Author Topic: Dental Insurance (HMO vs PPO)  (Read 1369 times)

FLBiker

  • Pencil Stache
  • ****
  • Posts: 985
  • Age: 43
Dental Insurance (HMO vs PPO)
« on: October 31, 2016, 08:08:36 AM »
I've read the other dental insurance threads on here, but I was hoping that folks with insight in this area could give their opinions on our specific situation.

DW and I have several plans available through work (State of Florida).  You can see a full list here (http://mybenefits.myflorida.com/health/supplemental_insurance_plans/dental_plans) but the two I think we're deciding between are Humana Network Plus Prepaid [which I believe is an HMO] and Humana Preferred Plus PPO.  The cost for the HMO is $24 for just me, $47 for me and wife, $72 for family (we have a 19 month old).  The PPO is $32/$60/$97.

My teeth are a bit of a mess (one broken and bonded, many cavities [some filled in China], low to moderate gum pockets), DWs are great, DD has never been to a dentist.  DW currently has a cheaper HMO plan, but her dentist (and every other dentist I called) is not accepting it in 2017.  I currently have the HMO plan, and the dentist I've been going to (who I'm relatively pleased with) will accept it in 2017 as well.  I get the impression that PPOs are better for folks with janky teeth (like me) but the plan limit is $1200.  Wouldn't I be better off with an HMO that has copays for every procedure with no limits?  That said, I don't expect needing anything major -- maybe a cavity, some basic periodontic cleaning, maybe a repair to my bonded tooth.

Here's a list of the copays for the HMO (http://www.compbenefits.com/custom/stateofflorida/Network-Plus-Prepaid_Sched-Lim_Exc.pdf) and here's a breakdown of how the PPO works (http://www.compbenefits.com/custom/stateofflorida/Preferred-Plus-DPPO_Sched-Lim_Exc.pdf).

My current plan is to add DW to my HMO plan ($47 per month) and have her start using my dentist.  Alternatively, I could change us both to the PPO ($60 per month) and she could stay at her current dentist (or we could both switch to another dentist I've heard good things about).  And DD would probably not go to the dentist next year, but if she did we'd just do out of pocket.

Any advice would be greatly appreciated!  And if you need any additional info from me, please don't hesitate to ask.

ysette9

  • Walrus Stache
  • *******
  • Posts: 5383
  • Location: Bay Area, CA
    • Insert Snappy Title Here (Journal)
Re: Dental Insurance (HMO vs PPO)
« Reply #1 on: October 31, 2016, 11:09:19 AM »
I can't dig into all of the details of your situation, but I can relate anecdotally our situation with PPO vs. HMO for dentists. A few years ago my husband needed to get braces to set him up to fix various teeth problems he had (bad genetics combined with poor dental hygiene and care from living in Asia as a kid). We switched to an HMO for the first year because it had MUCH better benefits for orthodontia. However, we found that the HMO had almost no decent dentists in the network. Literally, my husband searched though the entire HMO list of local dentists, bounced them off of Yelp reviews, and found exactly one office that both accepted the HMO insurance and had good reviews. That office notified my husband that they were dropping HMO the following year.

After doing that for a year we decided that I would get the HMO through my work to cover his braces and he'd get PPO through his work so we could keep going to decent dentists. Your situation may be very different, but it is worth looking into the details in my humble opinion. I mostly had great dental care as a kid with almost zero incidents of anything. I had two years of abominable care while in college that really screwed me over years later due to what I'll call a "lack of preventative maintenance". Dental care is something I am not willing to skimp on at this point in my life.

FLBiker

  • Pencil Stache
  • ****
  • Posts: 985
  • Age: 43
Re: Dental Insurance (HMO vs PPO)
« Reply #2 on: October 31, 2016, 11:33:17 AM »
Thanks Yvette.  That's actually pretty similar to our situation.  I've been happy with my HMO plan (in terms of both coverage and premiums) but more and more dentists in our area are dropping it.  My dentist (who I like well enough but don't love) is keeping it for next year, but the other two dentists I called (my wife's and one with great Google reviews) don't take it.  I think we'll stay with the HMO plan for next year, but we might end up having to switch to PPO at some point in the future.

Thanks!