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HMO Dental Insurance

One of the most popular types of dental plan, HMO dental insurance can be a great choice for many people. We’ll explore the plan in detail, from its payment structure and breadth of coverage to the advantages and disadvantages of the plan itself. We will help you work out whether it’s the right option for you when it comes to your dental insurance.

Overview

HMO dental insurance is a type of plan which requires you to choose one primary dentist from whom you can receive treatment from. Usually, you’ll choose the primary dentist from a pre-approved list from your insurance provider, however in some cases you’ll be able to receive treatment from a range of different in-network dentists. If you need to see a specialist, you’ll need to receive a recommendation from your primary dentist.

Coverage

HMO dental insurance provides you with coverage for all types of dental treatments, from diagnostic and preventative to advanced procedures. The range of dental treatments that you can receive coverage for includes:

  • Diagnostic and preventative procedures: routine x-rays, routine exams, fluoride treatments, and cleanings.

  • Basic procedures – non-routine x-rays, non-surgical extractions, periodontal scaling, fillings, emergency treatments, anesthesia, and palliative treatment.

  • Advanced procedures – root canals, gum disease treatment, surgical extractions, oral surgery, dentures, crowns, and bridges.

There’s likely to be numerous limitations and exclusions on procedures that you’re able to claim for with your HMO dental insurance. A common exclusion for HMO dental plans is cosmetic and orthodontic treatment, which means that in the majority of cases you won’t be able to claim for braces on them. You can find HMO dental plans which cover orthodontic treatment, but they’re much less common.

Financial

Most HMO dental insurance plans do not require you to pay deductibles. Instead, you just pay a fixed amount towards the cost of your treatment (a co-payment). In addition, HMO dental plans do not generally have annual maximums, as PPO dental plans do. In addition, monthly premiums tend to be much lower than the premiums you can expect to pay for a PPO dental plan. Most HMO dental plans cover 100% of the cost of diagnostic and preventative procedures (while those that do charge will only demand a fraction of the cost), 80% of basic procedures and around 50% of advanced procedures, although this can vary from plan to plan.

Benefits

An HMO dental insurance plan is an excellent type of insurance for those who do not travel very often, and as such are unlikely to need to receive dental care in a different area or city than the one in which their primary dentist is located. The other major benefit is how affordable they are when compared to other plans, making them a fantastic choice for people who aren’t eligible to receive Medicaid but are still looking to save money on their dental insurance. Finally, HMO dental plans don’t require wait times for procedures, which means that you can get the dental care you need, exactly when you need it.

Disadvantages

HMO dental plans are not very flexible, and because of this they can have very strict restrictions. Unlike PPO dental plans, HMO dental insurance won’t contribute anything towards dental care from out-of-network dentists. If you choose to see a dentist other than your primary dentist, you’ll probably have to pay the full cost of the procedure out-of-pocket. They can also leave you without coverage if a dental emergency happens while you’re travelling, and you’re therefore unable to get to your primary dentist.

Process

So, how do you go about using an HMO dental plan? It’s a simple process. Importantly, you don’t have to worry about filing the claims paperwork, your dentist will take care of that. You simply pay the cost of the co-payment.

Need to find a dentist in the local area? Contact 1-800-DENTIST, and we’ll get you an appointment with an HMO dental insurance dentist the very same day.