The Dental HMO Plan

Continuing our review of insurance plans, today we review the HMO plan. A Dental HMO (DHMO) Plan differs from a Dental PPO Plan in several ways including: premiums, maximums, deductibles, co-pays, claims, coverage, and doctor selection.

DHMO plan premiums are typically cheaper than those of PPO plans and those of most other plans, meaning overall they are the least expensive to enroll in. With a DHMO plan you have no deductible, so there is no amount you must pay first for services before insurance becomes responsible for their portion of your claims such as in a PPO plan. With a DHMO plan there is also no calendar year maximum amount that insurance will pay for services either, which differs from the maximums PPO plans offer. However, you are responsible for a co-payment each visit that is pre-determined by the fee schedule assigned with your plan. DHMO plans can have limitations to services they will cover and it is important to read the full details of your plan to maximize your benefits and minimize your out-of-pocket cost.

With a DHMO plan, you must pre-select and get assigned to a primary care dentist that will be your sole provider for services that is also in network with your DHMO plan. It is important to do research on your available dentists before selecting a primary care dentist. In order to switch providers, you must un-assign yourself to your current dentist and reassign yourself with a new dentist through your insurance company. While most selections aren’t permanent, it can take up to 30 days to switch providers in some cases. While you are under a DHMO plan, if you visit an office other than your primary care dentist, you will not be covered for services rendered at that office. In addition, under a DHMO plan all claims are filed by your primary care dentist to your insurance company for you. While most offices do this regardless of plan type, it isn’t guaranteed by a PPO plan.

A DHMO can be cheaper than a PPO plan, but can limit your options for providers and services. There are no deductibles or maximums to limit you typical of a PPO plan, but you must establish yourself at one office that can fulfill all your dental needs. Going out of network or not waiting for the paperwork before switching providers can leave you paying entirely out of pocket. A DHMO plan can be a very beneficial plan to you if you do your research thoroughly on providers available to you in your area.

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