The Difference between HMO and PPO Dental Plans

What’s the difference between the two? Does one cover more services than another? Which type is more cost-effective, and how will it help to meet your family’s needs? These questions and others are very common when presented with this choice, and here we’ll discuss some of the qualities of each type of plan.

PPO, or preferred provider organization plans, allows those covered to receive discounted services from a pre-selected list of dental professionals. If you have a dentist currently, you’ll want to determine if he or she is a participating dentist in your proposed plan. Participating providers offer the same services at lower rates, offering discounts that can save you money before reaching your deductible requirements.

If your dentist is not a participating or “preferred” provider, your discounts are usually much less and require more out-of-pocket contributions from you. Examining this one aspect of your proposed dental plans will save you considerable funds over the life of your policy.

The major disadvantage to a PPO is that if your chosen dentist is not preferred, you’ll be required to cover more of your regular dental costs. Although you will still receive coverage and discounts, they will be much less. However, if you don’t already have a regular dentist, you can simply ask the insurance company for a list of preferred providers in your area to receive the maximum benefits.

HMO, or Health Maintenance Organization dental plans, still offer coverage for the most common dental services. However, the largest difference between this type and a PPO all care dental plan is that you must use designated professionals in order to use your policy. This means that if your dentist is not part of the HMO, you will receive no discounts through your plan.

HMO dental plans will also typically offer co-payments for several services. HMOs are typically less expensive because your choices are much more limited. Another aspect of HMOs is that you will usually be required to receive a professional referral to a surgeon or orthodontist for specialized services; you can’t simply choose one and make an appointment – your dentist must tell the company that they suggest you consult with the other member of the HMO.

Preventive and routine dental visits usually will also cost much less out of pocket in HMOs versus PPOs. If you do not have a current dentist, HMO dental plans may warrant a closer look. However, consider that you may need emergency services at some point. If you are on vacation or do not have a local HMO emergency office, you may be at a loss.

The most important decision is to choose some type of coverage to protect your dental health. If your employer offers coverage, you simply need to choose which plan fits your life the best. Anyone searching for individual policies may need to talk with their preferred dental provider to determine which plans they participate in and accept in order to stretch their dollars further.