HMO Dental Insurance Plans

Introduction to HMO Dental Insurance

While a small part of the market (less than 10 percent), HMO dental plans are some of the least expensive insurance options. In this article, you'll learn how dental HMO plans:

• Charge less than PPO and indemnity plans
• Manage the services an enrollee receives from a dentist
• Lack an annual limit on care
• Limit dentist choice

At the conclusion of the article, there is a link so you can explore dental HMO plans available in your region.

Why Are Dental HMOs So Inexpensive?

HMO dental insurance is often less costly than PPO dental plans and indemnity dental plans. >. The foundation of their lower prices rests in the way the plan is structured. An HMO dental plan (otherwise known as a DHMO) is a health maintenance organization. A health maintenance organization is a type of "managed care" where a primary medical professional (in this case, a dentist) is chosen by the enrollee, and this professional makes decisions on what care is advisable and whether a referral to another dentist is warranted. Just as important as this method of managing care is the network of dental professionals associated with the HMO.  Fewer dental providers are used, giving these providers a greater share of the patients belonging to the HMO. Patients are strongly incentivized to receive dental care from in-network providers because out-of-network providers are normally not covered. The HMO's model of care produces both low premiums and out-of-pocket costs. Unlike PPO and indemnity dental plans, HMO out-of-pocket costs are often flat-fee copayments (as opposed to coinsurance fees based on a percentage of the total service cost).

Below are examples of how inexpensive HMO coverage can be. Your prices will depend on the cost of dental care in your region, whether you choose single or family coverage, etc.

• TakeAlong Dental HMO-Managed Care 350 (Low) starting around $7.50 a month
• Guardian Managed DentalGuard starting around $8.06
• Dominion National Select Plan Basic starting at $8.20
• Humana Dental Value Plan HI215 starting around $10.29

HMO Dental Plan Benefits

Alongside lower costs, HMO dental insurance commonly has:

• No limits on how much the insurance company pays for dental care annually
• No deductible
• No waiting period for dental care
• Claim forms to file (as is the case for some indemnity plans)

There are some HMO plans that deviate from the characteristics listed above, but they do not represent the majority of HMO plans.

Enrollment Considerations

A choice in dental insurance involves trade-offs. For HMOs, the most common trade-off is the restriction of a narrow dentist network versus the very low costs of HMO premiums and out-of-pocket costs. Another trade-off concerns referrals. A referral to a specialty dentist must be made by the enrollee's primary care dentist or the HMO plan will not pay for the specialty service. If the primary care dentist does not believe the specialty dentist is necessary for the enrollee, a referral will not be provided even if the enrollee wants to see the specialist. On the subject care not provided by a primary dentist, when shoppers considering an HMO plan know they will need to have a special type of dental work performed, it is wise for them to review how many dental specialists participate in the HMO plan’s network.

One of the overlooked advantages of HMO plans is the common absence of waiting periods. If you need dental care quickly and enroll in an HMO plan, you are less likely to face coverage delays of 3-months, 6-months, or a year. In PPO and indemnity plans, waiting periods are much more prevalent.

A final consideration is emergency care. Before enrolling, find the plan's policy regarding emergency care needed during travel when the enrollee is outside the plan's network. This can be a major concern for people who frequently travel for business.

HMO Dental Basics: Challenges and Strengths

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

HMO Challenges:

• You must choose an in-network provider as your primary care dentist
• Your favorite dentist may not be in-network
• A higher ratio of patients to dentists may result in longer waits before an appointment is available
• The plan will not pay for out-of-network care
• Like all dental insurance, HMO plans do not pay for treatments that are not specifically covered in the plan's Summary of Benefits
• Referrals are at the discretion of the enrollee's primary care dentist

HMO Strengths:

• Lower premiums and out-of-pocket costs
• No waiting periods before covered services are available to the enrollee
• HMOs 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
• Dentists are incentivized to improve the oral health of their patients
• Flat-fee copayments easier than coinsurance for understanding the cost of prescribed care
• No “maximum benefit” to limit how much the insurance plan can spend on an enrollee during a year

HMO Dental Insurance Options in Your Area

Interested to see if DentalInsurance.com has any HMO options available in your region? Just visit our page for dental insurance quotes. As mentioned earlier, HMO plans comprise less than 10 percent of dental insurance market so you are not guaranteed to find a local HMO plan.

Frequently Asked Questions (FAQ) on HMO Dental Plans

Can I use an out-of-network dentist if I have HMO dental insurance?

In most cases, no. HMO plans achieve their low costs through restricting enrollees to their network of dentists.

Are HMO dental plans cheaper than PPO plans?

They often are less expensive with respect to monthly premiums and out-of-pocket charges for covered dental services. However, if you use an out-of-network dentist, the HMO would not pay for the expense while a PPO plan would (though at higher out-of-pocket costs than if you used an in-network PPO dentist).

Do HMO dental plans have in-network specialists like oral surgeons or periodontists?

Yes, HMO dental plans do have specialists. However, in order to see a specialist, a plan enrollee must first obtain a referral from his primary care dentist. If the primary care dentist does not believe a specialist is justified, a referral will not be given.