Features DHMO DPPO Cost

Dental HMO plans typically have lower monthly premiums than comparable PPO plans

Dental PPO plans typically have higher premiums than comparable HMO plans

Out-of-pocket costs may run higher in a DPPO plan

Out-of-network coverage

Out-of-network visits are typically not covered

Out-of-network visits are covered, however, in-network visits may have lower out-of-pocket costs

Coinsurance (percentage of costs you and your plan share for covered services)

Yes, some DHMO plans may base benefits on coinsurance percentages

Yes, typically DPPO plans base benefits on coinsurance percentages

Deductible

DHMO plans typically do not have a deductible

DPPO plans typically have an annual deductible but some plans may waive it if you stay in network for preventive services

Copay

Yes, DHMOs typically include set copayments

Often there is minimal or no copayment for preventive and diagnostic care

Sometimes, depending on type of service

Annual maximum

No, most DHMO plans do not have an annual maximum

Yes, DPPOs include a maximum amount of annual coverage

Primary dentist required?

Under a DHMO plan, you may have to choose an in-network primary dentist for all your dental care needs. If you need to visit a dental specialist, your primary dentist must refer you to an in-network dental specialist

Dental PPOs do not require you to pick a primary dentist and you can visit any licensed dentist in or out of network. You won’t need referrals to visit specialists

You may pay less out-of-pocket for in-network dentists and specialist visits, compared to visiting an out-of-network dentist

Network Size

Smaller network. Out-of-network costs are not covered

Larger network

Out-of-network costs may be covered

Specialist Referrals

Referrals may be needed to see specialists

No referrals are required