Dental HMO vs. PPO Plans: What’s the Difference?

Dental HMO vs. PPO Dental Plans

Like the health insurance market, insurance providers offer multiple dental insurance plans, including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Let's explore their main differences so you can choose the right plan for your needs.

4 Min Read

Table of Contents

Key Takeaways

Dental HMO plans tend to have lower out-of-pocket costs but require you to use in-network dentists, while PPO plans allow you to choose your own dentist.
Both dental HMOs and PPOs have networks of dentists under contract with the insurance company to help reduce your out-of-pocket expenses.
HMOs can save you money if you have significant dental needs, like major surgery, while PPOs offer the flexibility to choose a preferred dentist and specialists.

How dental HMO plans work

Dental HMOs (DHMOs) are designed to help keep costs down by requiring you to see dentists and specialists within the plan’s network. These providers have contracts with the insurance company, which helps lower out-of-pocket expenses for patients.

With a DHMO, your costs are usually set ahead of time, so there are no surprises, and there’s no annual coverage limit for covered services. These plans also put a big focus on preventive care, like cleanings and X-rays, making it easier (and more affordable) to visit the dentist regularly.

Here are some benefits of DHMOs:

Usually lower premiums than PPOs
There is no deductible
Transparent copays for covered services
No annual coverage limit

DHMOs also come with some limitations, such as:

Patients must choose in-network dentists
To see a specialist, you’ll usually have to get a referral from your primary care dentist
Out-of-network costs are not covered

How dental PPO plans work

Dental PPO (DPPO) insurance plans prioritize flexibility, allowing patients to choose their own primary care dentist, although they usually have deductibles and higher out-of-pocket costs.

With a DPPO, you can see dentists within your insurance provider’s preferred network for lower costs, but you also have the freedom to choose your own dentist or specialist if you prefer. Basically, you’re paying a little more for extra flexibility with your care. DPPOs are a top choice for both employers and individuals, dominating the commercial dental insurance market and making up 86% of total enrollment in commercial dental plans.¹

Here are some benefits that DPPOs offer:

Flexibility to choose your preferred dentist or dental facility
You don’t need referrals to visit specialists
More dentists to choose from
Don’t need to designate a primary care provider (PCP)

Here are some limitations of DPPOs:

Higher premiums than DHMOs
Usually have a deductible before coinsurance kicks in
Usually have an annual coverage limit
Coinsurance, copays, and out-of-pocket costs are often higher than DHMOs

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Dental HMO vs. PPO plans

Each provider and plan may be different, so it’s important to research a plan’s details to understand its features. We’ve broken done some of the most typical differences between DHMO and DPPO plans below:²

	DHMO	DPPO
Cost	Typically lower monthly premiums	Typically higher monthly premiums
Copay	Usually set copays, including minimal or no copay for preventative and diagnostic services	Depends on the service and plan
Deductible	Usually do not have a deductible	Usually have an annual deductible, but may be waived by staying in network for preventative care
Out-of-network coverage	Usually not covered	Covered, although in-network visits may have lower out-of-pocket costs
Annual coverage limit Typically no annual coverage limit Yes	Typically no annual coverage limit	Yes
Referrals	Required	Not required

How to choose between a dental HMO and PPO plan

DHMOs and DPPOs each have advantages, so it can feel difficult to decide which is right for you. Your employer may only offer one type of plan, which simplifies this choice, but if you have options, it’s important to understand the factors that will inform your decision.

What’s your budget for monthly premiums?

Your monthly premium is the amount you pay each month for the insurance plan. According to the National Association of Dental Plans, the average DHMO costs an estimated $14 per month, while the average DPPO costs about $35 per month.³

Who do you need coverage for?

If you’re young, single, and healthy, you can save money with a DHMO since your dental needs are fairly straightforward. Whether you have an employer-sponsored plan or you need self-employed dental insurance, a DHMO can help lower your out-of-pocket costs.

However, if you need a plan that helps cover your whole family, including children or a new baby, you may prefer the flexibility of a DPPO plan. These plans are more expensive, but they’ll give you greater choice in dentists, make specialist referrals easier, and allow you to better accommodate the whole family’s unique dental needs.

Do you have a preferred dentist?

You can search for a DHMO plan with your preferred dentist in your network, or choose a PPO plan to ensure you can always go to that dentist, even if the network changes.

Will you need to see a dental specialist?

People with specific dental health needs will benefit from a DPPO because you have access to more dentists and specialists. You don’t have to wait for referrals and can choose your preferred specialist, even if it’s not in the network.

Get a quote for Aflac dental insurance

There are advantages to both DHMOs and DPPOs. Many Americans choose DPPOs for the flexibility and freedom of choice, despite slightly higher out-of-pocket costs.² Aflac dental insurance allows you to use both in-network or out-of-network dentists and specialists for preventative, basic and major services. To learn more about the coverage we offer and get a quote, chat with an Aflac agent today.

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