reimbursement. The deductible has to be met before any reimbursement is paid at all.
- Most PPO plans only cover part of a specialist’s fee, so the patient makes a co-payment towards the treatment. PPOs also have annual maximums, and the amount varies from one carrier and plan to the next.
Which One Should You Choose?
There are several things to weigh up before choosing one network over the other. If there aren’t many dentists in the HMO network near you, or your preferred dentist is not one of them, you are better off on a PPO plan.
If your work takes you away from home and you want to see a dentist while you are away, a PPO is the more flexible choice. The same logic applies to any provider you might need: if they sit outside the HMO network, the plan will not cover them.
Choosing between the two is genuinely difficult, because there are so many options and no one-size-fits-all rule in dental care.
It comes down to personal preference, and to who you want to be able to see. More people are enrolled in PPO plans than in HMO plans, but that does not make a PPO the right answer for everyone. Work out which dentists you want access to first, then find the plan that covers them.
At Dental Plan Provider we want you on a plan that keeps your oral health in check without a bloated bill. Compare the discount dental plans available in your area, and get 10% off when you sign up online.
