What does dental insurance cover?

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.

100% dental coverage for preventive care

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.

80% dental coverage for basic procedures

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 dental insurance coverage kicks in. You may also have to pay more out of pocket and have a lower amount of coinsurance if you visit a dentist outside of your plan’s network.

50% dental coverage for major restorative procedures

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:

• Copays: the amount you pay every time you visit a dentist
• Deductibles: the amount you need to pay before your insurance begins to cover costs
• Coinsurance: typically shown as the percentage the insurance company pays for dental procedures once you meet the deductible
• Annual maximums: the yearly limit of how much your plan will pay to cover costs each year

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).

Dental PPO

Dental PPO plans (DPPO) allow you to get coverage for dental services from dentists within a select network, which may reduce your out-of-pocket expense. If you visit a dentist outside your network, you may be able to get some dental coverage through a DPPO plan, though you might pay more out of pocket for treatment. Dental PPOs typically have deductibles and annual maximums. They also usually have waiting periods for many dental procedures outside of preventive care.

Dental HMO (DHMO)

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.

Dental discount plans are not insurance. Instead, they provide discounts on procedures and services at a select network of dentists in exchange for an annual fee. This yearly fee may be as low as $100 for an individual or $150 for a family. Discounts for services may range from 10–60%. Unlike insurance, dental discount plans don’t pay any of the cost of dental care for you. You are responsible for paying the discounted rate of services directly to the dentist at the time services are rendered. However, discount plans typically don’t have annual maximums, waiting periods or deductibles.³

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 are the same. They can vary based on costs, the services they cover and their dentist networks. Before choosing a dental plan, it’s important to consider your budget and dental care needs.