
Dental care
Dental FAQsLike all body parts, your mouth needs regular
Most people who have dental coverage get it through a group program or their employer, although some purchase plans individually. The number of services and the cost covered may vary between insurance companies or from plan to plan. In general, most dental plans work on the 100/80/50 coinsurance model. This means that once you meet your deductible, you could get 100% coverage for preventive dental care, 80% coverage for basic dental procedures and 50% coverage for major procedures if you receive care in your network.
Many dental insurance plans will cover 100% of the cost for in-network routine preventive care after you meet your deductible. This includes treatments such as bi-annual dental cleanings, exams and dental X-rays. Generally, dental plans don’t have waiting periods for preventive care. That means you can usually get cleanings or exams covered by your insurance as soon as you’re on the plan.
Most dental plans will usually cover up to 80% of the cost for basic procedures such as dental fillings. However, you may pay a larger share of the cost if you haven’t met your deductible. This is the amount you must pay until your
For more extensive dental work, like crowns or dentures, many dental insurance plans will cover up to 50% of the cost. Other factors could affect how much you pay, such as your deductible or if your dentist is within your plan’s network.
The cost of dental insurance varies based on several factors, including where you live or what kind of plan you buy. Americans pay around $360 a year on dental insurance or about $15–$50 each month.1 You can usually expect to pay a monthly premium for your coverage, but keep in mind there are other costs associated with dental insurance:
There are different kinds of dental insurance. Two of the more common types of dental plans are dental preferred provider organizations (DPPOs) or dental health maintenance organizations (DHMOs).
With a dental HMO, you must receive services within a set network of dentists, and you may also be required to choose a primary care provider from within that network. Services received from dentists outside of your network typically won’t be covered. Dental HMOs also generally require you to pay a copay for most services you get at the network dentist. However, these plans normally don’t have annual benefit maximums.
Waiting periods are lengths of time between when your dental insurance coverage starts (i.e., coverage effective date) and when you can get full coverage for some dental services. Most dental plans don’t include waiting periods for routine preventive care like teeth cleanings or exams. For basic procedures like fillings, some plans may have waiting periods from 3 to 6 months. Major dental work such as crowns, bridges or fillings could have waiting periods from 3 months to a year.
Not all dental insurance plans cover
Many dental insurance plans have an annual maximum of coverage. The annual maximum is the limit of how much your plan will pay for dental costs each year. Once you meet this amount, you will have to pay for all dental care out of pocket. The annual maximum differs from plan to plan, with a typical amount ranging from $1,000–$2,000 per year. It’s not common for people to exceed their annual maximum, with only about 2–4% of Americans reaching this limit annually.4
Not all dental insurance plans are the same. They can vary based on costs, the services they cover and their dentist networks. Before