Dental insurance helps cover the cost of dental care, from routine cleanings to major procedures. Understanding plan types and coverage helps you decide if dental insurance is right for you.

Types of Dental Insurance Plans

DHMO (Dental Health Maintenance Organization)

  • Must use dentists in network
  • Choose a primary care dentist
  • Referrals needed for specialists
  • Lower premiums
  • Fixed copays for services
  • No deductibles usually

PPO (Preferred Provider Organization)

  • More provider flexibility
  • Can see any dentist (higher cost out-of-network)
  • No referrals needed
  • Higher premiums than DHMO
  • Annual deductibles apply
  • Coinsurance percentages

Indemnity Plans

  • See any dentist
  • Reimbursement-based
  • Most flexibility
  • Highest premiums
  • May pay upfront, get reimbursed

Discount Plans

  • Not insurance—membership for discounts
  • Pay reduced fees at participating dentists
  • No waiting periods
  • No annual maximums
  • Lower monthly cost

Coverage Levels Explained

Most dental insurance uses tiered coverage:

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Preventive (Usually 100% covered)

  • Cleanings (typically 2 per year)
  • Exams
  • X-rays
  • Fluoride treatments

Basic (Usually 70-80% covered)

  • Fillings
  • Extractions
  • Root canals (sometimes major)
  • Periodontal treatments

Major (Usually 50% covered)

  • Crowns
  • Bridges
  • Dentures
  • Implants (often excluded)

Orthodontia (50% if covered)

  • Braces
  • Often separate lifetime maximum
  • May have age restrictions
  • Frequently excluded or limited

Understanding Dental Insurance Costs

Key Terms

  • Premium: Monthly cost for coverage
  • Deductible: Amount paid before insurance kicks in
  • Annual maximum: Most insurance pays per year ($1,000-2,000 typical)
  • Coinsurance: Your percentage share of costs
  • Waiting periods: Time before coverage for certain services

Average Costs

  • Individual: $20-50 per month
  • Family: $50-150 per month
  • Annual maximums: $1,000-2,000

Is Dental Insurance Worth It?

Dental Insurance Math

Example annual calculation:

  • Premium: $40/month × 12 = $480/year
  • Two cleanings: $200 value (100% covered)
  • Two exams: $100 value (100% covered)
  • X-rays: $100 value (100% covered)
  • Total preventive value: $400

If you only need preventive care, you may break even or pay more than services cost.

When Insurance Makes Sense

  • Expecting major work (crowns, root canals)
  • Have children who may need orthodontia
  • Available through employer at subsidized rate
  • Want predictable dental expenses

When to Skip Insurance

  • Only need preventive care
  • Can pay out-of-pocket for unexpected work
  • Premium exceeds expected benefit
  • Waiting periods would delay needed care

Alternatives to Traditional Dental Insurance

Dental Discount Plans

  • $80-150 per year typically
  • 10-60% off dental services
  • No waiting periods
  • No annual maximums

Dental Schools

  • 50-70% less than private practice
  • Supervised student dentists
  • Longer appointments
  • Quality care at lower cost

Health Savings Account (HSA)

  • Pay dental expenses tax-free
  • Pair with HDHP health insurance
  • Funds roll over
  • Not insurance, but tax-advantaged payment

Getting Dental Insurance

Through Employer

  • Often most affordable option
  • Employer may pay portion
  • Limited plan choices

Individual Plans

  • Buy directly from insurers
  • More plan choices
  • Full premium responsibility

Marketplace Plans

  • Dental may be bundled with health
  • Stand-alone dental available
  • Check during open enrollment