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What Is The Best Online Payday Loan?
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21 February 2023

HMO vs. dental plans PPOs: how are they different?

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

Simply put, the differences between DHMO and DPPO plans are cost and flexibility.

What are the main differences between an HMO dental plan and a PPO dental plan?

When comparing an HMO dental plan to a PPO dental plan, it's a good idea to know their main differences. These are the characteristics of the plans that distinguish them from each other. They can help you decide what type of dental plan is best for you. Let's compare these plans based on the following:

  • deductible
  • coinsurance
  • annual maximum
  • In-network requirement
  • Primary Dentist Requirement
  • waiting period
  • Types of covered dental services

Dental HMO Plans vs. PPO: Comparison of Deductibles and Coinsurance

Here are some common questions about any type of dental insurance plan: "Does my dental plan have a deductible?" and "Does my dental plan have coinsurance?" These characteristics of a dental plan vary between DHMO and DPPO:

  • Deductible – This is what you will pay out-of-pocket for covered services until the deductible is met. Most DPPO plans have an annual deductible. In general, DHMOs do not have an annual deductible.
  • Coinsurance – The percentage of the costs that you and your plan share for covered services. For DPPO plans, this coinsurance kicks in once you've met your deductible. DHMOs also ask you to share a percentage of the costs. It's based on a flat fee for each dental service, and you generally don't have to meet an annual deductible first. What Is The Best Online Payday Loan?

Do you need dental coverage?

Cigna offers a variety of affordable dental plans, from basic plans that cover preventive care to plans that help cover complex dental care.
Explore our placenta Do the annual maximums apply to dental HMO or dental PPO plans?

Some dental insurance plans have an annual maximum. This is the most your dental plan will pay for covered services in a plan year. If you reach the 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 I have to see in-network dentists with an HMO dental plan vs. with a PPO dental plan?

DHMO plans may be more affordable because they require you to see in-network dentists for coverage. Most DHMOs will only cover out-of-network services in an emergency or when required by law. In contrast, a PPO dental plan will allow you to see any licensed dentist, in-network or out-of-network, but you'll pay less if you choose to see one within the plan's network.

Do you need to choose a primary dentist with an HMO dental plan or a dental PPO?

For primary dentists, DHMOs and DPPOs work as follows:

  • If you have a DHMO plan, you will need to choose a primary dentist. Your primary dentist will be your first contact for all dental care. If you need to see a dental specialist, they will refer you to one within the plan's network.
  • With DPPO plans it is not necessary to choose a primary dentist, although it is recommended. You also don't need referrals to see specialists, but you will save money if you see a specialist within the network.

What dental services are covered by the DHMO and DPPO plans? 

Whether you buy a dental plan on your own through a private insurance company, the health insurance marketplace, or your employer, DHMO and DPPO plans may cover the following:

  • Preventive Dental Care –  Generally covered at 100% by both DHMO and DPPO plans. care dental care preventive covers dental cleanings, oral exams, certain types of X-rays, and fluoride and sealant treatments. Age limits and limits on the number of times you can access each treatment in a plan year may apply.
  • Fillings, root canals and extractions:  These services may also be listed as basic restorative in your dental plan details. For DHMO plans, you will typically have to pay a flat fee for these types of dental services. With DPPO plans, you'll first have to meet your deductible, then you'll share a percentage of covered costs with your plan for non-preventive services up to an annual maximum.
  • Crowns, Bridges, Dentures, etc.:  Certain major restorative care such as crowns, bridges, dentures, 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 are looking for appliance coverageorthodonticLook for DPPO and DHMO dental plans that offer these types of benefits. Also, pay attention to age limits. If your plan has a deductible, you may need to meet it before your plan begins to share the costs. Then you and your plan will each pay a percentage for covered orthodontic services until you reach your annual maximum.

Before you enroll in any dental insurance plan, be sure to read the plan's coverage details, including limitations, exclusions, and possible waiting periods.

DHMO vs. DPPO: do you have waiting periods?

Some dental insurance plans require you to wait a period of time after enrollment before coverage begins, especially for non-preventive dental services. Many plans will waive this waiting period if you can prove that you were enrolled in a dental plan just prior to your new plan. But which plan (DHMO or DPPO) has this waiting period? Generally, it is the DPPO plans that have a waiting period, but it depends on the plan.

DHMO vs. DPPO: a comparative table

In summary, these are the key differences between an HMO dental plan and a PPO (these differences are general and you should always review the details of any plan before purchasing or signing up):

Benefit Information
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