Dental Health Info Article

Delta Dental Insurance: PPO vs HMO

Without a dental plan, the surprise of a chipped tooth, cavity or gum disease can cost you thousands. That’s why it’s best to sort out an insurance plan before anything goes wrong. Delta Dental Insurance is one of the largest and most popular providers in the US, offering a range of dental plans – from PPO to DHMO – to choose from. However, it can be difficult to know which one is best suited to your needs. Learn more about the dental insurance plans offered by Delta Dental:

Delta Dental: Overview

Offering both individual and group-sponsored dental plans, Delta Dental Insurance delivers affordable and comprehensive dental coverage. They’ve got over 74 million people enrolled , making them one of the most popular providers nationwide. As Delta Dental offers group plans, you should check with your employer if you’re interested in a Delta Dental PPO or DHMO plan to see whether it’s offered as part of your benefit package. So, what’s the difference between the PPO plan and the DHMO plan? 

Delta Dental PPO plans

A PPO (Preferred Provider Organization) is a type of insurance plan which allows you to receive treatment from a network of dentists, while you can also get coverage from dentists who are outside of the network, albeit at a lower rate. If you’re on a PPO plan, you’ll only have to pay a percentage of the normal cost of the dental procedure.

The amount of the cost that your plan covers depends on the actual procedure, with diagnostic and preventative services receiving greater coverage than major dental services. In addition, a PPO requires you to pay a deductible (the amount that you have to pay before the policy kicks in), while they also have a maximum amount that you are allowed to claim on an annual basis.

Delta Dental PPO offers you the chance to choose from an extensive, nationwide network of dentists. You won’t have to pay the entire fee and wait to get reimbursed. Instead, your dentist will submit your claim for you. The only thing that you have to do is pay your proportion of the fee. You’ll spend the least when you visit a dentist who accepts the Delta Dental PPO plan, although you can still get coverage when you visit another dentist, in which case your out-of-pocket costs will probably be a bit higher. Delta Dental’s PPO plan is available in a wide variety of states: 

  • Alabama

  • California

  • Delaware

  • Florida

  • Georgia

  • Louisiana

  • Maryland

  • Mississippi

  • Montana

  • Nevada

  • New York

  • Pennsylvania

  • Texas

  • Utah

  • Washington, D.C.

  • West Virginia

Delta Dental DHMO plans

A DHMO (Dental Health Maintenance Organization) requires you to choose from a small network of dentists. Often, you’ll only be able to pick one primary dentist or facility from which to receive care. These plans are much more affordable than PPOs because the providers offer heavily discounted rates, plus you don’t have to deal with any deductibles or maximums. Instead, you just pay one fixed amount (known as a co-payment) for any service.

With DHMO plans, diagnostic and preventative services have no co-payments, so you don’t have to pay anything at all. However, there are some drawbacks to DHMO plans, the most important of which being that if you choose to visit a dentist who is outside of the network, you’ll probably have to pay the entire bill yourself. This ends up limiting your options and can mean that DHMO plans are not ideal choices for people who travel frequently.

Delta Dental Insurance’s DeltaCare USA offers set co-payments, so you know how much every procedure is going to cost. There aren’t any deductibles, and you can receive coverage for preventative, basic, and major dental services. In the majority of states, you have to select a primary dentist from the DeltaCare USA network, which means that this DHMO-type plan is relatively inflexible. The DeltaCare USA plan is available on a national basis, which means that you can gain access regardless of where you’re based in the U.S. 

Choosing the right Delta Dental insurance plan

Of course, there are advantages and disadvantages to both types of plan. The main differences come down to affordability, flexibility, and network size:

  • Affordability: In terms of cost, a DHMO is probably the best option. If you’re on a low income, the lack of deductibles and annual maximum limits is a big selling point. While PPOs do offer reduced rates, they’re nowhere near as low as they are for DHMOs.

  • Flexibility: If you want a specialist treatment and you’re on a DHMO plan, you’ll need to get a referral from your primary dentist. This isn’t a problem for PPO plans, which are more lenient.

  • Network size: With a DHMO, you’re limited when it comes to the dentists that you’re able to receive coverage from. PPO plans have many more providers, making them an overwhelmingly better option, while they also give you the opportunity to go outside of the network for reduced rates. In addition, many dentists simply won’t accept DHMOs due to their relatively low reimbursement rates.

Ultimately, it’s completely up to you. When it comes to Delta Dental Insurance’s dental plans, the Delta Dental PPO is the more versatile option. However, you will end up paying more, so if cost is a factor, the DHMO could be a viable choice.


How do I file a claim with Delta Dental? 

After you’ve signed up for a Delta Dental insurance plan, the claims process is simple. Usually, your dentist will deal with all the paperwork. However, if you receive care from an out-network dentist, you may need to handle the claim yourself. Here’s how to file a claim with Delta Dental insurance: 

  • Download the correct claim form for your Delta Dental insurance plan. 

  • Fill in the patient/subscriber information. 

  • Provide a detailed receipt or a copy of the Statement of Treatment from your dentist. 

  • Make a copy of the documents for your own records

  • Send the documents to the address shown on the claim form. 

  • Then, you just need to sit back and wait. Usually, claims are processed within 2 weeks. 

Interested in finding a Delta Dental Dentist? Call 1-800-DENTIST today to book your next appointment!