DHMO vs PPO is a question I get often during open enrollment. Basically, nobody wants to think about dental insurance ever. People hate the dentist and they hate paying for dental insurance. But every year around open enrollment, I get the same question: should I get a DHMO or a PPO for dental insurance? Do I even need dental insurance? Let’s break it down:
- My experience with DHMOs and dental PPOs
- The difference between dental and health insurance
- A breakdown of DHMO plans
- A breakdown of dental PPO plans
- Comparison: DHMO vs PPO
- The best plan for you
Why I hate the dentist
I am one of those people that get nervous every time I have to go to the dentist. Working at a sub shop in high school and drinking soda and lemonade all day everyday did a number on me. I destroyed my teeth as a teenager and am still paying for it (literally) to this day.
My experience with a dental HMO and a PPO
When I was in graduate school I had a DHMO (more on this later). My teeth were still reeling from my high school days and I had several small cavities. My dentist quite frankly told me “you have an HMO, which means I won’t get paid enough to fill these cavities”. I didn’t argue because I really did not want to get a filling.
A year later, I had a dental PPO and went to a different dentist who told me I needed 7 or 8 fillings. I could tell as she was examining my mouth that the cash register noise was going off in her head. The feeling came over me that I was being taken advantage of, and I was. I called my college roommate who is now a dentist and he said “no way”. He told me to go down the street to a different dentist who said I only had ONE!
What I learned
As you can tell, this left a bad taste in my mouth (pun intended). The bottom line of this story is that you need to find a dentist you can trust and make sure that you have the right dental insurance for your needs.
I now have a wonderful dentist who finds ways to save me money and encourages me in my dental health journey. I’m not hesitant or wary of the dentist anymore and have a great, trusting relationship.
As you read the below, consider you and your family’s needs from your dentist. It is worth having a dental plan that is more costly if it means you can go to a dentist that you trust.
Dental insurance vs health insurance
Whether or not you need dental insurance is completely up to you. Dental insurance is similar to health insurance in how the plans operate, but different in its necessity. You do NOT want to be caught without health insurance no matter how healthy you are.
Accidents can happen to the healthiest people on earth, resulting in major medical bills that can bury you in a mountain of debt. Therefore, health insurance is an absolute necessity. Dental accidents are much less likely.
In fact, dental health is much easier to manage and you typically know where you stand.
Do I need dental insurance?
I recommend it. Dental insurance is typically way cheaper than health insurance and is worth the money. If you go in twice per year and get your teeth cleaned, x-rays, etc. you will end up saving a good amount of money.
If you have a history of cavities, root canals, crowns, bridges, or other dental issues, then having dental insurance is an absolute must. Many dentist offices offer cash-pay for these services but they can easily get into the five-figure range.
What about a subscription plan?
Driving around town, I have seen dental practices advertising subscription plans for those without insurance. I typically see about $299 or so for a subscription to routine cleaning and x-rays for a family. I highly caution against using these. IF they find something that needs to be further examined or a procedure needs to take place, you will pay significantly out of pocket to cover the cost. Dental insurance for a family is close to the same cost and covers these costs (or at least majorly helps offset the cost).
What is a DHMO plan?
DHMO stands for Dental Health Maintenance Organization. Similar to health insurance, DHMOs are characterized by having a low monthly cost and a narrow network of providers.
A narrow network of providers means that the dental insurance company will only allow you to seek dental services from an approved list of dentists. These are dentists trusted to provide quality, low-cost dental services.
DHMOs are great if you have good oral health, don’t have a strong opinion of who your dentist is, and are looking to save on a dental plan.
What does PPO mean for dental?
PPO stands for preferred provider organization, which is almost exactly like what I described with the DHMO. PPOs are characterized by slightly higher monthly costs (relative to a DHMO) but a larger variety of in-network dentists.
Dental PPOs offer great coverage and are definitely the higher-end option. These plans allow you much more flexibility with choosing your dentist. With a dental PPO, you will notice the amount of money taken out of your paycheck each month but can save a TON of money if you have a dental procedure.
Comparing a DHMO and a Dental PPO
DHMOs and Dental PPOs are both great options for making sure you are covered at the dentist. Below is a breakdown of a DHMO vs a PPO by each category.
DHMO vs PPO: Monthly cost
DHMOs cost about $7-15 per month for an individual selecting a dental insurance plan. This is a very nominal fee and would be a great way to save money on dental insurance. PPOs will cost somewhere between $30-50 per month for quality coverage.
Winner: DHMO
DHMO vs PPO: Coverage and choice
DHMOs restrict the amount of dentists you can see into a very narrow network. DHMOs also don’t offer as robust benefits and coverage for if and when you need a costly dental procedure. PPOs tend to allow for more flexibility with choice of dentists and help cover the costs of procedures.
Winner: PPO
DHMO vs PPO: The best choice for you
DHMOs and PPOs will offer different benefits depending on your oral health status. For those that have had cavities in the past and get nervous whenever you go to the dentist, I would go with a PPO.
If you have a healthy mouth but love your dentist and wouldn’t dream of going to another, get a PPO or call your dentist and ask them if they accept a DHMO.
Similarly, if you couldn’t care less where you go to the dentist, get a DHMO and save some money every month.
As you can see, there isn’t a correct answer as to which one is better. If you have healthy teeth and want to save a buck, get a DHMO. If you have a not-so-great dental history, get a PPO and spend more to save more. The most important aspect of all of this is to find a dentist that you trust.