What choices of dental plans do you have? Which should you pick?
HMO- Stands for “Health Maintenance Organization”. In an HMO network Contracted dentists are “pre-paid” a certain amount each month for each patient that has been assigned to that dentist. The offered treatments are limited and the places that offer to take those plans are few.
Limits the providers members can go to. Dentists are limited to providing only certain contracted services at no cost or reduced cost to those patients. The plan usually does not reimburse the dentist for their services and therefore patients must receive treatment at their assigned office in order to receive a benefit.
PPO- Stands for “Preferred Provider Organization”. In a PPO network, contracted dentists agree to deliver services for set fees and according to the provisions of the contract. Most PPO plans allow a yearly maximum and cover treatments at set percentages.
Patients have the freedom to see a dentist outside of their “PPO network” with a slightly different out of pocket expense.
Below are a few main points to help you compare and better decide which plan is best for you:
- Premiums are less
- Co-Payment is consistent
- Provider network is smaller
- Cannot choose your own dentist, Insurance assigns it for you
- Limited amount of procedures the dentist can provide
- May not see another dentist until insurance approves your dentist termed as “closed”
- If you have an emergency and go to a different dentist you pay full fees out of pocket
- Patients most common complaints:
- Long wait times to be seen by dentist and/or Clinics assign different dentists to patients all the time
- Choose any dentist you like in network
- May see dentist out of network
- Wide range of dentists
- Discount for procedures
- Most procedures are covered
- No waiting on preventative procedures
- If you have an emergency, you may see any dentist in or out of network
- You may build a relationship with dentist to determine long and short term treatments
- Co-pay varies
- Premiums are slightly higher than HMO
- Some plans have a waiting period for certain procedures
- Patients most common complaint:
- The co-pay is higher