Dental Insurance: What are the Differences between HMO and PPO Plans?
By Mina Levi, DDS, 05/21/2015

One of the most common questions we get asked here at the office of dentist Mina Levi, DDS in San Francisco is “what is the difference between choosing an HMO dental plan and a PPO dental plan?” along with “are you an in-network provider?” Many people who have dental insurance or are in the market for dental insurance have concerns and/or are confused about different plan aspects and sometimes can end up locked in with a plan that isn’t a good fit for them. Dentist San Francisco Mina Levi, DDS clears up some of the dental insurance lingo and answers some questions in this week’s article.

PPO Dentist San Francisco

What is an annual maximum?
Most dental insurance plans limit the amount that they will pay out for services per year. The average annual maximum in our experience is around $1500. This means that after that annual maximum has been paid out for the year, any services rendered after that will be an out-of-pocket expense for the patient until the new year comes and the annual maximum rolls back over.

What is an in-network provider?
Dental insurance companies have contracts with certain dentists in your area. This means that the dentist has agreed to see patients who have this insurance plan and only charge the fees for services as lined out in the contract. This means that when you see an in-network provider with your insurance, the services you receive will be charged at a “discounted” in-network rate. So even when you are maxed out of your dental insurance yearly maximum and all services are out-of-pocket, all services will be at this same discounted rate.

What is an HMO plan?
HMO stands for Health Maintenance Organization and this kind of plan limits subscribers to choosing a dental care provider that is an in-network provider only. The patient must choose or is assigned a pre-approved dentist and if the patient seeks treatment elsewhere, the dental bills will not be covered at all.
                Pros: More affordable
                Cons: No freedom of choice, limited access to dental providers

What is a PPO plan?
PPO stands for Preferred Provider Organization and offers flexibility for subscribers when choosing dental providers. A PPO dental plan will allow the patient to choose an in-network provider or an out-of-network provider, but will pay more or a higher percentage for an in-network provider.
                Pros: Freedom of choice, wider range of providers
                Cons: More expensive

If you have more questions about dental insurance, PPO plans or HMO plans, visit Dentist San Francisco Mina Levi, DDS on the web at www.minalevidds.com or give us a call at (415) 513-5066.