PPO Vs. DMO for Dental

by Rod Howell
Your PPO plan may require you to submit your own claim forms.

If you're looking for affordable dental coverage, you can choose a plan with a dental maintenance organization or a dental preferred provider organization. Insurers of both DMOs and PPOs have worked out deals with dentists to lower your costs for care. There are several similarities and differences between the two types of plans. One plan keeps more money in your pocket, and the other gives you more control over your dental care.

Dental Maintenance Organization

A DMO plan is a low-cost dental maintenance plan. You are given a list of dentists in your area who have contracted to provide dental services at discounted rates. You must choose one of these as your primary care dentist, who will be responsible for your general dental services. If he determines that you need to see a specialist, he will refer to one without you incurring extra out-of-pocket expenses. You can see a DMO orthodontist without a referral as long as your plan covers orthodontia.

Preferred Provider Organization

A PPO plan covers you to visit any dentist you want. Your insurer has negotiated lower rates with the dentists in the PPO's network, and you receive maximum benefits when you use one of these dentists. You're also covered if you see a dentist who's not in the network, but then you might have to pay more.

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Advantages

If you have a DMO plan, you might not have to pay a deductible, and there might be no cap on your annual benefits. You don’t have to submit claims to your insurance company, as your primary care dentist takes care of that. DMO patients pay less in premiums and out-of-pockets expense than dental PPO patients do. One advantage of a PPO is that you don’t need referrals to see specialists, in or out of network. You’re not required to choose a primary care dentist.

Disadvantages

A DMO plan doesn’t cover you to see a non-participating dentist or specialist without a referral. If you go to one without a referral, you might have to pay the entire cost yourself. The flexibility of PPO plans comes at a price. You don't get full benefits for non-network visits, so you pay more of the bill if you go out of network. Also, your PPO plan might come with deductibles and might limit the dollar amount it covers each year.

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