PPO vs HMO vs Discount Dental Plans: Which Saves More
The three main ways to pay less at the dentist are not the same thing. Here is how PPOs, HMOs, and dental savings plans differ on price, network, and what they actually pay.
What each plan type actually is
A dental PPO is true insurance with a network, coinsurance, a deductible, and an annual maximum. You can usually see any dentist, but in-network care is far cheaper. A dental HMO is also insurance, but you pick a primary dentist inside a tighter network and need referrals for specialists; in exchange the premiums are low and copays are predictable. A dental savings plan is not insurance at all: you pay a yearly fee and get a discount, typically 10 to 60 percent, at participating offices. It pays nothing toward your bill and has no annual maximum.
Because only the PPO and HMO pay a share of your charges, the "which saves more" answer depends entirely on how much care you expect. The calculator models the PPO and HMO path; a discount plan is best judged by comparing the discounted fee to your local cash price.
Side-by-side comparison
PPO
- Premium: moderate ($30 to $50/mo)
- Network: large, out-of-network allowed
- Coinsurance: 100-80-50 after deductible
- Annual maximum: usually $1,000 to $2,000
- Specialists: see directly, no referral
- Waiting periods: 6 mo basic, 12 mo major
HMO
- Premium: lowest ($15 to $30/mo)
- Network: small, must stay in plan
- Cost share: fixed copays, often no deductible
- Annual maximum: often none
- Specialists: referral required
- Waiting periods: frequently none
Discount plan
- Fee: annual, not monthly premium
- Network: participating dentists only
- Benefit: 10 to 60 percent off fees
- Annual maximum: none
- Pays toward bill: no
- Waiting periods: none
When a PPO wins
If you expect major work — a crown, a root canal, or an implant — a PPO is usually the clear winner because it actually pays 50 percent of the major bill up to the annual maximum. An HMO may cover the same work for a low copay, but only at its limited network, and a discount plan leaves you paying the other half of a $1,200 crown yourself. For anyone with a known treatment plan, the PPO's coinsurance is the only option that puts a real dent in a big bill.
When an HMO or discount plan wins
For someone who only needs cleanings and the occasional filling, an HMO's low premium and no deductible can beat a PPO, and a discount plan can beat both if your local dentist offers a steep negotiated rate. The trade-off is network rigidity: an HMO locks you to its dentists, and a discount plan only helps at participating offices. If you have a dentist you love and they are not in either network, a PPO's out-of-network flexibility may be worth the extra premium.
Frequently asked questions
Is a PPO or HMO better for dental?
A PPO is usually better if you want to keep your current dentist or see specialists without a referral, while an HMO is cheaper but limits you to a fixed network and often requires a primary dentist.
What is a dental savings plan?
A dental savings plan, also called a discount plan, is not insurance. You pay an annual fee and receive negotiated discounts, typically 10 to 60 percent, at participating dentists. It pays nothing toward your bill and has no annual maximum.
Which plan saves the most money?
For routine preventive care, an HMO or a discount plan is often cheapest. For expensive major work, a PPO with strong major coverage usually saves the most because it actually pays a share of the bill.