A PPO plan covers you to visit any dentist you want. Your insurer has negotiated lower rates with the dentists in the PPO's network, and you receive maximum benefits when you use one of these dentists. You're also covered if you see a dentist who's not in the network, but then you might have to pay more.
If you have a DMO plan, you might not have to pay a deductible, and there might be no cap on your annual benefits. If you go to one without a referral, you might have to pay the entire cost yourself. The flexibility of PPO plans comes at a price. Cigna may not control the content or links of non-Cigna websites. For the best experience on Cigna. Overview Medicare Coverage Options. Broker Resources. Individuals and Families. Understanding Insurance.
Most DPPO plans have an annual deductible. DHMOs typically do not. Coinsurance: This is the percentage of costs you and your plan share for covered services. DHMOs also require you to share a percentage of the costs.
Do you have to see dentists in a network with a DHMO plan vs. DHMO vs. Your primary dentist will be your initial go-to for all dental care. DPPO plans do not require you to choose a primary dentist, although one is recommended.
What dental services are covered by a DHMO vs. Preventive dental care covers teeth cleanings, oral exams, certain types of X-rays, fluoride treatments, and sealants. Age limits and limits on how many of each you can have in a plan year may apply. Fillings, root canals, extractions: These services may also be called basic restorative in the details of your dental plan. For DHMO plans you will typically have a flat fee to pay for these types of dental services. For DPPO plans you will need to first meet your deductible, then you will share a percentage of covered costs with your plan for non-preventive services up to any annual maximum.
They give you the freedom to visit any dentist you want. And you can switch dentists at any time without having to call the insurance company or wait for your name to appear on an office roster.
DPPO plans allow you to be covered whether you visit an in-network or out-of-network dentist. But it's worth noting that just because you can go out of network doesn't mean you should every time.
Using an in-network provider on your DPPO plan will save you a lot of money compared to an out-of-network provider. DHMO plans mean you'll pay the specific fee copayment listed on your Schedule of Benefits to the dentist for covered services. DPPO plans, as mentioned above, are based around a fee schedule. A fee schedule is an agreement with your insurance company to charge up to a certain dollar amount for covered services.
So, you pay a coinsurance, which is a percentage of this negotiated fee and the insurance company pays the rest of that negotiated fee. When you use an out-of-network dentist, your coinsurance is higher because that dentist does not have an agreement with the insurance company and will therefore, charge his or her usual fee for all procedures. DHMO plans are convenient since you shouldn't ever have to worry about filing claims.
Your network dentist will file them for you. And if you ever have an issue with your claim you can just call your insurance company's customer service line and they can help you!
DPPO plans are a bit trickier when it comes to claims. As long as you use a network provider, they will file your claims for you.
But if you receive care from a non-network dentist, you may have to file your own claim. DHMO plans don't have any deductibles.
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