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Last Updated on March 28, 2022
Dental DMO vs. PPO
When it comes to protecting your body, health and dental insurance are crucial. They’ve been around for a long time. However, that doesn’t mean they’re necessarily intuitive to understand.
When exploring dental insurance options, you might come across acronyms like PPO or DMO. Both of these terms refer to different types of dental insurance plans that you can choose from.
In order to make the best decision for your circumstances, however, it’s best to know the ins and outs of each type of plan first. In this article, we will briefly cover the main points of DMO and PPO insurance plans, as well as the advantages and disadvantages for both.
Dental DMO Vs. PPO at a Glance
DMO Plan pros:
- Reduced cost
- Avoid paying a deductible
DMO Plan cons:
- Limits which dentist you can see
- You need a referral for a specialist
PPO Plan pros:
- Can see various dentists
- You don’t need a referral for a specialist
PPO Plan cons:
- Still some plan limitations
- More expensive
Verdict: The editor’s choice is the PPO plan, as these plans are generally more flexible and offer better dental cover. However, they do come at a higher cost.
DMO (Dental Maintenance Organization)
DMOs are very similar in concept to the health insurance equivalent of an HMO, or Health Maintenance Organization. In a basic sense, DMOs were created to reduce upfront costs and premiums, but for the tradeoff of limited freedom to choose any dentist you want.
With a DMO, you will need to select a primary dentist from a list of pre-approved dentists from the insurance agency, and if you need to see a specialist, you will need to get a referral. Without a valid referral, your insurance company won’t cover the cost of your specialist visit.
By restricting which dentists you can receive care from, DMOs ultimately help save money and reduce expenses. The only dentists on the approved list have already made a deal with the insurance provider to offer lower rates in exchange for patient referrals from the insurance plan. Dentists are incentivized to participate even more if there are only a few approved dentists on the list because this means insurance customers will have limited options and are more likely to choose them.
DMO Plan Advantages
DMOs are the best choice for anyone who doesn’t have a preference for which dentist they see and who is also looking to minimize premium costs.
With DMO plans, it’s common to skip having to pay a deductible, and it’s also likely that there will be no cap on the annual benefits your plan offers. With DMOs, your primary care dentist will also handle the job of submitting claims to your insurance provider, so you won’t have to worry about that.
DMO Plan Disadvantages
Due to the strict rules of visiting dentists on the approved list and only seeing referred specialists, if you happen to visit a dentist or specialist outside of this specific list, you should expect to cover all costs yourself, which can be expensive.
PPO (Preferred Provider Organization)
PPOs, much like their health insurance counterparts, are significantly less restrictive than DMOs. With a PPO, you can visit whichever dentist you want (usually) as long as they accept your insurance— no preferred provider list required. You also don’t need to have a referral to see a specialist with a PPO plan.
That being said, PPOs often still have networks of providers that you can choose from, and choosing within the network will typically lead to lower out-of-pocket costs than choosing outside the network. At the time of your visit, you will still have to pay the deductible or copay, depending on your plan, but if your dentist is in the preferred network, the insurance company may retroactively waive these fees.
In some cases, PPOs are referred to as PDNs, or Participating Dental Networks. Whether they’re called PPOs or PDNs, however, they still mean the same thing.
PPO Plan Advantages
PPOs are far more flexible than DMOs, including the fact that you can see whatever specialist you want whenever you want to. Additionally, you aren’t required to declare a main primary care dentist the way you are with a DMO plan.
PPO Plan Disadvantages
Even though PPOs are far more flexible, this comes at a cost. For non-network visits on a PPO plan, you typically won’t get full plan benefits and will likely have to cover more of the bill than for a DMO plan. It’s also more common for a PPO plan to have higher deductibles than a DMO plan. If you’re unfamiliar, a deductible is an amount that you will have to pay in order for your plan benefits to kick in and your insurance provider to cover the costs.
Therefore, if you have a $500 deductible for the year, you would need to spend $500 on dental care before you could expect your insurance provider to cover the cost of your visits and treatments.
Which is better?
Overall, PPOs provide more comprehensive dental care as well as more flexibility and options for which dentists you can see. They do come at a higher cost, however, so it all depends on your budget.