What is dhmo dental insurance

A dental health maintenance organization or DHMO is a type of “managed care.” With this type of coverage, a network of highly qualified dentists provides comprehensive and affordable care for individuals or families. Consumers choose a dentist from the network, and they pay a low monthly premium to receive services at either no cost or a reduced price (some services may require a copayment). The participating dentists receive fixed monthly fees.

HMO Dental Overview: What is a dental health maintenance organization?

A dental health maintenance organization (DHMO) is a structured type of dental plan. With these plans, the plan’s approved dentists provide broad and affordable care for a low monthly premium. Most of the work is done at no cost or for a reduced price. In addition, you may need to make a copayment for some types of work.

How HMO Dental Plans Work

With a DHMO plan, you will need to choose a primary dentist to work with. You must also let the plan provider or carrier know if you want to change your dentist. There are no waiting periods, calendar year maximums, deductibles, or claim forms when you have a DHMO plan.

This type of plan, which is also called a “capitation plan,” is most often the least costly type of dental plan you can buy. Not that dentists need it, but DHMO plans do give them even more reason to help keep you well. When you stay well, they can avoid doing more free work.

HMO Dental Plans and You: What to Consider

Many people look to a DHMO plan when they need work to be done in the next month that they can’t put off until the waiting period on their PPO or Indemnity plan can be met. Also, with a DHMO, it is easy for you to know the cost of work you need to have done before you go in for care. This is because DHMO services have copays. The cost of the work is not paid through coinsurance.

Other than office visits, exams, x-rays, and cleanings, the work you have done through a DHMO most often requires a copay for services. As a rule, work that is not spelled out in the plan’s summary of benefits is not covered.

If you think you may want to buy a DHMO plan, it’s a good idea to be alert to some key details. For instance, those who get a DHMO plan should look at the average time people on the plan have to wait between their dental visits. Also, ask about the size of the patient pool for the DHMO plan and try to learn how many dentists serve that pool.

If you know you will need to have a special type of work done, it is also good to learn how many dental specialists take part in the plan. Your main dentist can refer you to a dental specialist, and you’ll get a discount for the work they do.

Lastly, get to know all of the plan’s rules about emergency dental care for when you travel or are away from home.

HMO Dental Basics: Challenges and Strengths

Some strengths and challenges of HMO dental plans include the following:

DHMO Challenges:

• Other than office visits, exams, x-rays, and cleanings, most work usually requires a copay
• Most often, plans do not cover treatments that are not spelled out in the plan’s summary of benefits
• You will have to wait a set time between dental visits
• The size of the patient pool for the DHMO plan and the number of dentists who service that pool could impact ease of use
• For work to be covered, you have to choose a primary care dentist

DHMO Strengths:

• DHMOs are good for those who need work done in the next month but who can’t wait for another plan’s waiting period to be met
• You’ll know the cost of work up front
• Provides broad and affordable care from a set group of dentists
• Dentists provide work at either no cost or a lower price
• Dentists have an added incentive to keep you well
• Most often the least costly of dental plans
• There are no waiting periods, calendar year maximums, deductibles, or claim forms
• Your main dentist can refer you to a dental specialist, and you’ll get a discount for their work

Having dental insurance can be a great way to cover or reduce the costs of many treatments. At Ballston Dental Care, we’re in-network with many insurance providers. If you’re new to dental insurance, you may have questions about the differences between certain plans. For example, what’s the difference between DHMO and PPO insurance?

DHMO

DHMO plans are similar to regular HMO health insurance plans. With a DHMO plan, you’re getting lower-cost coverage that focuses on preventive care. You’re encouraged to keep up with biannual dental visits and checkups. Out-of-pocket costs are clearly defined. If you choose this type of plan, you need to choose from a list of in-network dentists. If you need treatment from a specialist, your primary care dentist submits a referral.

The benefits of DHMO insurance include lower premiums than PPO, no deductible, and set copayments. On the downside, you won’t be covered for out-of-network dental care and you may have some restrictions on the number of covered visits and treatments.

PPO

PPO dental plans give you more flexibility when choosing your dentist, but there are higher out-of-pocket costs. You aren’t required to choose a primary care dentist, so you can switch in-network dentists or see a specialist without a referral. Depending on the plan, you may get partial reimbursement if you get treatment from an out-of-network dentist.

The main difference between DHMO and PPO is that PPO gives you more flexibility. On the other hand, PPO comes with higher premiums and possibly higher copayments. Most plans also involve a deductible and an annual limit on coverage.

Flexible Payment Plans at Ballston Dental Care

If you don’t have dental insurance or have costs that insurance won’t cover, we offer CareCredit financing. This third-party financing works like a credit card, so you can split your dental costs into affordable monthly payments. In certain situations, we also offer in-house financing.

Dr. Matney aims to provide quality dental care to every patient, no matter what their budget is. Please contact our Arlington office with any questions about our payment options!