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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.
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.
Here are the primary benefits of PPO dental plans:1
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.
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.
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.
Here are some key differences between dental PPO and HMO plans:
| PPO | HMO | |
|---|---|---|
| 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 |
Here are a few factors to consider when deciding if a PPO dental insurance plan is the right choice for you:
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.
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.
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.
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.
1 Investopedia - Dental Insurance HMO vs. PPO: What’s the Difference? Updated February 26, 2024. https://www.investopedia.com/dental-insurance-hmo-vs-ppo-whats-the-difference-8553452. Accessed March 4, 2024.
2Investopedia - Health Maintenance Organization (HMO): What It Is, Pros and Cons. Updated December 16, 2023. https://www.investopedia.com/terms/h/hmo.asp. Accessed March 4, 2024.
Coverage is underwritten by American Family Life Assurance Company of Columbus. In New York, coverage is underwritten by American Family Life Assurance Company of New York.
In Delaware, Policies A81100–A81400. Policies A82100R–A82400R. In Idaho, Policies A81100ID–A81400ID. Policies A82100RID–A82400RID. In New York, Policies NY81100–NY81400. Policies NY82100–NY82400. In Oklahoma, Policies A81100OK–A81400OK. Policies A82100ROK–A82400ROK. In Virginia, Policies A81100VA–A81200VA. Policies A82100RVA–A82400RVA.
Coverage underwritten by Tier One Insurance Company.
Dental, Vision and Hearing: In Arkansas, Policy T80000AR. In Delaware, Policy T80000. In Idaho, Policy T80000ID. In Oklahoma, Policy T80000OK. In Oregon, Policy T80000OR. In Texas, Policy T80000TX. Not available NY or VA. Dental claims are administered by Aflac Benefits Solutions, Inc. Vision claims are administered by EyeMed Vision Care, LLC. Hearing claims are administered by Nations Hearing.
NOTICE: The coverage offered is not a qualified health plan (QHP) under the Patient Protection and Affordable Care Act (ACA) and is not required to satisfy essential health benefits mandates of the ACA. The coverage provides limited benefits.
Tier One Insurance Company is part of the Aflac family of insurers.
This is a brief product overview only. Coverage may not be available in all states, including but not limited to DE, ID, NJ, NM, NY or VA. Benefits/premium rates may vary based on state and plan levels. Optional riders may be available at an additional cost. Policies and riders may also contain a waiting period. Refer to the exact policy and rider forms for benefit details, definitions, limitations and exclusions. For complete details, including availability and costs, please contact your local Aflac agent.
Aflac WWHQ | Tier One Insurance Company | 1932 Wynnton Road | Columbus, GA 31999
Z2400238
EXP 4/25
