Dental Insurance – HMO or PPO – What’s the Difference and Which Is Better?

There are several important differences between HMO and PPO dental insurance plans. If you are trying to decide which one to go with you will want to answer several questions, the first being, does your choice of dentist matter to you? With PPO dental plans they usually have a wide network of dentists to choose from.

With HMO’s you usually have a very limited number of dentists to choose from. This does not mean that HMO dental plans are inferior however because where your choice of dentist is limited, you make up for it with savings on the more major restorative procedures.

The way this works is that first off, PPO plans always have a calendar year maximum of $1,000, $1500 or $2000. That means that the insurance company will not pay claims on your behalf once you have reached this threshold.

HMO plans usually do not have any maximums, which only means that if you have extensive restorative work that needs to be done (think dental implants, inlays, onlays, multiple root canals/crowns) the savings will be substantial.

Another difference is that with HMO plans, all services are tied with copays, usually not more than $280 for the most involved procedures. With PPO plans you pay percentages which can be much more when it comes to the major restorative work.

What is the bottom line? If you don’t anticipate needing extensive dental work done and just want coverage for preventative care, x-rays and fillings and choice of dentist is important to you, a PPO plan will be just fine for you. If you know that you need some more major restorative work done and choice of dentist is not so much a concern as is saving on the work that you need to have done, an HMO plan may be a better fit for you.