Health Maintenance Organizations (HMO) Dental Plans
If you are part of a dental HMO plan or are planning to apply for HMO dental insurance, it is vital that you understand this type of coverage.
Understanding your dental coverage and your insurance options can help you get the dental care you need to keep your teeth and gums healthy.If you are part of a dental HMO plan or are planning to apply for HMO dental insurance, it is vital that you understand this type of coverage. Understanding your dental coverage and your insurance options can help you get the dental care you need to keep your teeth and gums healthy.
HMO dental coverage stands for "Health Maintenance Organization" dental insurance. This type of insurance requires some type of prepayment from you. In exchange, you get dental care from a network of dental care providers. If you want to use a dentist outside the approved network, you must pay your entire dentist's bill yourself. This type of insurance is also known as capitation dental insurance plan.
In HMO dental coverage, dentists in a network have to provide dental care to members of the insurance plan they are part of. No eligible patient can be turned away. Dentists that are part of the network are paid once a month by the insurance provider. Usually, this payment is a fixed monthly sum per person.
An HMO dental plan covers:
1. Basic dental services such as regular dental exams, cleaning, and dental x_rays
Often, these basic services are provided cost-free to individuals covered by the HMO insurance plan.
2. Other dental procedures such as dental crowns, bridgework, and dentures.
These slightly less common procedures often require that the patient cover some of the cost themselves.
How is an HMO dental plan different from a PPO dental insurance scheme?
There are several differences between HMO and PPO dental plans. While both can provide affordable dental insurance, HMO plans make it more difficult for patients to seek dentists outside a network. While PPO plans often allow patients to select dentists outside their network, many HMO plans do not. They are completely closed, meaning that you cannot accept financial penalties and see a non-network dentist when you need to.
The most serious difference between HMO and PPO dental insurance, however, has to do with the way that dentists are paid. In PPO dental insurance plans, dentists who are part of a network agree to lower costs for patients covered by a certain insurance provider, in exchange for the referrals from the insurance company that bring them more business. However, dentists get paid in full for the services they provide.
With an HMO dental plan, however, dentists are paid set fees. In some cases, this can mean that the less treatment a dentist provides, the more profitable the arrangement is. In extreme cases, patients have complained that dentists have made it difficult to get the correct services through an HMO plan. Even in the best circumstances, since dentists prefer PPO dental plans, many more join PPO networks. This can mean that patients have fewer dentists to choose from through HMO plans.
Advantages and disadvantages of HMO dental Insurance coverage Patients often select a HMO dental plan since these plans offer specific advantages:
1. Eligible dental patients cannot be turned away from care.
Even if your network dentist will not get full compensation for your care, you still have to be accepted as a patient and treated for your condition. This can mean that you are sure to get dental care when you need it.
2. Most companies offer a variety of HMO dental plans.
This can help you balance the coverage you need versus the amount of money you are willing to pay for dental insurance. Contact your dental insurance company to find out what HMO options you have.
3. Less expensive dental care.
Many patients find that an HMO dental plan allows for low monthly payments, which can help patients save money.
Disadvantages to HMO
If you are considering an HMO dental plan, you will also want to be aware of the drawbacks to such a plan:
1. Longer waiting times for some dental care.
Patients on an HMO plan may have to wait months for dental services such as fillings or other dental care options.
2. No options to get dental care from non-network dentists.
If you travel or want to see a dentist outside the network, you may not have the option. If you travel frequently or want the option of selecting your own dental care professional, this can be a problem for you.
Dental
Health Savings Accounts
You can use this account to pay for your qualified health expenses, including expenses that the plan ordinarily doesn’t cover, such as eyeglasses and hearing aids.
Expenses paid out of the HSA that are eligible expenses under your high-deductible health plan will count toward the plan’s deductible.
