What is the best type of dental insurance plan: HMO, PPO or indemnity?

If you are wondering what is the best type of dental insurance: HMO, PPO, or indemnity, the answer will vary from person to person and depend on how much you can afford to pay for dental insurance and what type of service you want.

As you can imagine, each of these different types of insurance offers its own coverage levels as well as different levels of flexibility, which may be important to you.

Although dental insurance is not considered health insurance, you will find that dental HMO, PPO, and indemnity plans are very similar to their health insurance counterparts, with some minor differences. Reading through this article will help you get an idea of what each type of dental insurance has to offer.

Dental HMO Insurance Plans

A Dental HMO plan (DHMO) is the most affordable option for dental insurance. Every dentist within the network agrees to only charge the insurance company a certain amount of money for each type of service provided.

Because of this, HMO providers require that the insured remains within the network in order to receive care. If you receive care from outside the network, then you will have to pay for your care out of pocket. There is no flexibility when using this option.

A DHMO typically has a co-pay that you will have to pay each time you visit your dentist. This copay will usually be $20 or $30. However, you can choose some plans that have a $50 or $75 copay. These plans have even lower premiums than a traditional HMO, so it simply depends on how much you can afford to pay out of pocket for each visit.

If you need to see a specialist, then you are going to have to receive a referral from your dentist. What’s more, the referral has to be to a dentist within your network, or you won’t be covered for your care. Even if there are no dentists in your area that provide the additional work you need, if the dentist is out of network, you will be unable to get your care covered.

Pros and Cons of Dental HMO Insurance Plans

DHMOs often receive criticism because many DHMO insurance providers require the dentist to see a specified amount of DHMO patients each day in order to remain under their plan. Some argue that this means that a dentist cannot spend the appropriate amount of time needed to give a patient quality care.

Another criticism is that DHMO providers only pay a certain dollar amount for each type of service. For example, a DHMO may only pay $100 for an exam, whereas the average cost in the dental industry is $200. The suggestion is that a dentist will use lower quality and faster methods when treating a DHMO patient because of these costs.

Your best bet if choosing a DHMO is to do a thorough background check on the dentists in your area to see who has the best reputation regardless of who their patients are.

A major benefit to choosing a DHMO is that most well-care visits are free to the insured person. Usually, this means that your bi-annual cleanings are covered under your plan with no out-of-pocket expenses, which means that you don’t have to pay a co-pay for a wellness visit. However, dental insurance does not cover for antibiotics, no matter what type of plan you have.

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Dental PPO Insurance Plans

Dental PPO plans or DPPO is sort of a hybrid of a DHMO and an indemnity dental plan. That is because a PPO still has a network of dentists that you can choose from, but it will still pay for some of your costs if you visit a dentist outside of the network.

If you do choose to go out of the DPPO network, your out-of-pocket costs will be higher. This is because within the network, much like a DHMO, the insurance company has negotiated with the dentist to keep costs for each type of care under a certain dollar amount. If the dentist you see out of the network stays within that agreed-upon amount, then you will not have an increased out-of-pocket expense. Generally, however, the costs outside of the network will be higher.

Comparing Dental PPO vs. Dental HMO Insurance Plans

DPPO providers do not require dentists to see a specified amount of patients each day, so there is no concern about whether or not they will rush through an appointment. They do, however, pay no more than the agreed-upon amount, which brings up some of the same concerns that a DHMO has. However, DPPO plans typically provide a higher allowance for services than a DHMO.

Of course, this higher allowance for services and the flexibility you get when you choose your own doctor comes with a price tag. Although a DPPO will be less expensive than an indemnity plan, it will be more expensive than a DHMO. In addition, many DPPO service providers require you to pay for your care out of pocket and then submit a form for reimbursement.

It will be in your best interest to find a dentist that will allow you to submit a claim for direct pay to the dentist so that you don’t have to pay out of pocket at the time of your visit. If you have a good insurance company, then it is possible to get a dentist to agree to this, especially if the dentist is well-established and can afford to wait on a claim to get paid.

