Affordable Dental Insurance: A Budget-Friendly Guide to DHMO vs. DPPO

updated on November 15, 2023

  • Have you ever struggled to understand the details of dental insurance plans and coverage policies? The options seem endless. Should I go for a Dental PPO or Dental HMO? What's the difference anyway?

    This article will help you better understand the folloiwng key aspects:

    • Two prevalent types of dental insurance plan: DPPO vs DHMO and how they work

    • What types of dental care will be covered by DPPO and DHMO

    • The average costs for DPPO and DHMO

    • article cover

  • What's a DPPO plan?

    DPPO stands for Dental Preferred Provider Organizations. It's a popular type of dental coverage mainly because of relatively large network of dentists. If you're a member of a DPPO plan, you can enjoy reduced fees for services covered by the plan, as long as you go to dentists within their network. But what if your favorite dentist isn't in their network? No worries! One thing about DPPOs is that they'll still partially reimburse you for dental services you get outside their network. Although, be aware that you might not save as much as you would with an in-network dentist.

    Usually, in dental DPPO plans, there is an annual deductible that members are required to meet before they can take advantage of reduced fees for their denal services. A deductible is the amount that an individual must personally pay out of pocket before the insurance coverage begins. It acts as a threshold that needs to be crossed before the dental insurance plan starts contributing to the cost of the services.

    Some DPPO services have a repeat clause. For instance, if you get a filling, but for some reason, it fails. If you need it replaced, the plan might not cover the cost unless a specific number of months have passed since the initial service.

    While DPPOs give you the freedom to choose out-of-network care, remember that dentists can charge more than what the insurance allows. That could mean you'll end up paying more out-of-pocket. Tip to avoid surprise out-of-pocket costs: Have your dentist submit a Pretreatment Estimate or Pre Determination to the insurance company on your behalf. This way, you'll know in advance what you'll be expected to pay.

  • What's a DHMO？

    DHMO, or Dental Health Maintenance Organization, is a good option for individuals or families looking for affordable dental coverage. Dental HMOs ( DHMOs ) tend to have lower premiums but less flexibility. Member of this plan must choose from a list of in-network dentists, which is a major difference from DPPOs.

    DHMO plans usually have no deductibles or maximums. As soon as you're enrolled, your coverage kicks in without the need to meet any initial payment threshold. But you need to pay some copayments for non-preventitives procedures at a flat rate. The plan provides you with predictable costs with a set pay rate for various dental services. No need to worry about upfront out-of-pocket expences.

    One significant limitation of DHMO insurance plans is their narrower provider networks. Often, these networks aren't as extensive as the wide-ranging options you'd find with PPO plans. Without an out-of-network option, you might find yourself traveling longer distances to visit a dentist, and chances are, it might not be the one you're accustomed to seeing.

  • DHMOs and DPPOs May Cover The Following:

    Basically, the coverage structure follow the mode of 100/80/50 for different dental services:

    • Preventive dental care: Both plans covers 100%. Preventive dental care includes cleaning, oral exams, certain types of X-rays, and fluoride treatments.

    • Basic dental services: Or named basic restorative in the detailed plan. Normally, both plans will cover a flat fee rate at around 80% for these services. But for DPPO plans, you will need to meet your deductible before the insurance coverage kicks in.

    • Major restorative services: For major services, like crowns, bridges, dentures and implants, coverage percentage varies, but often 50% of the costs.

  • Average Costs:

    Dental insurance premiums vary greatly based on geographical location, individual dentists, and several other determinants. The pricing structure is influenced by factors such as plan types, insurance providers, and the coverage levels. Monthly premium rates for individual coverage typically range between $12 and $50. Notably, Dental Preferred Provider Organization (DPPO) plans often fall towards the higher end of this spectrum. On average, Dental Health Maintenance Organization (DHMO) plans command monthly premiums of approximately $22.75, while DPPOs command a relatively elevated average of $62.75 per month.


  • Conclusion:

    Choosing between DHMO and DPPO plans ultimately depends on your individual needs and preferences. With DHMO plans, you can enjoy the convenience of no deductibles, and the assurance that preventive dental services are covered at 100%. However, be prepared for varying copays with different procedures. On the other hand, DPPO plans come with deductibles, and while preventive services are fully covered, you may encounter out-of-pocket costs for basic and major procedures, with coinsurance ranging from 20% to 50%. Additionally, the absence of an annual maximum in DHMO plans provides peace of mind, while DPPO plans typically have an annual maximum ranging from $1000 to $2000.

    It's essential to factor in your budget and expected dental needs when considering these costs. As you navigate the choices, weigh the benefits against your priorities to make an informed decision that suits your oral health and financial well-being.


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