The difference between HMO and PPO Dental Plans

Knowing the difference between a dental HMO and PPO plan can be very confusing. It is also hard to determine which dentist accepts what plans, how big is the network of the network, what are the deductibles, and which is the most expensive or least expensive among HMO dental plan and PPO dental plan. Without knowing the proper information it can be very difficult to choose the right plan. 

Dental HMO plan

DMHO, a nationwide dental plan is a structured type of dental plan where a group of dentists provides services at a low monthly premium. A DMHO plan is also called the capitation plan. The dentists who work under DHMO receives a fixed monthly fee. This dental insurance plan is a great option if you have an immediate dental need. Most of the dental treatments are done at no cost or for a reduced cost. Sometimes you need to make a copayment. There are no waiting periods, deductibles, calender year maximums and claim forms under this plan. You can start seeing a dentist immediately once you are enrolled under this plan. This is the least costly type of dental insurance plan.

Summary of DHMO Strengths and Challenges

Strengths

• ·         It is good for people who need to get dental treatment immediately as there is no waiting period.

• ·         You can know the cost of work up front

• ·         You can get access to a wide range of dental services at affordable cost from a group of dentists

• ·         Treatments are generally provided at no cost or at a lower price.

• ·         Dentists take more efforts to keep you well, as they don't need to spend more time on free work

• ·         It is the least costly of all the dental plans

• ·      You can get a referral to a dental specialist by your main dentist and you are eligible to get a discount for their work

Challenges

• ·   This plan seems to beneficial for regular visits, exams, x-rays, and cleanings. Other works usually require a copay.

• ·   This plan does not cover any treatment that is not included or mentioned out in the plan's summary.

• ·       The number of people opting for the DHMO plan in a specific area and the number of doctors servicing in that area could have an impact on the usage of the plan.

• ·         You need to choose a primary dentist, if you treatment has to be covered under this plan.

Dental PPO plan

Preferred Provider Organization (PPO) dental plans are extremely popular and most preferred plan by people as they offer the perfect middle ground between payments and possibility. Under PPO, you have the freedom to choose your dentist. PPO plans let you spend the least amount of money during your dental visit. PPO's have all the advantages of managed care health insurance.

Summary of PPO Strengths and Challenges

Strengths

• ·         PPO offers a negotiated dental fee that is lower than the regular dental fee

• ·         PPO lets you see any doctor within the network without any reference

• ·         It offers the flexibility to meet any doctor outside the network, but at a higher cost to you

• ·         PPO's network is much larger than the HMO network

• ·         You may choose your own doctor and you need not go through a Primary Care Physician (PCP)

• ·         PPO plans pay the dentist only after you receive the dental care

• ·         You may undergo dental treatment at any hospital of your own choice and you can make your own health decisions

Challenges

• ·         You need to pay the full fee if you visit the doctor outside the provider's network.

• ·        If you feel that the network is not up to the mark, you can simply continue your dental treatment out of the network.

Other than this DMHO and DPPO plans, Federal employees can enroll in The Federal Employees Dental and Vision Insurance Program (FEDVIP). This program offers federal dental and vision plans to be purchased on a group basis which means competitive premiums and no pre-existing condition limitations. Federal Aflac plans are a short term disability insurance available to federal employees.

American Marketing Administrators, Inc is a covered California agency which offers various insurance plans which are customized to meet every unique need. AMA offers DMHO plans that start from just $100 per annum. High option PPO plans are also available to get the maximum benefit for your entire family. AMA also offers flexible payment options so that you can pay either bi-weekly or monthly, through credit card, bank draft or cash. American Marketing Administrators, Inc also offer various plan options that combines different coverage and copay levels that cater to all budgets within your affordability.