When to choose an HMO dental plan?
Having mentioned the numerous benefits of PPO over HMO dental plans, it may seem hard to imagine a scenario where an HMO plan is actually better. However that is not true. There are certain benefits of HMO plans which make them a great option for many individuals, such as:
Benefits of HMO dental plans include lower costs along with basic coverage
HMO dental plans almost always have lower monthly premiums and are less expensive than PPO plans. HMO plans cover your basic dental needs such as X-rays, exam and simple dental cleanings as well as a portion towards dental fillings and other basic dental needs. If you’re not anticipating having extensive dental treatment done, then an HMO dental plan may just be the right fit for you.
HMO dental plans offer discount fees for major treatment
For more expensive dental treatment, such as roots canals or crowns, your HMO plan will offer a discounted rate on treatment. This means that while you will probably have to pay more than if you had a PPO plan for treatment, but it’s still much less than if you were a cash patient.
To better illustrate this, we will serve an example of how HMO and PPO dental plans help pay towards major dental treatment. Lets assume you require a root canal, post and crown on your tooth. This is a very common dental treatment and falls under major dental treatment. Assume that your dentist fee is $800 for root canal and $1,000 for post and crown, totaling to $1,800 for the entire treatment. Here are the scenarios you will face in each case:
Patient paying cash
Cash patient, which means you don’t have any dental insurance, should expect to pay the entire $1,800 for a root canal, post and crown. Of course, you can possibly bargain them down to $1,600 or $1,700 if you were to pay cash instead of charge. But it’s unlikely that your dentist will go much lower than this under any circumstances.
Patient with a PPO plan
If you have a PPO plan, your fees will vary on what percentage is covered by your dental insurance. On average you can expect copays to run around $500 to $1,000 with most typical PPO plans. That means your insurance is covering more than half of the cost of your treatment, which is pretty good.
Patient with an HMO plan
HMO plans offer you a discounts on treatment. Of course this may be somewhat offset by upgrade fees which dentists who accept HMO plans typically incorporate. On average you can expect to have to pay between $1,000 to $1,500 for a root canal, post and crown if you have an HMO plan. As you can see, this is much higher copays than if you had a PPO plan. In fact it could actually end up being nearly the same as what a cash patient would have to pay for similar treatment!
HMO plans are great so long as you require little to no advanced dental treatment
An HMO dental plan should meet these basic needs If you have excellent teeth and gums. HMO dental plans cover X-rays as well as exams and simple cleanings. Even if you end up needing a cavity or two or forced to pay a copay for dental cleanings, it’s still much more economical to just pay these copays than the extra monthly premium. Don’t forget that your copays will essentially be offset by your reduced monthly premium.
Make sure that you’re certain that you don’t actually require more treatment than you initially presumed if planning on choosing an HMO dental plan. There are not a lot of benefits of HMO plan if you need lots of dental treatment. Keep in mind that things such as braces, wisdom teeth removal or crowns on unsuspecting teeth can be very expensive. If you need lots of dental treatment then a PPO dental plan is still your better option.
Finding a good HMO practice can be a bit challenging
Since most HMO dental plans provide poor reimbursements you may find it hard to find yourself a good dental office. You may end up with a dentist who ignores your necessary dental treatments. Conversely, you might find a good HMO dental provider, but notice that they constantly demand substantial out-of-pocket upgrade and copays.
It could be quite a challenge finding a good dentist nearby that accepts your HMO dental plan while also offering great services. Many HMO dental offices are corporate ran and you may have a different dentist or hygienist every time you go there. If you’re seeking an HMO provider, then do some research first to make sure the dental office is a reputable one. Also verify that your dentist is stable and has been there for a while and is also planning on sticking around for several more years. This is important just in case you require followup on your treatment.