What is a Dental DMO (DHMO) Insurance Plan vs. a PPO?

I found out the hard way the difference between a dental insurance DMO® plan and the PPO plan I had last year. My first clue that a DMO® did not have the best coverage is when I did a search on Google and it suggested “Did you mean: Dental HMO?”

Aenta insurance owns the term “DMO®” and currently offers this plan. DMO® stands for Dental Maintenance Organization. This plan will cover basic coverage like cleanings and x-rays along with regular services like fillings, crowns, root canals, etc. Some services are not covered so review your insurance options.

The Dental DMO is known as a DHMO at most insurance companies.

• In a DMO® plan, you are forced to select a dentist from a specific list from your insurance company and indicate a primary dentist. With a PPO you can visit almost any licensed dentist.

• A DMO® plan is like a discount plan. The insurance company contracts with a dentist and the rate you pay a dentist is indicated by a % of coverage. For example, your coverage may state you pay 50% of the service fees for dental work. With a PPO, you may also see coverage which indicates you pay 50% of the fees. The difference is that with the DMO® plan you pay 50% of the Dentist’s listed fees vs. with the PPO you pay 50% of the insurance company’s contracted fees. The Dentist’s fees will almost always be higher. You pay a % of a higher price.

• DMO ®plan monthly fees may be lower than PPO monthly fees, making the plan to seem like it has the same (or better) benefits and less cost per month if you don’t read the details.

• DMO® will not have a deductible.

• Referrals required.

• If a service is not covered under the DMO® plan, there is no contracted discount on that service. Dentists who associate themselves with a particular PPO can offer discounted rates on services that are not covered under insurance.

• Co-pay may be required depending on you plan. Aetna’s PPO does not require a co-pay.

Next year when I renew my dental insurance I will pay the extra money for the PPO plan. I wish I had done my research and didn't on the information provided by my employer to make my choice in dental care and insurance.

Are you having trouble deciding which insurance plan is right for your and your family? Call your dentist and ask their opinion and to quote a few comparable rates based on the plan type you seek. Your dentist (we hope) wants to give you the best care and most information and keep you as a patient.

Do your research on your dentist as well as your insurance company. Find out your Dentist's reputation and billing rates with the links to the right. They will help you choose the right plan for your family.