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Index | Dental Insurance | Dental Health Maintenance Organizations (DHMO)

Dental Health Maintenance Organizations (DHMO)

Dental Health Maintenance Organization is a legal entity of dentists and specialists who accept the premise to provide dental care services to eligible participants at a fixed price. The DHMO plans normally cover preventive and corrective dental care, as well as basic and major dental treatment. The focus of most DHMO plans is on preventive care (annual checkups, x-rays, teeth cleanings). In general, the benefits offered by different plans differ considerably and it makes sense to get yourself familiar with the options available.

DHMO plans share some peculiar features of all Managed Care Plans. For example, the enrollees in DHMO plans are to apply only to the designated specialists working within the network of providers maintained by the DHMO. That is why signing up for a DHMO plan you are required to choose a primary care dentist from the list of the specialists participating in the network. If you have dependents in your policy, each of them should choose his or her primary care dentist. DHMO plans normally allow you to change your primary care dentist during the year if you are dissatisfied with the quality of treatment you receive.

The Dental Health Maintenance Organization pays a participating dentist a certain amount per patient. Therefore, all the dentists who join in the organization agree to provide dental treatment to the plan's enrolled members as specified by the conditions of the dental plan. Since a participating dentist is paid for each person, he/she may offer preventive care and maintenance services at very little or no cost at all. Still, co-payments are often a condition, but due to them your insurance covers all types of dental care procedures irrespective of their complexity. At the same time no deductible is usually required to join in this type of a plan. This is what makes DHMO plans so popular nowadays: they are the least expensive type of dental plans but at the same time they ensure an appropriate level of treatment as it is in the dentist's financial interest to help his patients maintain good dental health.

The policyholder also becomes part of the network. As a verification of a person's belonging to the network, the policyholder receives an ID card. Coming for a visit to the dentist the enrolled member must present his/her ID card which ensures the patient receives the proper level of coverage. In order to get dental treatment the policyholder is normally expected to make an appointment with the primary care dentist. It is of special note that if the policyholder receives dental treatment not authorized by the plan and not approved of by the primary care dentist, the DHMO will not cover any of the dental care expenses.

One of the advantages of DHMO plans is that usually there are no waiting periods. Unlike many other types of dental plans which impose waiting periods from 6 months up to 2 years on major dental procedures, DHMO plans, on the contrary, enable you to make full use of your coverage right from the moment your policy comes into force. You do not have to worry about restrictions on the scope of the coverage when you need dental care.

DHMO plans are very popular among employers as they allow them to offer relatively cheap coverage to their employees. With this plan employees get all dental treatment from their primary care dentist unless the primary care dentist authorizes a referral to a specialist. Therefore, if your employer offers this alternative to you, it is worth considering this option.

DHMO plans are not deprived of disadvantages. The first of them is that you are limited in your choice of specialists to apply to. Another thing to remember is that because the dentists are paid by the organization for each client they receive, irrespective of whether they provide any care and how much care they provide, you might have difficulty in getting access to complex dental care procedures. If it is likely that the amount of dental treatment an enrolled individual requires will exceed the amount the insurance company will pay the dentist, the dentist may make access to dental treatment difficult. The limited access may refer to corrective care. Most plans of this type do not cover cosmetic treatment as it is not considered medically necessary. Besides, non-routine services often require substantial co-payment.

As is seen from above, the distinct advantage of DHMO plans is that they are affordable and provide reasonable coverage. Knowing how a DHMO plan works, you can decide if it is right for you. As always, it is recommended to weigh all the advantages against the disadvantages of this dental plan taking into account your individual needs before you make your final decision.