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Article | August 2019

Dental HMO vs. PPO Plans: What Are the Differences?

Two of the more common types of dental plans are Dental HMO and Dental PPO plans. When it comes to Dental HMO vs. PPO, which is right for you?

In a nutshell, the differences between DHMO and DPPO plans are cost and flexibility.

What are the main differences between a DHMO and DPPO plan?

When you’re comparing a DHMO to a DPPO you will want to know the key differences between them. These are the features of the plans that make them distinct from each other. These may help you decide which type of dental plan is a better fit for your needs. Let’s compare these plans based on the following:

  • Deductible
  • Coinsurance
  • Annual maximum
  • In-network requirement
  • Primary dentist requirement
  • Waiting period
  • Types of dental services covered

Dental HMO vs. PPO plans: Comparing deductibles and coinsurance

Common questions about any type of dental plan include, “Does my dental plan have a deductible?” and “Does my dental plan have a coinsurance?” These features of a dental plan vary from DHMO to DPPO:

  • Deductible: This is what you’ll pay out-of-pocket for covered services until it’s met. Most DPPO plans have an annual deductible. DHMOs typically do not.
  • Coinsurance: This is the percentage of costs you and your plan share for covered services. For DPPO plans this coinsurance kicks in once you’ve met the deductible. DHMOs also require you to share a percentage of the costs. It’s based on the flat rate of each dental service and you typically do not have to meet an annual deductible beforehand.

Do annual maximums apply to DHMO or DPPO plans?

Some dental plans have an annual maximum. This is the most your dental plan will pay for covered services in a plan year. If you reach your annual maximum, you will have to pay for any additional dental services. Most DHMO plans do not have an annual maximum. Most DPPO plans do.

Do you have to see dentists in a network with a DHMO plan vs. a DPPO plan?

DHMO plans can be more affordable because they require you to see dentists within the network, in order to be covered. Most DHMOs will only cover out-of-network services in an emergency or where required by law. In comparison, a dental PPO will permit you to see any licensed dentist you want, in- or out-of-network, but you will pay less if you choose to see a dentist from the plan’s network.

Do you need to choose a primary dentist with either a Dental HMO or Dental PPO?

DHMO vs. DPPO when it comes to primary dentists stacks up this way:

  • If you have a DHMO plan, you will need to choose a primary dentist. Your primary dentist will be your initial go-to for all dental care. If you need to see a dental specialist, they will refer you to one in the plan’s network.
  • DPPO plans do not require you to choose a primary dentist, although one is recommended. You don’t need referrals to see specialists, either, but you will save money if you see one in your plan’s network.

What dental services are covered by a DHMO vs. a DPPO?

Whether you buy a dental plan on your own through an individual insurance carrier, the health insurance marketplace, or through your employer, DHMOs and DPPOs may cover the following:

  • Preventive dental care: Usually covered at 100% by both DHMO and DPPO plans. Preventive dental care covers teeth cleanings, oral exams, certain types of X-rays, fluoride treatments, and sealants. Age limits and limits on how many of each you can have in a plan year may apply.
  • Fillings, root canals, extractions: These services may also be called basic restorative in the details of your dental plan. For DHMO plans you will typically have a flat fee to pay for these types of dental services. For DPPO plans you will need to first meet your deductible, then you will share a percentage of covered costs with your plan for non-preventive services up to any annual maximum.
  • Crowns, bridges, dentures, etc.: Major restorative care like crowns, bridges, dentures, and oral surgery procedures and gum grafts are covered up to a certain amount. See your plan details for terms.
  • Braces and other orthodontic care: If you’re looking for coverage for braces, then shop for DPPO and DHMO dental plans that offer these types of benefits. Pay attention to age limitations, too. If your plan has a deductible, you may be required to meet that first, before your plan begins to share costs. After that you and your plan will each pay a percentage for covered orthodontic services until you meet your annual maximum.

Before you enroll in any dental plan, make sure to read the details of plan coverage, including limitations, exclusions, and possible waiting periods.

DHMO vs. DPPO: Do they have waiting periods?

Some dental plans require you to wait for a period of time after enrollment before your coverage kicks in, especially for non-preventive dental services. Many plans will waive the waiting period if you can prove you were enrolled in a dental plan just prior to your new plan. But which—DHMO or DPPO—requires this wait period? More often than not it’s DPPO plans that require a waiting period, but it depends on the plan.

DHMO vs. DPPO: Comparison table

In summary, here are the key differences between a dental HMO and PPO (these are general and you should always check the details of any plan before you buy or enroll):

Plan FeatureDental HMODental PPO

Dental PPO

No

Yes

Coinsurance

Yes (% of flat rate for services)

Yes (% of contracted rate per dentist)

Annual Maximum

No

Yes

Copay

Yes

Sometimes

Staying In-network required?

Yes

No, but costs will be lower if you stay in-network

Primary Dentist required?

Yes

No

Waiting Period

No

Yes

At a high level, DHMO plans are designed to help keep your dental costs lower. They work best for people who are cost-conscious and are willing to find a primary dentist and see dentists from within the network only. DPPO plans offer more flexibility when it comes to seeing providers, which comes with higher costs.

This information is for educational purposes only. It is not medical advice. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. Any third party content is the responsibility of such third party. Cigna does not endorse or guarantee the accuracy of any third party content and is not responsible for such content. Your access to and use of this content is at your sole risk.