The Difference Between DPPO vs DHMO Explained
A medical insurance plan from your employer may not be enough to cover your specific health needs, such as dental services. Therefore, it may be a good idea to consider purchasing an individual dental plan.
Choosing the right type of dental insurance plan for you and your family is essential to make sure that you are getting the coverage that you need.
A dental plan helps people enrolled in it cover fees for preventive care and get discounts on pricier procedures, such as bridges and crowns.
However, cosmetic procedures (such as whitening) are typically not covered.
There are various types of dental insurance plans and two of the most common types are Dental Health Maintenance Organization (DHMO) and Dental Preferred Provider Organization (DPPO).
DPPO vs DHMO
DPPO vs DHMO: Pros and Cons
DPPO is an organization of medical doctors, health centers, hospitals, and other medical care providers. It has a network of dentists under contract with a dental insurance carrier.
These dentists offer special rates on dental care. Typically insured members under DPPO will have a lower cost if they see an in-network dentist but they still have the flexibility of choosing an out-of-network dentist.
The medical doctors in DHMO are contracted with a dental insurance company with an agreement to get an insurance fee schedule. Participants in this type of plan are offered a lower cost for dental services for an in-network dentist.
If you are looking for information that can help you decide on what to choose between them, you’ve come to the right place. We have provided a brief guide on more of their features below.
Key Features of DPPO vs DHMO
Dental Preferred Provider Organization Plan:
Advantages
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See out-of-network dentists
You have the opportunity to visit an out-of-network dentist and still get at least partial coverage for it. But DPPO recommends you stay in-network if you’re a budget-conscious person.
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No primary dentist required
In DPPO vs DHMO, a DPPO plan may allow you to see a dental specialist without a referral from a primary dentist.
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Fewer limitations in dental care
Members under DPPO will be given a balance between low-cost dental care and preferred dentist. Typically members will have reimbursement for services they got from an out-of-network dentist.
Disadvantages
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Deductible
Before the DPPO plan covers your expenses, you must first pay your deductible. You will have to pay in full for your copay during your consultation with an out-of-network dentist before you can get reimbursement.
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Higher cost
DPPO vs DHMO, a DPPO plan has a higher out-of-pocket cost and it may pay the out-of-network dentist less than an in-network dentist. It also has a higher monthly premium than DHMO.
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Annual Maximum Amount
Members of DPPO vs DHMO, DPPO have an annual maximum or the total amount of the plan will cost for dental care covered in a year. The total annual maximum depends on the insurance company or the plan.
For Dental Health Maintenance Organization Plan
Advantages
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Lower Fees
Participants under a DHMO plan are provided with more affordable out-of-pocket fees. Among other types of dental insurance, DHMOs have the lowest premiums. The premium means the monthly amount you will pay.
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Primary care doctor
You will have a primary dentist that will manage and coordinate your treatment when you choose a DHMO plan.
A referral from a primary dentist is also compulsory before visiting a dental specialist. Also, filing claims by yourself is rare in DHMO because the in-network dentist will file it for you.
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No waiting period
You won’t have to wait for a certain period before your coverage kicks in.
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No Annual Maximum Amount
There’s no dental annual maximum in DHMO insurance.
Disadvantages
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Limit on dentists
Comparing DPPO vs DHMO, the latter have fewer options on which dentist to visit since you are only required to see in-network dentists.
Because of this, you might find it difficult to get a nearby dentist who’s covered by your insurance that may provide you a satisfactory service for your health needs.
Conclusion
Make sure to read the features of the dental plan you’re planning to be enrolled in, including exclusions and limitations.
Both DPPO and DHMO share good features but you might want to consider both of their aspects.
If you want the flexibility of the dentist and dental specialist you can visit and are willing to pay for a higher cost, then a DPPO plan must be the right insurance for you.
However, if you think you can stay in an in-network dentist for a lower cost, then choose a DHMO plan.