Humana dental plans: PPO and DHMO explained

The DHMO needs a primary care dentist in the network, uses set copays and has no annual maximum or deductible, but out-of-network visits are typically not covered. The PPO lets you see any licensed dentist, usually has a deductible and an annual limit, and needs no referrals. Choose by which dentists you want to see.

Humana says it has no waiting periods, no deductibles and no annual maximums. Preventive services carry a zero copay, and basic and major services are paid according to the benefit summary. That is Humana's description of the plan, so read your own benefit summary for the copay on each procedure.

Humana says its PPO plans include a maximum amount of annual coverage and typically have an annual deductible. The amounts vary by plan and state. Read the plan you are considering and ask how much of the maximum you have used.

Under a PPO, yes. Humana says PPOs do not require a referral. Under a DHMO, your primary dentist may need to refer you to an in-network specialist, which Humana says can cause a delay. If you already know you will need specialist care, weigh that when you choose.

On a DHMO, Humana says out-of-network visits are typically not covered. On a PPO they are covered, though in-network visits may cost less, and a patient may receive partial reimbursement for covered out-of-network services. You may need to file the claim yourself, and there can be a waiting period.

Yes. Humana's guide says patients and their families can buy individual DHMO or DPPO coverage without going through an employer. Plans are not available in every state and benefits vary by state, so enter your state on Humana's page to see the plans sold where you live.

On its Dental Value page, Humana lists fillings, extractions and X-rays as basic, and root canals, crowns and dentures as major. On the PPO side, the plans differ in whether they cover dentures and crowns at all. Your benefit summary decides how each procedure code is treated.

On the Loyalty Plus plan, Humana says benefits increase in the first years of membership. That is a feature of that plan and not of every PPO. If you are planning a large treatment, ask how much of the benefit is available in year one and whether waiting longer would change what the plan pays.

Humana says its DHMO network includes more than 135,000 dentists and specialists, based on its own network data from October 2024. That is a national count, and it does not show how many offices are near you. Search the directory for your own dentist and specialists under your plan.

Not always. Humana says a DHMO is designed to be cost-effective and usually has lower premiums, but that it is not necessarily better than a PPO. Its network is smaller, out-of-network care is not covered, and you may need referrals. It is cheaper only if your dentist is in the network.

The Dental Value DHMO does. Humana says you choose an in-network primary care dentist and pay a set copay for covered services. Its PPO plans do not require a primary dentist. Confirm which design you are enrolling in, and check that your current dentist is in the network for that specific plan.

Humana's dental page lists veteran dental discounts among its plans and programs. The page does not give the terms, so ask Humana what they include, who qualifies and whether they can be combined with other coverage. Compare any discount with the fee schedule of a participating dentist before you rely on it.