Add to Calendar 10/19/2018 08:00 AM 10/19/2018 10:00 AM America/Los_Angeles Summary of the event Description of the event Location of the event

It is crucial to have the right dental insurance in place. Otherwise, you run the risk of paying unnecessary costs, getting rejected from your preferred dentists and being subject to lower quality care.

While many believe they know all they need to about HMO and PPO insurance plans and the differences with each, it is a completely different ball game when choosing dental insurance.

When discussing the HMO and PPO dental insurance debate, it is important to have a general understanding of the differences between each and which one is best for your particular circumstance.

With a good understanding of each, however, you will be able to choose your dental insurance provider with confidence.

What Is HMO Dental Insurance?

HMO dental insurance most certainly has its advantages, including lower costs(typically) and a wide range of procedures that are covered. However, the lower price actually comes at a cost, which is a restriction on your freedom to choose your own dentist.

Since HMO typically costs less – and subsequently dentist work at lower rates – many highly trusted dentists won’t accept HMO coverages(in many cases this is because their bank loan prohibits it) and you will be assigned to a dentist in which you have no control over. Although there are times you can choose your own dentistry with HMO insurance, you are at best limited to a range of “in network” dentists. Depending on where you live, this range of dentist in many cases can be small with few trusted options.

With that said, if you already have a primary care dentist that accepts HMO insurance or there is a trusted dentist that is “in network” that you trust then HMO insurance can be a fantastic way to save money.

What Is PPO Dental Insurance?

The best part about PPO dental insurance is you have the ability to see whoever you want, whether they are in network or out of network, and don’t need any approval in order to do so. Also, since dentists are typically paid a higher rate with PPO dental insurance, they are more inclined to accept your insurance, leading you to the opportunity to receive the best care possible. 

As with anything, however, quality comes at a price. In general, PPO insurance is more expensive than HMO. Also, whereas there is no deductible necessary with HMO insurance, individuals with PPO dental insurance typically have to pay a deductible and more extensive operations, such as a root canal or dental implant, will require you to pay some money out of pocket as PPO insurance is less likely to cover 100%.  

If you are only concerned with quality and freedom to go to whichever dentistry you prefer, however, then PPO insurance may be the right plan for you, despite the risk of paying more than you might under HMO. 

dental-care

In Network vs Out of Network

Another important concept to understand before choosing between HMO and PPO dental insurance is In Network and Out of Network dentists.

For both HMO and PPO, you will be provided a list – which can typically be found on the company’s website – of in network dentists. An in network dentist is a dentistry that the insurance provider works with directly in order to negotiate rates, etc. With HMO, the “in network” list is usually much shorter as fewer dentists cover HMO. On the other hand, PPO offers a much more has more “in network” options.

In Network vs Out of Network

Another important concept to understand before choosing between HMO and PPO dental insurance is In Network and Out of Network dentists.

For both HMO and PPO, you will be provided a list – which can typically be found on the company’s website – of in network dentists. An in network dentist is a dentistry that the insurance provider works with directly in order to negotiate rates, etc. With HMO, the “in network” list is usually much shorter as fewer dentists cover HMO. On the other hand, PPO offers a much more has more “in network” options.

An out of network dentistry is one that does not work directly with your insurance provider. If you have HMO insurance, you are usually not able to visit out of network and still receive coverage.

With PPO, however, you are able to visit out of network dentists using what is called a UCR fee, which is the amount covered by the insurance company based on the average rate. For example, if the UCR amount for a dental cleaning in your area is $100, but your particular dentist charges $150, then you are more than likely responsible for the additional $50, assuming the dentist is out of network and you have PPO insurance.

Due to the out of network restrictions that accommodate most HMO coverage, it is important to decide on your dentist or find out which dentist you will be assigned to before committing. In most cases, your HMO provider can work a great deal with a fantastic dentist, but it is important to always make sure that is the case.

Dental Insurance

How to Decide Between HMO and PPO Dental Insurance

Both HMO and PPO dental insurance have positive attributes as well as negative, so there isn’t a simple answer that one is better than the other. Instead, the option that is best for you is completely dependent upon your personal situation, needs and desires. Here are some questions you should ask yourself before choosing between the two:

  • Do you currently have a primary care dentist?
  • What is your dental insurance budget?
  • How often do you see the dentist?
  • What type of dental procedures do/will you need?

By answering these four questions, you should have a general idea of whether you are better suited with HMO or PPO dental insurance. While each individual has a different set of circumstances, generally HMO is better for those who rarely visit the dentist outside of scheduled cleanings and would prefer to spend less. HMO is also typically recommended for individuals who currently have a primary care dentist that accepts HMO insurance.

If you plan to endure more costly and complex procedures and don’t currently have a primary care dentist, then you may want to consider PPO dental insurance more strongly than HMO as the freedom to find more qualified dentists is important.

While there are most certainly qualified, trusted dentists that accept HMO, you are more at risk of receiving lower quality care with HMO as they typically work for lower rates with HMO insured patients. Quite simply, HMO insured patients are time slot fillers to many dentists and the dentists motivation may be slightly diminished during that time, so it is important to find an ethical, trusted dentist to treat you if you choose HMO insurance.

At Sudbury Dental Excellence, we accept both HMO and PPO dental insurance and provide comprehensive dental treatment for all age groups. Call and schedule your next appointment today!

Pin It on Pinterest

Share This

Share this post with your friends!