Both DHMO and PPO are dental insurances with the main difference between them being freedom of choice on which dentist you want to see. The former is more restrictive while the latter gives you more options.
However, there are also a lot of other benefits and limitations that come with each type of dental insurance.
DHMO insurance
DHMO (Dental Health Maintenance Organization) insurance requires you to select a dentist that is contracted with your insurance. If you see a non-contracted or out of network dentist, your treatment will not be covered.
That is the gist of it but there are benefits and limitations that come with it.
Benefits of DHMO plans:
Lower monthly premiums
No deductible
Set copayments
No annual maximum for covered benefits
Limitations of DHMO plans:
Smaller selection of dentist to choose from
Requires referral to see dental specialists
Out of network dentists have zero coverage
May be restrictions around the number of visits, treatments, or diagnostic tests allowed
What it means for you: Most patients with DHMO plans often don't realize that they already have a pre-assigned dentist. They'll call our office asking to make an appointment but when they show us their insurance call, it'll have a dentist's phone number listed on there.
That dentist is who you MUST see in order to get full coverage.
If you don't want to see them and want to switch to someone else, you have to give your insurance a call and then they'll provide you a list to choose from.
PPO insurance
PPO (Preferred Provider Organization) insurance allows you to see any in-network as well as out-of-network dentist as long as they accept the insurance.
Benefits
About 99% of dental offices accept it.
Dental specialists require no referral.
Can cover out of network dental care.
Limitations
Higher premiums vs DHMOs
Annual deductible applies
There is an annual maximum of benefits for treatment
Higher copays vs DHMOs
What it means for you: If you have a PPO plan, feel free to call and make an appointment with whatever dentist you want to see. Even if they're out of network you can still receive coverage and reimbursement for your visit.
Which one is better?
In my opinion as a practicing dentist, PPO dental insurances are miles better than the DHMO plans and you should choose it if you're able to financially.
Because DHMO plans cost less for you as a patient, they also reimburse your dentist less. Therefore, dentists will not accept DHMO plans unless their offices are struggling. As a consequence, most of the "good" dental offices will not participate with the Dental Health Maintenance Organization plans.
As you may have guessed, the very high end cosmetic dental offices usually don't take any insurance at all but you can typically still get reimbursed for part of the visit.
Ultimately you will most likely receive better dental care with a PPO dental plan vs a DHMO plan. What that means for you would be the difference between a 5 minute dental cleaning vs a 30-45 minute one. Can you guess which plan is more likely to give a 5 minute cleaning?
Accepted insurance at 1311 Jackson Ave Dental
At our dental practice, 1311 Jackson Ave Dental, we only accept PPO insurances and we do not accept DHMO plans.
For the PPO plans, we are in-network with most of the major insurance carriers but you should see our full list of accepted dental insurances. Although sometimes there are insurances that we are in-network with that we're not aware of. If you see our office listed in your plan's directory but we don't have it listed on our website, you are still eligible to receive care!
FYI, if your insurance is out of network with our dental office, you can usually still receive care with us as long as it is a PPO plan. As long as our administrative staff knows how to bill your insurance to receive reimbursement we can accept it.
There are hundreds of different insurances out there and it is impractical to be contracted with all of them.
The only time we cannot accept an out of network dental PPO plan is if we do not know how to bill it for reimbursement. Yes, some of the really obscure ones we have no idea how they work.
Nonetheless, if you have any questions regarding what plans we take, just drop us an email or give us a call. Or you can walk on over if you're nearby in Long Island City, NY.
