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What is a Dental HMO?

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  • Written By: Ken Black
  • Edited By: Andrew Jones
  • Last Modified Date: 16 June 2018
  • Copyright Protected:
    2003-2018
    Conjecture Corporation
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Though many people are familiar with health maintenance organizations (HMOs) for health insurance coverage, some also provide dental insurance. A dental HMO is very similar in function to a medical HMO, with the exception that coverage is only provided for dental care. In some cases, there are other fundamental differences between a dental HMO and medical HMO as well.

The main goal of the dental HMO is to make services, especially preventative services, affordable for each individual. This, in theory, should help keep the costs down, as preventative care can stop some major dental issues from occurring. These preventative services often come with a copay that varies depending on the program. They will include a regular oral checkup twice a year, as recommended by most dental professionals.

Other services, such as major oral surgery and orthodontic work, will likely be discounted to a certain degree, but not as much. These procedures can often be very costly. Therefore, those who feel they may need more coverage may opt for a major dental plan, which may or may not be available from the same companies that offer general dental HMO plans. These major procedures may also require pre-approval before any benefits will be paid.

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Before purchasing any plan, it is important to make sure the dental HMO you are looking at has your dentist as a choice. If it does not, it is likely there will be no benefits provided through the dental HMO at all. It is not like a preferred provider plan, which will have different benefit rates for in-network and out-of-network coverage. If the dentist is not on the plan, then there is very little likelihood that any claims will be honored at all. Those who are locked into a certain plan because it is provided by an employer may find they have to find a new dentist, if they do not want to pay out of pocket.

The company that offers a medical HMO may not be the same company that offers a dental plan. In fact, usually the two are kept separate, and so the procedures and plans have the potential to be quite different. While there are a few insurance providers that will include both HMOs in the package of coverages, this is very rare. In cases where it does happen, the two may be packaged together yet still come from different providers.

As with most types of insurance, a dental HMO will offer the account holder an identification card. This card should be presented at the time services are rendered in order to receive the benefits of the plan. A dental HMO plan is usually available for as little as $80 USD per year, even for those who are paying individually.

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