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Aetna Dental Insurance: PPO vs. DHMO

Aetna Dental Insurance: PPO vs. DHMO

Are you trying to decide which type of dental plan is best for you or your family? If you already have a dentist that you like, you’ll want to take that into account. Since dental coverage includes specific networks of providers, the type of plan you pick will affect where you go for your care.

Two of the most common types of dental insurance are PPO and DHMO plans. While they cover many of the same treatments, the way they work is something you’ll want to consider before enrolling.

What’s an Aetna DHMO?

Short for dental health maintenance organization, DHMOs are the dental version of an HMO. That is, a specific network of dentists who participate in the insurance plan and see patients for all of their care needs. The DHMO plan pays your dentist a set amount per year, regardless as to which treatments you have completed. Everything is covered at the same amount, since the network offices and your insurance provider have a contractually agreed fee schedule.

The catch is that you’ll see the same dentist for all of your services. If you move, you’ll also need to sign up under another DHMO dentist on your insurance plan. As long as your dentist is part of the DHMO network, you can pick any one that you want!

While HMO and DMHO plans have been around for years, they’re becoming less common in private practice dentistry. However, some people continue to prefer them because of the straightforward and easy-to-understand benefits that they’re entitled to by enrolling in the plan.

What’s an Aetna PPO?

PPOs are preferred provider organizations. What that means is some dentists can choose to participate in the insurance company’s fee schedule by accepting their benefits. When you see these dentists, your treatment is covered at a higher percentage.

However, unlike DHMOs, you can also use your PPO plan at dental offices that are not part of the network. But if you do, those dental practices do not have to charge the same agreed-upon fees as an in-network dentist. If their fees are slightly higher than what an in-network PPO dentist would be, you will be responsible for covering the difference.

The advantage of being in a PPO plan is that you can see any dentist, even if they’re not in-network with your specific plan. It’s just that participating dentists will usually be more affordable.

A lot of people prefer PPO dental plans because they’re not tied down to a specific list of dentists to choose from. You can take your PPO plan with you anywhere, but you’ll get greater incentive out of your benefits if your particular dentist chooses to be a part of the network. If your dentist doesn’t participate, you can always talk to their office manager or the practice owner to encourage them to change their policy.

Which Costs Less?

Asking if a PPO or DHMO is cheaper than the other is subjective, based on where you live and the dentist you want to see. It also depends on which types of treatment you need, and how often they’re required.

When it comes to out-of-pocket expenses for dental care, a DHMO may seem more affordable, even if the monthly premium is slightly more. That’s because you’re not paying much (if anything) out of pocket at your appointments. This makes DMHOs easier to fit into fixed monthly budgets.  PPO benefits are dependent on the fees established by your dentist, that is, if you’re seeing one that’s out of network. Otherwise, you’ll know exactly how much is covered as long as you’re seeing a preferred provider. You can still save just as much money, but you’ll have to do a bit of math in advance.

Other Aetna Alternatives to Consider

If you’re uncertain about committing to a DHMO or PPO, another great alternative is to join an Aetna dental savings plan. Discount dental plans allow members to take advantage of immediate savings at any participating dentist nationwide. Plus, there are no deductibles or annual maximums. If you need only a little or an extensive amount of dental work, a discount program could help you save thousands of dollars per year.

Talk to one of the discount dental experts at Aetna Dental Offers to find out if a membership plan is right for you.


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