What's the Catch? (Dental insurance buffs) Why go with a PPO over a HMO?

Question

So I've been researching dental insurance in my area. (S. Florida Metro - Ft. Lauderdale/Miami/Palm Beach)

I've received a quote from a dental HMO that provides the following;
Individual Premium per month - 11.95$
No Wating Period
No Plan Maximum
No Deductable.
As examples of coverage;
Cleanings are no charge.
Fillings for one surface are 25$ for composite fillings. Standard silver fillings are no charge.
Crowns run between 245$-300$
Endodontics/Root Canals run between 110$ and 345$
Periodontic services run between 110$ and 300$ for surgical services.
Non surgiacal periodontic services run between 38$ and 65$
Dentures and bridges are fairly priced between 300$ and 425$
Extractions run between 30$ and 100$
The only place they really get you is with orthodontics.

Now let's look at a PPO.

Individual Coverage is between 30$ and 42$ a month for basically the same services between plans, with large waiting periods, tiny plan maximums, and really not that great of coverage.

(Cont.)

My boyfriend needs a 3 fillings and a root canal and possibly a crown in the future. They cover 50% of the root canal, which would stick us with a 500$ bill. They cover 50% of a crown, which would stick us with another 500$ bill and we’ve reached our plan maximum of 1,000$, which is the largest plan maximum I’ve found.

Am I basically paying an obscene amount and tiny maximums with a PPO to go to a larger network of dentists? What’s the difference? Why should I pick a PPO over a HMO?

When it comes to orthodontics, which may also be something we consider in the future, the PPO isn't able to provide a significant advantage over a HMO. The HMO's charge around 1,000$ flat for orthodontic treatment. PPO's either don't cover orthodontics at all or only pay 25%.

Can anyone shed any light on the differences and why they exist?

So basically, I'm correct in that all I'm paying for is a larger network of dentists? There's plenty of HMO providers in the area which are accepting patients. There's nearly a dozen within 5 miles of my home.

And by the way, idiots need not reply. Christ you people are stupid.

Could a dentist possibly imput their .02 on this issue? Why do you choose to go with a HMO network? Why do you choose to go with a PPO network?

Up until recently, I've shared the same feeling, that in general, PPO insurance is better than HMO insurance.

It seems to me like this applies only with health insurance. I still feel the same way, go with PPO for health. But with Dental insurance, there is an amazing discrepancy. I was SO blown away at the differences.

This is simply an individual dental coverage plan with no bearing on my medical insurance. I have Tricare/Humana through my father and United Healthcare through my office. United Healthcare's dental is the PPO I outlined, and I actually have only a 750$ per calender year with my office's dental plan, and they cover NO major dental work, not even extractions. That's NOTHING.

Answer 1

Great question. I recently was stuck trying to decide between the two. I chose the PPO just cause that's what everyone else has in the office. But the more I kept comparing the two, I couldn't understand why you pay more with a PPO if the HMO gave you more coverage. I guess I feel better about the PPO cause I get a wider range of doctors and I can go outside the network if I wanted to. That seems to be the only advantage.

Answer 2

Dental Hmo Vs Ppo

Answer 3

This Site Might Help You.

RE:
What's the Catch? (Dental insurance buffs) Why go with a PPO over a HMO?
So I've been researching dental insurance in my area. (S. Florida Metro - Ft. Lauderdale/Miami/Palm Beach)

I've received a quote from a dental HMO that provides the following;
Individual Premium per month - 11.95$
No Wating Period
No Plan Maximum
No Deductable.
As examples of...

Answer 4

*Usually* PPO plans are better because they pay the provider more. HMO is *usually* more strict about which doctors you can go to, whether they're in network or not. Though from the information you provided, I would go with the HMO plan, unless that means that your medical insurance would switch to HMO. Medical insurance is always better as PPO. No pre-certification required for the more non-traditional procedures.

Edited to add:

the docs like the PPO plan better because they pay better, and it is less hassel. HMO plans require a lot of documentation to get a procedure pre-certified with the insurance before they will even approve it. PPO plans don't require all that.

Answer 5

Without reading a word of your question (Sorry - I will later on...) I will say that an HMO forces you to choose a dentist from a restricted list. A PPO would RATHER if you used one who is on their list, but you are still able to see the dentist of your choice.

Imagine buying car insurance and finding that you are only covered if you take preauthorized roads to and from work. If you go off those roads and have an accident, you are not covered. That's the HMO way of doing things.

Answer 6

The problem with dental insurance is that most all of the companies have a waiting period...usually 6 months...and require pretty high copays. Some only cover basic things and don't cover things like crowns and orthodontics.

You might want to try a discount dental plan. They are cheap...usually less than $100 per year and they give you a big discount off of what the dentist charges, and there is no waiting peroid. I found a plan at http://dental-ppo.com that worked well for me. You can search by zip code to see what plans are available in your area.

Answer 7

A PPO is better than an HMO because a YMO is longer than a LMO, so go with the DMO.

Answer 8

In a PPO, you can choose any dentist you want at any givin time, With HMO, you are stuck with your dentist That the HMO picks for you.

Answer 9

They all looking for the easy money.