Learn about the difference between a dental HMO and dental PPO plan and easily compare costs and coverage, so you can find the best dental insurance plan for your needs.


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Dental HMO vs. PPO

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

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Dental HMO vs. PPO insurance plans: What’s the difference?

Knowing the differences between dental health insurance plans will help you pick the best one for your needs. Two of the most common are dental health maintenance organization (DHMO) vs. a dental preferred provider organization (DPPO), which have several key differences, like cost and the flexibility to choose your preferred dentist or select dentists within a defined network.

Let’s take a closer look at the key features of DHMO vs. DPPO plans to help find the one that’s best for you. (Keep in mind: These are general features for each type of plan. You should always check plan specifics with your insurer before you enroll.)

A dental HMO plan, commonly referred to as a DHMO, is designed to help keep costs lower. Any out-of-pocket dental costs are usually pre-determined, and there is no annual maximum for covered benefits. DHMO plans tend to focus on preventive care and encourage regular dentist visits. These plans have networks of dentists under contract with the insurance company.

Benefits of dental HMO:

Lower premiums than dental PPO

No deductible

Set copayments for covered services with little or no copayment for diagnostic and preventive care

There is no annual maximum

Limitations of dental HMO:

Smaller network of dentists to choose from

You may be required to choose a primary care dentist from a pre-approved list

To visit a specialist, you may have to get a referral from your primary care dentist

Out-of-network costs not covered



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A dental PPO plan usually has higher out-of-pocket costs and has a deductible, but allows greater flexibility to choose any dentist and usually does not require a referral to visit a specialist.

Like DHMOs, DPPOs have a network of dentists under contract with a dental insurance carrier. The patient can see dentists in network (which will usually keep costs lower), but has the freedom to choose dentists and specialists out of network.

Benefits of dental PPO:

Flexibility to choose your dentist or dental facility

Larger network of dentists from which to choose

No referral needed to visit a specialist

Do not need to designate a primary care provider (PCP)

May receive a partial reimbursement for covered services from out-of-network dentists

Limitations of dental PPO:

Higher premiums than DHMO plans

Will typically have a deductible

Coinsurance only kicks in when deductible is met

Typically has an annual coverage limit

DPPO coinsurance or copayments may be higher compared to DHMO plans

Out-of-pocket costs may be higher than DHMO plans

To receive reimbursement, patients must file claims and there can be a waiting period



Here are the key features of typical dental HMO vs. dental PPO plans. Note, this information may not apply to all dental HMO or dental PPO plans.

Los planes dentales HMO suelen tener primas mensuales más bajas que los planes PPO comparables​​

Los planes Dental PPO suelen tener primas más altas que los planes HMO comparables​​ 
			Los gastos de bolsillo pueden ser más elevados en un plan DPPO​​

Las visitas fuera de la red no suelen estar cubiertas​​

Las visitas fuera de la red están cubiertas, sin embargo, las visitas en la red pueden tener menores gastos de bolsillo​​

Coaseguro (porcentaje de los costos que usted y su plan comparten por los servicios cubiertos)​​ 

Sí, algunos planes DHMO pueden basar los beneficios en porcentajes de coaseguro​​

Sí, normalmente los planes DPPO basan los beneficios en porcentajes de coaseguro​​

Los planes DHMO no suelen tener un deducible​​

Los planes DPPO suelen tener un deducible anual, pero algunos planes pueden eximirlo si permanece en la red para recibir servicios preventivos​​

Sí, los planes DHMO suelen incluir copagos fijos​​ 
 A menudo se requiere un copago mínimo, o ningún copago, para la atención preventiva y de diagnóstico​​

A veces, dependiendo del tipo de servicio​​

No, la mayoría de los planes DHMO no tienen un máximo anual​​

Sí, los planes DPPO incluyen un monto máximo de cobertura anual​​

¿Se requiere un dentista primario?​​ 

En un plan DHMO, es posible que tenga que elegir un dentista primario en la red para todas sus necesidades de cuidado dental. Si necesita visitar a un especialista dental, su dentista primario debe remitirlo a un especialista dental en la red​​

Los planes Dental PPO no requieren que elija un dentista primario y puede visitar a cualquier dentista autorizado en la red o fuera de la red. No necesitará referidos para visitar a un especialista​​ 
			Puede pagar menos gastos de su bolsillo por las visitas a dentistas y especialistas en la red, en comparación con la visita a un dentista fuera de la red​​

Red más reducida. Los gastos fuera de la red no están cubiertos​​

Red mayor​​ 
			Los costos de proveedores fuera de la red pueden estar cubiertos​​

Pueden ser necesarios referidos para visitar a un especialista​​

No se requieren referidos​​

Dental HMOs and PPOs are similar in that both offer dental care for patients.

