While the Affordable Care Act (ACA) focused on changes to medical insurance, there are choices to make when it comes to dental insurance as well. Americans are adjusting to the changes in their medical coverage, but it’s important to be informed about different types of dental coverage as well, including health maintenance organization (HMO) dental insurance.
How Dental HMOs Work
An HMO dental plan works very similarly to an HMO medical plan. The dental HMO may require you to choose a primary dentist who will help to coordinate your care. That dentist would then provide referrals for any specialized work that needed to be done outside his or her office.
A dental HMO also tends to have a lower monthly premium and lower cost-sharing, because the primary care dentist ensures that only needed care is done, and that is done as effectively as possible. You can expect low or no deductibles and a fixed copayment for most services. Some preventive or diagnostic care may be provided without any cost-sharing at all.
Some HMO dental plans will have an annual maximum benefit – the most the insurance will pay for dental care during the plan period, which is usually one year. Other HMO dental insurance will not have a benefit maximum, meaning that you will continue to have insurance coverage during the entire policy period, no matter how much care you use.
Finally, HMO dental plans will generally have lower costs for in-network dental providers. In fact, many plans will offer no coverage at all for out-of-network dentists – you would pay the entire bill yourself.
Is HMO Dental Insurance Best for You?
An HMO dental plan would be best for someone who enjoyed having highly coordinated care, and didn’t mind receiving most of their care from a specific dentist. Also, this plan is best for those who live and work in a single primary area, since they would be able to access in-network dentists easily.
For someone who travelled often or wanted to have a broad choice of dentists, a dental HMO would likely not be a good choice. HMO dental insurance often has a very narrow network of providers to keep costs low. Because coverage is often limited or not provided out of the network, those with HMO dental coverage may find that they have few providers they can use with their insurance coverage. If this is a concern, you may prefer a different plan.
If you choose a dental HMO, be sure to review the renewal terms each year. The provider networks change from time to time, and you want to ensure that your preferred dentist is still in the network before you renew your policy. Otherwise, you may find yourself paying high out-of-pocket costs or starting over with a new dentist.
Dental HMOs can be a good choice for those who live and work in a single geographic area and are looking for a low-cost plan with fixed copayments for services. The care is often coordinated by a primary dentist that offers referrals for complex care. However, if you want a broader choice of dentists or are concerned about a maximum care limit for the year, a HMO dental insurance might not be a good choice for you.
To learn more about the benefits and disadvantages of a Health Maintenance Organization (HMO), read The Pros and Cons of an HMO.