Dental HMO (DHMO)

Dental health maintenance organization. Some carriers call it a DMO, for dental maintenance organization, or a managed care or prepaid plan. Cigna says the term covers designs that vary by state. The common feature is a primary dentist in a network who manages your care and gives referrals.

Usually not. Cigna, Humana and UnitedHealthcare say most dental HMOs have no annual maximum, and Aetna says its DMO has no yearly dollar limits. That is a statement about the design, and you still pay copayments for each service. Check your plan's fee schedule for the services you expect.

Usually. Cigna and Humana say your primary dentist refers you to a network specialist, and Aetna says a referral is needed for specialists except orthodontists. Humana notes the referral step can cause a delay. Ask your plan which specialties need one, and whether any are exempt.

Generally not. Cigna says most DHMOs cover out-of-network services only in an emergency or where the law requires it, and Humana says out-of-network costs are not covered. Some states require more. Check your plan documents for emergency rules before you travel.

Often in premiums, and it depends on your care. Cigna says DHMOs tend to be some of the more affordable plans, and Humana says premiums are usually lower than a comparable PPO. The saving applies only if your dentist is in the network. Compare the copayments for the services you expect against a PPO's coinsurance.

Yes, from the plan's network. Aetna says covered family members can each choose their own, and MetLife says each enrolled family member may select a different participating dentist. Search the network before you enroll, and ask how often you can change.

Through the plan, usually on the member website. Aetna says you can change your primary care dentist once a month by the fifteenth for the change to start the next month, and MetLife says you can change up to once a month. Your plan's rules may differ, so check them.

A set dollar amount you pay for a covered service, as listed in your benefit summary. Aetna says you may pay a copay or coinsurance, and Humana says a set copay means you know what basic and major services will cost. Ask for the full fee schedule before you agree to treatment.

Often not. Cigna's Dental Care DHMO page and Humana's Dental Value page say no waiting periods for those plans, and Cigna's guide says waiting periods are more often a feature of PPOs. It depends on the plan, so ask before you enroll if you expect major work.

It varies by carrier. MetLife says its dental HMO or managed care plan is available in California, Florida, New Jersey, New York and Texas, Cigna says its Dental Care plan is not available in all states and Guardian says its DHMO is offered in select states. Check what is sold where you live.

Change to another dentist in the network, following the plan's rules. Carriers such as Aetna and MetLife allow changes on a monthly basis. If the problem is care quality, ask the plan how to file a complaint. Keep records of what was done and of any treatment plan.

Some are. Humana says patients and families can buy individual DHMO or DPPO coverage without going through an employer, and Guardian sells a DHMO in select states. Availability varies by state and carrier, so check each company's page for your ZIP code.

No. A DHMO is insurance with a network and set copayments, while a discount plan is not insurance. MetLife, Anthem and UnitedHealthcare say a discount plan gives you reduced fees and pays none of the bill. See the guide to types of dental insurance.