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The Difference Between Dental PPO & HMO Plans

October 22, 2020

Filed under: Uncategorized — tntadmin @ 11:30 pm
Man reviewing dental plan on laptop

Whether you are currently researching dental insurance or interested in utilizing your benefits, you may have one important question on your mind, “What is the difference between dental PPO and HMO plans?” After all, they are the two most popular types and play a crucial role in factors of your coverage, like annual maximums and in-network requirements. Therefore, a dentist in Lebanon is here to share the differences!

Annual Maximums

An annual maximum refers to the highest dollar amount your insurance provider will pay for a covered service within a plan year. Once you reach your annual maximum, then you will be responsible for any additional dental services. On the other hand, if you don’t meet yours, then you’ll leave unused benefits and wasted dollars on the table. While most HMOs do not have an annual maximum, many PPO plans do.

In-Network Requirements

In the world of dentistry, “out-of-network” doesn’t necessarily mean “out-of-coverage.” That being said, HMOs require you to see a dentist within the network to utilize your coverage (unless it is a dental emergency or regions where it is mandatory by law). Conversely, PPO plans allow you to see any licensed dentist of your choice regardless if they are in or out-of-network. However, you will still pay less if you choose a provider who is from the plan’s network.

Types of Dental Services Covered

The leading advantage of dental insurance is that it can make everything from routine cleanings to complex root canals more affordable. Therefore, it is important to consider how each option impacts your coverage of common dental services.

Preventive Care

Since dental care is centered around prevention, services like dental exams and professional types are typically covered at 100% by both HMO and PPO plans. However, there are typically limits on how many you can utilize annually.

Minor Treatments

Basic restorative services, like fillings and root canals, are handled differently in dental HMOs and PPOs. In HMOs, patients typically pay a flat fee before their coverage kicks in. In contrast, PPO plans require patients to meet their deductible before contributing a pre-determined percentage (up to your annual maximum).

Major Restorative Procedures

Crowns, bridges, and dentures are a few major restorative procedures that are covered up to a certain amount by both HMO and PPO plans. Typically, it’s 50%, but it’s best to check the fine print to be sure.

When it comes to dental insurance, the type you pick is crucial for both your oral health and your wallet. Fortunately, you can use the above information to help make your decision!

About the Practice

At Hanover Road Dental Health, patients can enjoy a friendly dental team, a judgment-free atmosphere, and a comprehensive array of high-quality services. Plus, they are in-network with Delta Dental and Cigna and are happy to accept out-of-network providers as well. So, if you have any questions about your coverage, would like us to file a claim on your behalf, or have been searching “dentist with my insurance in Lebanon” on Google, then don’t hesitate to visit their website or give them a call at 603-643-4362.

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