Health & Wellness
What Is Dental Insurance & How Does It Work?
Maintaining good oral health can be easier if you have a dental insurance plan. This is because dental insurance can help cover a portion of dental care costs — making care easier to afford. Whether it’s keeping your oral health in good shape or getting the necessary treatment to get it back on track, being able to pay for necessary care can also help prevent further problems down the line.
Understanding how dental insurance works is a vital step in keeping your smile and your bank account healthy.
What is dental insurance?
Dental insurance provides coverage for services and treatments related to oral health care. For instance, it can help individuals and families manage the costs of routine dental cleanings and exams, as well as surgeries and emergency procedures. Dental insurance covers a portion of your expenses, so you’re not left paying all the costs on your own.
How does dental insurance work?
Just like other types of insurance, you pay a monthly premium to keep your policy active. If you have employer-sponsored dental insurance, your employer might pay the full cost or partial cost of premiums. If your employer pays a portion of the cost, you’ll be responsible for the rest of the premium — which is normally deducted from your pay.
In addition to premiums, you may also be responsible for deductibles, coinsurance, and copays. After meeting your deductible, you and your plan will split a percentage of the costs for your dental care, known as coinsurance. For example, if your plan's coinsurance is 70%/30%, your plan pays 70% of the costs, and you pay the remaining 30%.
You might also need to pay a fixed fee, aka a copay, when you visit the dentist. Some plans also have an annual coverage maximum — which is the highest amount your plan will pay for your dental care within a single year — and lifetime limits on certain services or procedures.
What are the different types of dental insurance plans?
The two most common types of dental plans are dental preferred provider organization (DPPO) plans and dental health maintenance organization (DHMO) plans. A DPPO plan allows you to visit any licensed dentist, in or out of network — although you may pay more for out-of-network services. A DHMO plan requires you to choose a primary dentist from a network of participating dentists. If you need to see a specialist, your dentist will provide you with a referral to another in-network provider. And unlike DPPOs, out-of-network services typically aren’t covered by a DHMO plan.
In addition to DPPOs and DHMOs, other types of dental plans include:1
- Dental exclusive provider organization (DEPO) plans: This type of plan often limits coverage to in-network dental services, except in emergencies. You’re not required to choose a primary dentist, and you don’t need a referral for specialty care.
- Dental indemnity plans: This is also referred to as a traditional or fee-for-service plan. It typically offers the most flexibility in choosing a dentist, but it also has higher out-of-pocket costs compared to other plans. With this plan, your insurance pays a certain percentage for services, and you pay the rest.
- Dental point of service (DPOS) plans: This plan blends aspects of DHMOs and DPPOs. It offers coverage for out-of-network services — like a DPPO — but you’re also required to select a primary care dentist who can refer you to specialists — like a DHMO.
- Direct reimbursement plans: In this plan, your employer directly reimburses you for eligible dental expenses. You pay for dental services upfront and then submit an insurance claim for reimbursement.
- Dental savings or dental discount plans: These plans offer reduced fees for services from a network of participating dentists.
What does dental insurance cover?
Most dental plans offer coverage for services that fall into one of three categories:
- Preventative care: Preventative dental care can help you detect and address issues early, which might reduce the need for treatments in the future. Some examples of preventative dental care include cleanings, routine X-rays, checkups, and exams.
- Basic care: Basic dental care addresses existing oral health issues that require specific treatments. This can include procedures such as fillings, extractions, gum disease treatments, and root canals.
- Major care: Major dental care typically involves restorative treatments such as bridges, crowns, dentures, and surgeries.
Most dental PPO plans follow a 100/80/50 payment plan.2 This means your insurance will pay 100% for preventative care, 80% for basic care, and 50% for major care. Dental HMO plans may not follow this plan design, but they usually offer services at a low cost or no cost to patients. That said, how a dental plan categorizes services and how much they cover can differ by provider. Check your plan details for specific coverage information.
What does dental insurance not cover?
In general, any treatments and services that aren’t deemed medically necessary to a patient's health won’t be covered by dental insurance. For instance, cosmetic procedures like teeth whitening, veneers, and dental bonding aren’t covered.3 These procedures are focused on improving the look of a person’s smile rather than treating or preventing a health issue.However, you should always check with your provider to learn what they consider an essential versus nonessential service.
What are the benefits of having dental insurance?
Having regular access to preventative care and saving on the costs of treatments and services is often what makes dental insurance a worthwhile investment. But to figure out if dental insurance is right for you, consider your individual dental needs while also factoring in the cost of premiums, deductibles, and any other financial responsibilities you have.
Here are some common benefits of dental insurance:
- It can help you maintain your oral health, which is linked to overall health.
- It offsets the cost of dental care, reducing your out-of-pocket expenses.
- It provides coverage for regular checkups, which can help detect problems before they become more serious and costly.
- It gives you access to a network of dentists in your area.
- It offers a range of coverage options to fit your needs and budget.
Dental insurance FAQs
Not all health insurance plans include coverage for dental services, and if one does, it may not be comprehensive. While it may cover dental procedures related to medical conditions or surgeries, more routine dental care typically won’t be covered. To get preventative and basic dental care, you’ll most likely need to get a separate dental insurance plan.
You can get dental insurance from your employer during open enrollment — as part of your employee benefits — or you can get an individual policy through the health insurance marketplace or directly from a dental insurance company.
Unlike a group dental plan that’s tied to an employer, an individual plan is portable so you can use it no matter where you work.
Dental insurance coverage will depend on the type of service needed and whether it falls under preventative, basic, or major care. Remember that most dental PPO plans may cover 100% of preventative care costs, 80% of basic care costs, and 50% of major care costs, and HMO plans typically provide low or no cost services. Review the details of your dental insurance plan to learn about what it covers, how much is covered, and what your responsibilities are.
Some dental insurance plans cover orthodontic care. If yours doesn’t, you may have the option to include orthodontic coverage as an add-on benefit. Keep in mind that braces and other orthodontic services are typically only covered for kids and young adults. For instance, with MetLife dental insurance, kids up to age 19 are covered.
An insurance waiting period is a specified duration of time in which you must wait before your plan’s coverage kicks in. Some dental plans will have a waiting period and some won’t. For plans that do have a waiting period, it may only apply to specific parts. For example, you might have immediate access to preventative services, while major treatments are covered only after the waiting period is over. Consult with your employer or insurance provider to learn about waiting periods for your specific plan.