Much like a DHMO, you will find that your cleanings are usually 100% covered, and most of the time, you won’t have any out-of-pocket costs at the time of your visit.

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Dental Indemnity Plans

Dental indemnity plans offer you the most flexibility in terms of your care. Naturally, you pay for this flexibility with higher annual premiums than other types of insurance plans. If you want the freedom to:

• Trade dentists whenever you want
• Visit a specialist, such as a periodontist, without a referral

then an indemnity plan is for you.

Dental indemnity plans pay a certain percentage of your care, typically 80% for standard care and 50% for high-end care, such as crowns. Sometimes they offer three different levels of care coverage, such as:

• 80% of cleaning, x-rays, and fillings
• 70% of root canals, gum therapy
• 50% of crowns, braces, etc…

Of course, you have to review your own policy to see what your dental insurance offers.

How Dental Indemnity Plans Work

When you choose an indemnity plan, you will receive a Table of Allowance, which will detail each of the most common treatment types and just how much the company is willing to pay for each type of treatment. Most insurance companies also offer a usual, customary, and reasonable fee addendum to your policy so that you understand that if the cost of care exceeds their Table of Allowance breakdown, then you will pay for the difference out of pocket.

For example, if the insurance company deems that a reasonable fee for a filling is $150 and your dentist charges the insurance company $175, then you will have to pay an additional $25 out of pocket. Before you purchase an insurance plan, you can review their reasonable fee schedule to determine if they are offering enough for the dental coverage you think you will need.

As you can see, there are a lot of things to consider when deciding between these three options. If money is a major factor, then a DHMO or DPPO may be your best choice. Once you have decided which option is best for you, then it’s time to use our free quote tool to find the best premiums.

Case Studies: Comparing the Best Dental Insurance Plans: HMO, PPO or Indemnity

Case Study 1: HMO Dental Insurance Plan

Mrs. Johnson, a 40-year-old working professional, opted for an HMO dental insurance plan due to its cost-effectiveness and convenience. As an HMO plan member, Mrs. Johnson had access to a network of dentists who agreed to provide services at reduced rates. The plan offered comprehensive coverage for preventive services, such as routine cleanings and exams, with low or no out-of-pocket costs.

However, Mrs. Johnson faced limitations in terms of choosing her preferred dentist outside the network and had to obtain referrals from her primary care dentist for specialist visits.

Case Study 2: PPO Dental Insurance Plan

Mr. Rodriguez, a self-employed man in his early fifties, chose a PPO dental insurance plan for its flexibility and wider network of dentists. Mr. Rodriguez’s PPO plan allowed him to visit any dentist he wanted, whether they were in-network or out-of-network. In-network dentists provided better coverage and lower costs, while out-of-network coverage had higher deductibles and co-pays.

This flexibility was ideal for Mr. Rodriguez, particularly when he required specialized dental services, as it allowed him to choose from a wider range of providers outside the network.

Case Study 3: Indemnity Dental Insurance Plan

Ms. Thompson, a retiree with specific dental care preferences, enrolled in an indemnity dental insurance plan. With an indemnity plan, Ms. Thompson had the freedom to visit any dentist without restrictions. She appreciated the plan’s flexibility, as it allowed her to maintain a long-standing relationship with her preferred dentist, even though they were not part of any specific network.

However, the indemnity plan required her to pay the dental bill upfront and then submit a claim for reimbursement, which meant managing some administrative tasks.

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Understanding the Difference Between Dental HMO, PPO, and Indemnity

What is the best type of dental insurance plan: HMO, PPO, or indemnity? You might like a dental HMO plan as they are the most affordable. However, you are limited to in-network dentists with an HMO plan.

Dental PPO offers more flexibility when choosing the dentist or specialists you want, but monthly dental insurance rates will be higher. Dental indemnity plans may have lower rates, but the Table of Allowance may not be enough to pay for your dental bills.

The easiest way to find the top dental insurance coverage near you is to compare insurance quotes from local dentists in your area. Use our online quote tool below to get free dental insurance rates today.

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