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What is PPO Dental Insurance? PPO vs. HMO Plans

Dental insurance can help cover the cost of many dental procedures and treatments. However, there are several policy types that can offer different advantages to policyholders. Two of the most common are Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs). Each plan differs in features, benefits, coverage, and average costs. This article will explore how PPO dental insurance works and how it compares to HMO plans so that you can select the best type of plan for your needs.

What is a dental PPO plan?

A dental PPO plan is a type of dental insurance plan offering a network of dentists who provide policyholders with services at rates negotiated with the insurer. Members can visit any dentist within or outside the network, although costs are lower for in-network providers.

Benefits of dental PPO plans

Here are the primary benefits of PPO dental plans:1

Large network

PPO plans tend to offer more extensive provider networks. This gives you more options for seeking affordable dental treatments.


PPO dental plans don’t limit you to in-network providers. If you have a preferred provider who is not in-network, you can still potentially get some coverage. However, keep in mind that this plan offers less coverage for out-of-network providers, resulting in higher costs.

No referrals needed

PPO policyholders don’t need to visit their primary care dentist to get a referral for a specialist. This could save you time and offer extra convenience, helping you resolve issues more quickly.

Might receive partial reimbursements

If you go out-of-network and a provider charges more than the PPO’s set rate for a service, you’ll pay the difference. However, that means you’ll still potentially receive reimbursement for some of the cost.

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Dental PPO vs. HMO plans 

Here are some key differences between dental PPO and HMO plans:

In-network coverage Large network Smaller network
Out-of-network coverage Yes Limited to emergency services under specific circumstances2
Cost Higher premiums Lower premiums2
Deductible Higher Usually none, but lower if they exist2
Annual maximum Yes1 No
Co-pays Can be higher Generally lower than other plans2

Is a dental PPO plan right for me?

Here are a few factors to consider when deciding if a PPO dental insurance plan is the right choice for you:

The need for flexibility

PPOs can work well if you want additional flexibility when seeking your primary dental provider. For example, if you prefer a particular provider outside the network, a dental PPO plan will let you visit them. They may partially reimburse certain services as well. Otherwise, finding an HMO plan containing that provider may be best if you plan to stick to one in-network provider.

Specialist needs

If you believe you’ll need to visit specialists, a PPO may be the best option. You won’t have to schedule an appointment with your primary dentist to get a referral, saving you time and making it easier to get the specialized care you need. However, if you don’t anticipate much care beyond regular check-ups and minor services, you may opt for an HMO.

Whether you’re willing to pay more for coverage

PPOs tend to charge higher premiums for the extra benefits and more extensive network. So, this type of plan can make sense if you’re willing to budget more for dental insurance. However, if you don’t believe you’ll need the extra benefits a PPO offers, an HMO can help you potentially bring down your coverage costs.

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PPOs can offer a larger network, increased flexibility, and more convenience than HMOs. However, HMOs typically charge lower premiums and only have co-pays rather than deductibles. Ultimately, weigh your budget against the features of PPOs to see if this type of plan is right for you.

Aflac’s dental insurance offers enhanced insurance coverage for a variety of preventative, basic, and major services. Start chatting with an agent today to explore your dental coverage options and get a quote.

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