Q:

What is the difference between DeltaCare USA's HMO and PPO plans?

A:

Quick Answer

The difference between Delta Dental's DeltaCare USA HMO plans and its PPO plans is that members of an HMO plan choose a primary care dentist who coordinates all fixed co-payment oral care, while members in a PPO plan pay a lower coinsurance, seeing providers within the network. PPO plans also require members to meet a deductible, and there is an annual maximum amount of coverage. The HMO plans have no deductibles or maximums, according to Delta Dental.

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Full Answer

Out-of-pocket costs are generally lower in the Delta Dental PPO provider network, because its dentists agree to accept lower fees, and members pay only a percentage of these reduced fees. Individuals who belong to a PPO plan pay higher costs to see out-of-network providers. PPO plan members are individuals who belong to associations and organizations that buy group coverage for their members, states Delta Dental.

The DeltaCare USA HMO plans have set co-payment amounts for each type of covered treatment. Many diagnostic and preventive services have no co-payment in an HMO plan. Plan members may need to seek pre-authorization for specialty care, and only their primary dentists can refer them to specialists. If members see out-of-network providers, they may be responsible for the full costs of treatments, reports Delta Dental.

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