Dental Insurance: What is the Difference?

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Thomas L. Anderson and Associates feels passionately about providing our patients with the highest quality dental care. To achieve our goals, we would like to share some dental insurance facts to help you better understand different types of dental policies, and how they work. Below we will explain some facts about PPO dental plans versus DHMO dental plans. These are some of the most common dental plans offered to employers and individuals.

As I mentioned above, the two most common types of dental plans offered to consumers are preferred provider organization (PPO) and the dental health maintenance organization (DHMO).

  • A PPO plan consists of a network of dentists who partner with the insurance company to offer you discounted rates.
  • DHMO plans contain a network of dentists who agree to provide many services at low or no cost.

A PPO plan offers more flexibility than a DHMO plan, but a DHMO plan often limits your out-of-pocket costs more than the PPO.

Coverage

Both plans will likely cover your routine dental exams, x-rays, and cleanings with little to no out-of-pocket costs. These types of services help dentists discover problems and prevent new ones, such as cavities and gum disease. For more extensive treatments such as fillings, extractions, crowns, root canals, etc. you will likely have a co-payment required by your insurance company. Under a DHMO, the co-payment is usually small and you pay it when you receive treatment. A PPO plan may require that you pay an annual deductible for treatments. Once you meet your deductible, a PPO will cover a percentage of the costs.

Pros and Cons of PPO

Pros:

  • PPO plans have more flexibility when it comes to choosing a dentist.
  • You may receive treatment from any dentist, and the number of in-network dentists to choose from is vastly higher than with a DHMO.
  • Your costs will be lower when you seek treatment from a dentist in the PPO network, but most PPO plans offer out-of-network benefits at a lower coverage rate still help limit out-of-pocket costs for you.
  • A PPO plan does not require that you select a primary dentist or get referrals before seeking treatment.

Cons:

  • The major disadvantages of a PPO dental plan are its higher out-of-pocket costs and variances in percentages of coverage.
  • A PPO plan may also limit the amount of coverage you can receive in a year.

Pros and Cons of DHMO

Pros:

  • A big advantage of a DHMO is that it will probably limit your out-of-pocket expenses.
  • For most procedures, you’ll need to pay only your co-payment.
  • You won’t have to worry about a bill from the dentist’s office showing up a few weeks later.
  • An in-network DHMO dentist cannot refuse to treat you.

Cons:

  • You will have to choose a primary dentist and get referrals from him for special procedures.
  • Often times the number of dentists you can choose from is small, and in some cases the insurance can assign you only one dentist.
  • If you chose to see an out-of-network dentist, you will be required to pay all treatment costs.

 

While both plans have pros and cons, the most important thing is that you understand the benefits of the dental insurance plan you have chosen. We hope that by sharing these insurance facts we have helped to ease some of the confusion you may feel when selecting a dental plan. If you have any questions regarding these or you have any other questions about your dental insurance, please contact us and we would be happy to assist you to the best of our abilities!

Related Article: We Can Help Maximize Your Dental Insurance Plan

Contact us today to schedule an appointment for teeth whitening with any of our skilled dentists at one of our three conveniently located dental office locations within the Kansas City area, including Lee’s Summit / Independence, the Country Club Plaza and Downtown Kansas City. The gentle dentists and expert team at Thomas L. Anderson and Associates look forward to working with you to treat your dental emergency, achieve proper oral health and a beautiful smile that will last a lifetime. If you have any questions about your dental insurance benefits, please do not hesitate to contact us.  We are happy to review your policy! Please give us a call today to schedule an appointment and become part of our dental family.

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