Understanding the differences between DHMO and PPO dental plans is crucial for making informed healthcare decisions. Whether you’re advising employers or helping individuals choose coverage, this guide breaks down everything you need to know about these two popular dental plan options.
What is a Dental HMO (DHMO)?
A Dental Health Maintenance Organization (DHMO), also known as a Managed Care Dental (MCD) plan, operates similarly to a medical HMO. Under this model, patients select a primary care dentist who manages their dental care and provides referrals when specialist care is needed.
DHMO plans typically offer:
- Lower monthly premiums compared to PPO plans
- Preventive care with minimal or no copayments
- No deductibles or annual maximums on covered services
- Pre-negotiated rates for dental procedures
What is a Dental PPO?
A Dental Preferred Provider Organization (PPO) offers more flexibility in choosing dental providers. These plans feature a network of participating dentists but also allow patients to seek care outside the network, albeit at a higher cost.
Key features of PPO plans include:
- Freedom to visit any licensed dentist
- Larger network of participating providers
- No referral required for specialist visits
- Coverage for out-of-network care (usually at a lower benefit level)
DHMO vs PPO: Key Differences Explained
| Feature | Dental PPO Plan | DHMO Plan |
|---|---|---|
| Choice of Dentist | Any dentist; increased savings with in-network providers | Must use in-network dentists only |
| Plan Costs | Higher premiums; deductibles and plan copayments apply | Lower premiums; set copayments for each visit |
| Annual Maximum | Dollar limits may apply annually | Often no annual maximum |
| Specialist Care | Self-referral allowed; no referral needed | Referral required from primary dentist |
| Changing Dentists | Switch at any time; unlimited changes | Usually limited to one change per month |
| Emergency Care Away from Home | Coverage available in or out of network | Limited benefits available |
Which Plan Is Right for Your Clients?
When helping clients choose between DHMO and PPO plans, consider these factors:
Choose a DHMO if your clients:
- Prioritize lower monthly premiums
- Are comfortable with a designated primary care dentist
- Want predictable out-of-pocket costs
- Focus primarily on preventive care
Choose a PPO if your clients:
- Value provider choice and flexibility
- Want to keep their current dentist
- Travel frequently and need broader coverage
- Prefer direct access to specialists
Making the Sale: Positioning DHMO and PPO Plans
Success in selling dental plans comes from effectively matching clients with the right coverage type. When presenting DHMO plans, emphasize their cost-effectiveness and predictable expenses for budget-conscious clients. For PPO plans, focus on flexibility and provider choice for clients who prioritize options. Leverage our comprehensive plan comparison tools and provider network directories to help demonstrate the value of each option.
For more tips on selling dental insurance read our article 9 Tips on How to Sell Group Dental Insurance.
Expert Support from Word & Brown
At Word & Brown, we offer access to dental plans from over 30 carriers in California and more than 20 in Nevada. Whether your clients need employer-sponsored or voluntary coverage, our experienced team can help you find the right solution.
Contact us at (800) 869-6989 to explore our comprehensive dental plan options. With over 35 years of industry experience, we’re here to help you succeed in providing the best dental coverage for your clients.
