If you’re in the market for dental insurance, you’re likely to come across two popular types of coverage — a prepaid dental plan (also known as a DMO – Dental Maintenance Organization plan) and a dental PPO (Preferred Provider Organization). And if you aren’t exactly sure what either is, rest assured you’re not alone. Dental coverage, like many other types of insurance, has its own lingo and it’s not always very clear to understand. The good news is that we’ll break down these two popular dental insurance options into bite size chunks, so you can choose the best dental coverage for yourself or your family.
What is prepaid dental insurance?
Prepaid dental insurance—often referred to interchangeably with a dental HMO (Health Maintenance Organization) plan—is a type of dental coverage structured around a fixed, prearranged payment model. Members typically pay a set monthly or annual premium in exchange for access to a defined network of dentists who agree to provide covered services at predetermined fees. Unlike traditional dental insurance, prepaid dental plans generally do not operate on a reimbursement basis and do not involve percentage-based coverage levels or annual deductibles.
Under a prepaid dental (HMO) plan, most preventive and basic services are either fully covered or available at very low copayments, while more complex procedures follow a published fee schedule. Care must be received from an in-network primary care dentist, who coordinates all treatment and referrals. These plans usually have no annual maximums, no claim forms, and minimal waiting periods, making costs more predictable and budgeting easier for members.
Do I have to pay for dental services on a prepaid dental plan?
Yes, you typically do pay for dental services on a prepaid dental plan, but how and how much you pay is clearly defined in advance. Prepaid dental plans use a fixed fee schedule that outlines the cost of each covered service. In exchange for a monthly or annual premium, members gain access to in-network dentists who agree to provide care at these predetermined prices. Many preventive services, such as exams and cleanings, are often included at no additional cost or with a very low copayment.
For other types of care, including restorative or major procedures, members pay set copayments or flat fees at the time of service rather than a percentage of the dentist’s usual charges. Because these fees are established upfront, there are no deductibles to meet, no claims to file, and no surprises after treatment. This structure makes prepaid dental plans especially appealing for people who want predictable, transparent pricing and fewer administrative steps.
That said, payment is required for services that fall outside the plan’s coverage or if you choose to see an out-of-network dentist, which is generally not covered under prepaid plans. While members do pay for certain treatments, costs are typically lower and more controlled compared to paying full retail dental prices, provided care is received within the plan’s network and according to plan guidelines. It’s important to note that if you go to an out-of-network dentist on a prepaid dental plan, you will be responsible for 100% of your dental fees.
What is a dental PPO?
A Dental Preferred Provider Organization (also known as a dental PPO or DPPO) is another dental insurance option. A key advantage of a dental PPO plan is provider choice. PPO plans allow you to see any licensed dentist, with the highest level of coverage when you use in-network providers. This flexibility is especially valuable for patients who want to keep an existing dentist or who want to access specialist care without needing a referral. By contrast, dental HMO plans generally have stricter network requirements. Members must select an in-network primary care dentist and obtain referrals for specialists.
While HMO plans can be cost-effective for routine and preventive care, PPO plans are typically advantageous for those who value flexibility, broader provider access, and fewer restrictions on how and where dental care is delivered. With a dental PPO, even if you visit an out-of-network dentist, your dental insurance company will likely still pay a portion of the expenses. You will, however, save the most if you see a dentist who is in your plan’s network.
With a dental PPO, the amount you owe after a dental visit is known as coinsurance. Most dental PPO plans cover 100% of preventative and diagnostic dental services, 80% of basic dental services and 50% of major dental services. You would be responsible for 20% of the cost of basic dental services and 50% of the cost of major dental services.
Unlike a prepaid dental plan, dental PPO plans have a low deductible (typically $50 for an individual, or $150 for a family) that must be satisfied before your coverage kicks in, as well as an annual maximum spending limit, usually $1000-$1500 a year. After you exceed your spending limit, you pay out of pocket for your dental care.
There is also a waiting period when you first sign up for new-to-you PPO plan. Typically, you’ll need to wait 6-12 months before coverage kicks in for more expensive treatments such as root canals and crowns. Some insurance providers, like Aetna, will waive the waiting period if you can provide proof of continual dental coverage before you purchased your new plan.
Which dental insurance is the best?
The dental plan that’s right for you depends on your particular needs. Dental plans aren’t one-size-fits-all. Take some time to identify what is most important to you. If you appreciate the flexibility of being able to see any dentist you want, a dental PPO may be best. If you’re looking to keep costs as low as possible, a prepaid dental plan may be in your best interest. You might also want to look into a dental savings plan.
What is a dental savings plan?
A dental savings plan, also known as a dental discount plan, incorporates some of the advantages of both a prepaid dental plan and a dental PPO. With an Aetna dental savings plan, you pay a low annual or monthly membership fee and receive discounts between 10% and 50% off the cost of most dental procedures as long as you visit an in-network dentist. Dental savings plans don’t have waiting periods or annual maximum spending limits and may be the best choice if you have a significant amount of dental care that needs to be completed ASAP, and weren’t recently covered by dental insurance.
How to choose the best dental insurance plan?
Identify your particular needs, and think about what’s most important to you. Then, do a little more digging into prepaid dental plans, dental PPO plans, and dental savings plan and compare things like monthly premiums, treatments covered, deductibles, waiting periods and annual maximums. If you already have a dentist who you would like to keep seeing, ask what plan they would recommend based on their knowledge of your oral health needs with a just little work, you’ll find a dental plan that makes the most sense for you. If you ever need assistance, give us a call!