Dental insurance helps many people afford dental treatments, with 59% enjoying private dental benefits. Dental HMO insurance and PPO are the most popular plans, often involving specific networks of providers and primary-care dentists.

Let's explore the differences between these two and other alternatives to improve access to dental services for your patients.

Source: Ada.org

WHAT IS DENTAL HMO INSURANCE?

It stands for Dental Health Maintenance Organization (HMO). It provides accessible dental care to patients with an emphasis on preventive care. Patients enrolled in HMO plans usually select a Primary Care Dentist (PCD) from the participating dentists in the HMO network. 

It comes with many benefits but also has some limitations.

Benefits for Providers:

  • Steady Stream of Patients

These plans focus on preventive care. They motivate patients to get more regular check-ups and cleanings. It can help build long-term patient relationships and loyalty.

  • Reduced Administrative Burden

The Dental HMO insurance provider typically handles much of the administrative work. So, it can reduce the administrative burden on dental offices and free up staff time.

  • Predetermined copayment: 

Providers in the HMO network can expect to receive fixed copayments as agreed for covered services. Hence, providers can enjoy a consistent cash flow.

  • Referrals: 

Being a part of the HMO network means the insurance company refers plan members to in-network providers. Hence, it can help providers attract new patients with more ease.

Benefits for Patients:

  • Features lower monthly premiums.
  • Fixed copayments for covered services.
  • Coverage typically includes essential and preventive care at low or no cost.
  • Lower out-of-pocket costs.

Dental HMO Insurance Limitations:

  • Limits choice to in-network providers. So, patients need referrals to get specialty care from providers outside the network. 
  • May have limited coverage for major procedures.
  • Limited treatment options as DHMO plans usually don't cover all dental services.
  • Providers may receive lower fees per service than in fee-for-service models.
  • Providers may have less freedom due to network requirements and fee structures. 

WHAT IS DENTAL PPO INSURANCE?

Dental Preferred Provider Organization (PPO) insurance has a different approach. It allows access to a broader network of providers with more comprehensive coverage. 

These plans provide patients with more flexibility when it comes to selecting a provider. As a result, they can choose a specialist outside of the PPO network. So, providers don't necessarily need to join the PPO network, although there are various perks. 

Pros of PPO dental insurance for Providers:

  • Attracts patients with various insurance plans.
  • Providers have more freedom in setting their fees while adhering to terms.
  • Earn higher fees per service.

Pros of Dental PPO Insurance for Patients:

  • Patients can choose both in-network and out-of-network providers.
  • Better coverage for major dental procedures.
  • No need for referrals to see specialists.
  • No need to select a specific dentist as a primary care provider.
  • Provides greater flexibility in treatment options.

Limitations of Dental PPO Insurance:

  • Higher monthly premiums, compared to HMOs.
  • Often involves deductibles and coinsurance.
  • May involve out-of-pocket costs due to balance billing for out-of-network care.
  • May involve more administrative work, such as filing claims for reimbursement.
  • More competition within the network.

DHMO VS. PPO: WHICH IS BETTER?

Selecting which is the best choice depends on various factors. DHMO plans cost less for patients and restrict the choice of dental care providers in the network. PPOs offer more flexibility but can be expensive for patients. Thus, they both provide different advantages while also having some limitations. 

Therefore, it's best to explore other alternatives to overcome the limitations of Dental HMO vs. PPO plans. 

DENEFITS PAYMENT PLANS

Denefits is a modern alternative to traditional insurance. It's a payment solution that allows providers to create custom payment plans for patients. This way, patients can get the needed treatment without the burden of paying all at once.  

Pros of Denefits Payment Plans:

  • Flexibility: Customize plans to fit every patient's budget.
  • No Credit Check Policy: You can approve more patients from different backgrounds.
  • 95% Approval Rate: Quick approvals for patients.
  • Easy Process: It has a straightforward application process.

Limitations:

  • Not a Replacement for Insurance: Denefits is not a substitute for dental insurance. However, it can work in addition to insurance to reduce the burden of out-of-pocket expenses with affordable payment plans. This way, patients can pay monthly instead of all at once.
  • Minimum Limit: The minimum limit for creating payment plans is $300.

A Brief Comparison between DHMO vs. PPO and Denefits Payment Plans

Criteria Dental HMO Insurance Dental PPO Insurance Denefits Payment Plans
Premiums Low monthly premiums High premiums than HMO plans Affordable monthly installments
Coverage Limit Fixed copayments for covered services Coverage includes deductibles and coinsurance, which vary depending on the plan Payment plans are available for dental treatments amounting to $300-$20,000
Approval Rate  Varies Varies 95% approval rate
Application Process Waiting period ranging from a few days to 12 months Six-month waiting period for major services Quick process & instant approvals
Services Covered Includes preventive care and essential services  Includes preventive care and major treatments Payment plans for all kinds of dental services providers offer
Additional Perks A designated primary care physician Can choose any provider, including those outside of the dental PPO network for an additional cost 

+ Flexible payment plans for 3 months and over 48 months.



+ NO CREDIT CHECKS



+ More control over the contract terms

FINAL THOUGHTS 

Dental insurance plans like HMOs and PPOs provide essential coverage for many patients. But, these may not cover all the costs, and not everyone may qualify for them. So, for patients needing more flexible payment options, Denefits offers a solution. 

By combining both insurance and Denefits payment plans, you can help more patients receive essential care without financial hurdles.