Both plans have networks of dentists under contract with the dental insurance company, which can help reduce your out-of-pocket dental expenses.

An employer might offer a DHMO or DPPO plan to its employees. Patients and their families can purchase Individual DHMO or DPPO coverage without needing to go through their employer.



Dental HMOs and PPOs are different in many ways, but that doesn’t make one insurance plan better than the other. Patients should consider what’s most important to them when making their decision.

Generally, dental HMO plans require a primary dentist and only provide full coverage for in-network visits, but will usually have lower premiums than a comparable PPO plan.

Dental PPO plans tend to have higher premiums than dental HMO plans, but usually provide more coverage for out-of-network visits, and PPOs will not require you to select a primary dentist.

Choosing a dental PPO vs HMO plan depends on the patient’s specific needs. DHMOs, though usually more cost-effective, are not necessarily better than DPPOs. Here are some reasons people select a dental HMO or PPO given their dental needs:

If you have a preferred dentist:

If you have an existing dentist or preferred dentist not in the DHMOs network, you may want to choose a DPPO.

If you need to see a dental specialist:

Under a DHMO plan you may need your primary dentist to refer you to a specialist in network, which may cause a delay. In a DPPO plan, you can choose a specialist without needing a referral.

If you expect to undergo major surgery:

A DHMO may be a better choice when planning to undergo major dental surgery because there’s no deductible nor annual maximum, but you should first determine if the procedure will be covered by your dental plan.

What procedures are typically covered by a DHMO vs. DPPO?

Preventive services like teeth cleanings, oral exams and dental X-rays are usually covered 100% by DHMO and DPPO plans.

Dental fillings, root canals and tooth extractions may be considered basic restorative care. Under a DHMO, these typically have a flat fee. Under a DPPO, you will first need to meet your deductible before paying a percentage of covered costs.

Dental crowns, bridges, dentures and oral surgery are usually considered major restorative care. They may be covered up to a certain amount based on your plan’s terms.



Will I need to file claims?

If you don’t want the hassle of filing claims for reimbursement, a DHMO would be your preferred option. However, in-network PPO providers may also file claims for you.

It depends on your needs. DHMO plans are intended to be more cost-effective, while DPPO plans offer greater flexibility and a wider network in choosing your care. You should always research out-of-pocket costs for any plan and the limitations for each. If possible, consult your current dentist so you know what types of plans their facility accepts.

Knowing your unique needs will help determine the dental insurance plan that is best for you.

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Características	DHMO	DPPO
Costo	Los planes dentales HMO suelen tener primas mensuales más bajas que los planes PPO comparables	Los planes Dental PPO suelen tener primas más altas que los planes HMO comparables Los gastos de bolsillo pueden ser más elevados en un plan DPPO
Cobertura fuera de la red	Las visitas fuera de la red no suelen estar cubiertas	Las visitas fuera de la red están cubiertas, sin embargo, las visitas en la red pueden tener menores gastos de bolsillo
Coaseguro (porcentaje de los costos que usted y su plan comparten por los servicios cubiertos)	Sí, algunos planes DHMO pueden basar los beneficios en porcentajes de coaseguro	Sí, normalmente los planes DPPO basan los beneficios en porcentajes de coaseguro
Deducible	Los planes DHMO no suelen tener un deducible	Los planes DPPO suelen tener un deducible anual, pero algunos planes pueden eximirlo si permanece en la red para recibir servicios preventivos
Copago	Sí, los planes DHMO suelen incluir copagos fijos A menudo se requiere un copago mínimo, o ningún copago, para la atención preventiva y de diagnóstico	A veces, dependiendo del tipo de servicio
Máximo anual	No, la mayoría de los planes DHMO no tienen un máximo anual	Sí, los planes DPPO incluyen un monto máximo de cobertura anual
¿Se requiere un dentista primario?	En un plan DHMO, es posible que tenga que elegir un dentista primario en la red para todas sus necesidades de cuidado dental. Si necesita visitar a un especialista dental, su dentista primario debe remitirlo a un especialista dental en la red	Los planes Dental PPO no requieren que elija un dentista primario y puede visitar a cualquier dentista autorizado en la red o fuera de la red. No necesitará referidos para visitar a un especialista Puede pagar menos gastos de su bolsillo por las visitas a dentistas y especialistas en la red, en comparación con la visita a un dentista fuera de la red
Tamaño de la red	Red más reducida. Los gastos fuera de la red no están cubiertos	Red mayor Los costos de proveedores fuera de la red pueden estar cubiertos
Referidos para especialistas	Pueden ser necesarios referidos para visitar a un especialista	No se requieren referidos