Types of Dental Insurance; PPO Versus HMO Insurance


What Type of Dental Insurance Do I Have?

There are three types of dental insurance that you may have.  They are PPO, HMO (also known as DMO) and Medicaid (AHCCCS in Arizona). The first two, PPO & HMO, are plans that you purchase through your employers insurance plan or directly as a consumer.  So let’s see how these plans differ. 

For simplicity we are going to skip over the Medicaid (AHCCCS Plans) other than saying that the State sets the rules for you as the patient and the dental office.  They tend to pay the dentist very little, very slow, and not as often as they should.  As a dental office, its not a good way to make a living so that should speak volumes to the quality of care that you can provide taking AHCCCS.

PPO:  This plan tends to be a little bit more expensive for you or your employer to provide.  But it’s the best type of plan.  You get to choose where you go.  You can go to both in-network versus or out of network offices.  We will cover this more in another volume.  Treatment is covered at various percentages, with you as the patient receiving coverage ranging from 100% all the way down to typically 50%, though sometimes higher and occasionally less.  You have an annual maximum and an annual deductible. 

Dental offices receive the highest level of reimbursement through this type of insurance so this is the one that they prefer and the one that provides the ability to offer the best level of care.

HMO (DMO): This is usually the cheaper option when you are looking for a dental insurance.  We will cover the economics of HMO plans in a different volume.  However, you as the patient do benefit in some ways from an HMO plan.  Typically you pay a little bit for exams, cleanings, and fillings.  The amount is pretty small as preventive care is very cheap for you as the patient.  It all sounds pretty good until you actually need treatment, then it can get expensive.  HMOs typically do not cover or provide limited coverage for actual treatment, meaning extractions, root canals, crowns, bridges, deep cleanings, dentures, and implants.  Dental offices typically receive lower reimbursement from HMO insurances than they do from PPOs.  Therefore, it can be tougher to find offices that take HMO plans or to get in right away to be seen.  Let’s face it, we live in a capitalistic society.  The final point with HMOs that is needed to be covered is that you have to be assigned to a specific office. That means that you can only go to one office and to switch you need to call that plan and be reassigned.  Most offices do not take HMOs so it’s a little but tougher to find an office.  If you find a good office and good dentist, an HMO plan can work great for you.  However, it is not always easy to find.

Choose long and hard when picking an insurance plan. At Dentistry For You we accept all PPO plans and would be glad to answer any questions regarding your dental insurance or the plans that your employer is offering.  We want to help you make an educated decision.

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