Types of dental insurance: PPO, HMO, indemnity, DEPO

Dental plans come in a small number of designs, and knowing which one you hold explains most of what you will pay. A dental PPO gives you a network plus coverage outside it. A dental HMO, also called a DHMO or DMO, asks you to pick a primary dentist and pays only in network. Indemnity plans have no network and reimburse up to a usual and customary amount. An exclusive provider plan needs a network but no primary dentist, and a point-of-service plan blends the HMO and the PPO. A discount plan is a separate thing, and it is not insurance. Cigna, Humana, UnitedHealthcare, MetLife and Aetna all describe these designs on their own pages, and they agree on the main trade: choice against cost. Match the design to how you use care: if you already have a dentist you like, confirm that dentist takes the plan before you choose.

Before you book: verify types of dental insurance

1
Find your plan type on the ID card or benefits summary
2
Search the network for your dentist and likely specialists
3
Check whether you need a primary dentist and referrals
4
Read the deductible, annual maximum and waiting periods
5
Ask for the current schedule of benefits in writing

The designs

What each dental plan type is

Factor	Detail
Dental PPO (DPPO)	A network of dentists with negotiated rates, plus coverage for dentists outside it at higher cost. No primary dentist and no specialist referral. Typically a deductible, coinsurance and an annual maximum. UnitedHealthcare notes that most plans are PPOs.
Dental HMO (DHMO, DMO, managed care)	You choose a network primary dentist who provides routine care and refers you to specialists. Usually lower premiums, set copayments, often no deductible and often no annual maximum. Out-of-network care is usually not covered.
Indemnity or fee-for-service	No network. You may see any dentist, pay until the deductible is met and then share costs up to what the plan considers usual, customary and reasonable. MetLife says you usually file claims, and Cigna says these plans tend to cost a bit more.
Exclusive provider (DEPO)	Cigna describes a plan that needs network dentists but no primary dentist and no referrals. Out-of-network coverage may apply to some emergencies.
Point of service (DPOS)	Cigna describes a blend: you may see dentists outside the network, with lowest costs in network, and you choose a primary dentist who provides referrals.
Discount plan	Not insurance. You pay a fee for access to reduced prices at participating dentists and pay the dentist directly. See the dental discount plans guide.

Carriers use the same words for slightly different products. Cigna says the term DHMO covers designs that vary by state, including prepaid plans, managed care plans and plans with open access features.

Side by side

The questions that decide your cost

Factor	Detail
Do I need a network?	HMO and exclusive plans: yes. PPO: no, though costs are lower in network. Indemnity: there is no network.
Do I need a primary dentist?	HMO and point-of-service plans: yes. PPO, indemnity and exclusive plans: no.
Do I need referrals?	HMO: usually for specialists, with exceptions such as orthodontists on some plans. PPO: no.
Is there a deductible?	PPO and indemnity: usually. HMO: typically not, according to Cigna and Humana.
Is there an annual maximum?	PPO and indemnity: usually. HMO: most do not have one, according to Cigna, Humana and UnitedHealthcare.
What if I go out of network?	PPO: covered at a higher cost to you. HMO: usually not covered except emergencies or where the law requires it.
Is there a waiting period?	Cigna says waiting periods are more often found on PPOs, though it depends on the plan. Cigna's and Humana's DHMO pages list none for their plans.

These are general features. Humana says to check plan specifics before you enroll, and every carrier says the plan documents control.

Choosing

How to choose among them

Start with your dentist. Search each plan's network for the office you already use, since a dentist may join one network and not another.
Think about specialists. If you expect to need one, weigh the referral step under a DHMO against the freedom of a PPO.
Look at the expected treatment. A plan with an annual maximum can run out quickly for major work, while a DHMO's copay schedule may be more predictable.
Read the waiting period for basic and major services, and ask what happens to treatment you start early.
Read what the plan excludes. Implants, orthodontics and cosmetic work are the usual gaps.
Ask for the current schedule of benefits and network list in writing before you enroll.

Where people get caught

Common mistakes when picking a plan type

Choosing an HMO to save on premiums and then finding your dentist is not in its network

Choosing a PPO for its flexibility and not noticing the annual maximum before a large treatment plan

Assuming a plan with the same name has the same terms in another state

Confusing a discount plan with insurance

Assuming preventive care has no limits. Carriers describe yearly limits on cleanings and some X-rays.

Questions people ask

Common questions

What is the difference between a dental HMO and a dental PPO?

Cigna, Humana and Aetna all describe it as cost against flexibility. A dental HMO requires a network primary dentist, uses set copays and usually has no annual maximum, but pays little or nothing out of network. A dental PPO lets you see any licensed dentist at higher cost outside the network, and usually has a deductible and an annual maximum.

What is a dental indemnity plan?

It is a fee-for-service plan with no network. Cigna and MetLife say you can see any dentist you like, you may pay up front and file a claim, and the plan reimburses up to a usual, customary and reasonable amount. These plans generally cost more in premiums than a PPO or an HMO, according to both carriers.

What is a DEPO or a DPOS?

Cigna describes a DEPO as a plan that requires network dentists but no primary dentist and no referrals, and a DPOS as a blend of an HMO and a PPO. With a DPOS you can see dentists outside the network but choose a primary dentist who gives referrals.

Which type of dental plan is most common?

PPOs. UnitedHealthcare notes that most plans are traditional PPO plans and that its individual plans from Golden Rule are PPOs, and Guardian says most of its dental policies are PPOs. DHMOs are available in select states or areas. Which types you can buy depends on your employer and where you live.

Do all dental plans have an annual maximum?

No. Most PPOs and indemnity plans do, and most DHMOs do not. Cigna and Humana say most DHMOs have no annual maximum, and UnitedHealthcare lists no annual maximum for dental HMOs and one for PPOs. Where a maximum exists, it caps what the plan pays in a plan year, and you pay after that.

Do all dental plans have waiting periods?

Not all. Cigna says a waiting period is the time between the plan's effective date and coverage, that it may differ for basic and major care, and that it is more often a feature of PPOs. UnitedHealthcare says some plans have none while others have four to twelve months for basic and major services.

Can I see a specialist without a referral?

On a PPO, yes. Cigna, Humana and Aetna say PPOs need no specialist referral. On a DHMO you usually need one from your primary dentist, with exceptions on some plans such as network orthodontists. Humana notes that the referral step can cause a delay.

Is a dental HMO always cheaper?

Not always. Humana says a DHMO is usually more cost-effective but not necessarily better. 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 and the copay schedule fits the treatment you expect.

Is a discount plan a type of dental insurance?

No. MetLife, Anthem and UnitedHealthcare all say a discount plan or savings membership is not insurance. You pay for access to reduced fees at participating dentists, and the plan pays no part of the bill. See the dental discount plans guide for how they work and what to check.

How do I find out which type I have?

Look at your plan name, your ID card and your benefits summary, or ask your employer or the plan. The words DHMO, DMO, PPO, indemnity, EPO or POS usually appear somewhere. If you are not sure, ask whether you must choose a primary dentist and whether the plan pays for out-of-network care.

What is a dental savings plan compared with a DPPO?

A savings or discount plan is not insurance. You pay a fee for reduced prices at participating dentists and pay the dentist directly, while a DPPO pays a share of covered services up to an annual maximum. MetLife, Anthem and UnitedHealthcare all draw that line. See the dental discount plans guide for how they work.

How do I compare two dental plans side by side?

Line up the network, the annual maximum, the deductible, the waiting periods, the coverage for the services you expect and the premium. Search each network for your dentist, and read the exclusions. The insurance benefit estimator can show how a specific plan would treat a specific treatment plan.