What are the Advantages and Disadvantages of PPO Dental Insurance Plans?
Many employers, employees, and even dentists prefer PPO dental coverage for the following reasons:
- Flexibility - PPO dental care allows you the flexibility to see any dentist you choose however, with most plans, you can get additional savings by using a dentist who is part of a California dental insurance provider's network of health care professionals.
- Low deductible - PPO dental coverage typically gives you a low deductible around $50. Some plans (usually HMO) have no deductible at all. This helps to make your dental coverage affordable.
- Less Hassle for Dentists - PPO dental coverage is preferred by many dentists because dentists get paid sooner and with less hassle through this type of coverage. This can mean that more dentists will agree to be part of a California dental insurance PPO network and more eager to work with patients who are part of a PPO plan.
- No Waiting Period - PPO dental coverage usually involves no waiting periods for basic services and preventive care. This allows you to use your plan as soon as you enroll. If you don't need fillings, crowns or root canals then a California dental insurance PPO is the right choice. You can still receive care for those services but there might be a waiting period of three or 12 months depending on the service.
- Less Paperwork - PPO dental coverage can save you some paperwork depending on the provider. You may have to present your insurance card but the dentist office will submit the necessary documents for you.
What is a HMO dental insurance plan?
HMO dental coverage stands for
Health Maintenance Organization dental insurance. This type of California dental insurance requires some type of prepayment from you. In exchange, you get dental care from a network of dental care providers. If you want to use a dentist outside the approved network, you must pay your entire dentist's bill yourself. This type of California dental insurance is also known as capitation dental insurance plan.
In HMO dental coverage, dentists in a network have to provide dental care to members of the California dental insurance plan they are part of. No eligible patient can be turned away. Dentists that are part of the network are paid once a month by the California dental insurance provider. Usually, this payment is a fixed monthly sum per person. An HMO dental plan covers:
- Basic dental services - such as regular dental exams, cleaning, and dental x-rays. Often, these basic services are provided cost-free to individuals covered by the HMO California dental insurance plan
- Other dental procedures - such as dental crowns, bridgework, and dentures. These slightly less common procedures often require that the patient cover some of the cost themselves.
How is an HMO dental plans different from a PPO dental plans?
There are several differences between HMO and PPO California dental insurance plans. While both can provide affordable California dental insurance, HMO plans make it more difficult for patients to seek dentists outside a network. While PPO plans often allow patients to select dentists outside their network, many HMO plans do not. They are completely closed, meaning that you cannot accept financial penalties and see a non-network dentist when you
need to.
The most serious difference between HMO and PPO California dental insurance, however, has to do with the way that dentists are paid. In a PPO California dental insurance plan, dentists who are part of a network agree to lower costs for patients covered by a certain insurance provider, in exchange for the referrals from the California dental insurance company that bring them more business. However, dentists get paid in full for the services they provide. With an HMO dental plan, however, dentists are paid set fees. In some cases, this can mean that the less treatment a dentist provides, the more profitable the arrangement is. In extreme cases, patients have complained that dentists have made it difficult to get the correct services through an HMO plan. Even in the best circumstances, since dentists prefer PPO dental insurance plans, many more join PPO networks. This can mean that patients have fewer dentists to choose from through HMO plans.
What are the main considerations for purchasing a HMO or PPO dental plan?
HMO's are plans for either health or dental treatment that require you to select a care provider. This doctor/dentist is your primary care giver. You will need get referrals from their office to get any types of specialized treatments done. They will typically send you to a physician or dentist that is within your HMO plan. So if you break your leg, you need to get a referral from your primary care doctor to see an orthopedic doctor. Same thing as getting your dentist to refer you to an orthodontist. California dental insurance PPO plans do allow you the flexibility to see who you want when you want, basically you lose the referral portion. So in the broken leg incident you go directly to the orthopedic doctor of your choice.
One thing to look into with California dental insurance PPO plans is the fact that some of these now have preferred provider networks. If your physical is in the network, you will pay less as they already have pricing agreements in place.
HMO's are good if you are set with your doctors/dentist and they are included with the HMO. You are limited to this one doctor without having a referral. Usually fees are lower for your out of pocket costs.
A California dental insurance PPO is good if you like to have the flexibility of going were you want when you want to.