Dental Insurance Explained

Whether you have dental insurance through your employer, through a health insurance marketplace or on your own, understanding how your policy works is vital. There are many different factors to consider, including deductibles, benefit caps and waiting periods.


Dental plans typically have dollar or service limitations. These limits help keep costs under control. They also make it easier to work with your dentist to plan for future care.


Dental insurance is a type of health coverage that helps pay for certain costs related to dental care. It often has a monthly premium and an annual maximum that the plan will pay toward dental procedures. It also includes out-of-pocket costs like copayments and coinsurance.

The average annual cost of a dental insurance plan is around $200 per person, according to the Consumer Health Alliance. However, there are many different types of dental insurance plans available, and the amount you pay will vary depending on your individual needs and coverage options.

Dental Preferred Provider Organization (DPPO) plans have networks of dentists that contract with the insurer to offer a discount on their overall fees. This allows the DPPO to better control costs and limit the number of claims paid. Traditional fee-for-service or indemnity plans reimburse dentists on a fee-for-service basis at the usual, customary and reasonable rate (UCR) that is recognized by the plan. These plans typically have a much higher annual maximum and require a more complicated claim process.


Dental insurance pays for the cost of care provided by a dentist. It covers routine visits that prevent wear and tear or the onset of disease and provide a thorough exam and cleaning. It also covers basic care such as fillings, root canals and gum disease treatment. Most dental policies have a deductible and coinsurance, similar to health insurance. Preventive care is typically covered 100% while basic care is often covered at 80%. Most dental plans have an annual maximum, which is the amount of coverage that the insurer will pay in a year.

There are many different types of dental insurance plans. Some are offered through employers and others are available through the ACA health insurance marketplace. Some are preferred provider organization (PPO) or dental health maintenance organizations (DHMO), which limit access to a list of providers that will accept the plan for a set copayment or no fee at all. Others are on a fee-for-service basis and require the enrollee to pay up front and submit the claim for reimbursement. Most of these plans have a deductible and an annual maximum, although some roll over some or all of their unused deductible.


Deductibles are the amount you pay out-of-pocket before your dental insurance begins to cover costs. The deductible usually resets each year, but it depends on the plan. Some plans do not include a deductible, and others have copays or coinsurance, which are the percentage of your bill that you must pay after the deductible has been met.

A deductible will usually apply to basic and major care, but preventive services are typically covered even before you meet the deductible. It is important to compare a plan’s deductible and cost-sharing features before selecting one.

Another factor to consider is the annual maximum. The maximum is the maximum dollar amount that your dental insurance will cover for approved procedures in a given year. Most dental insurances have a limit of $1,000 to $2,000 per year.

Some dental plans require you to visit a network of dentists to receive coverage. These are called Dental Health Maintenance Organization (DHMO) plans, and they offer lower premiums than PPOs. However, they also limit your freedoms and may restrict the type of treatment you can receive.


Many dental plans are available through an employer or independently purchased on the market. These may be a primary plan with a deductible and co-payment or an indemnity plan that pays a flat fee for each procedure, regardless of the actual charges. Indemnity plans are often paired with a PPO plan to limit contracted dentists to the plan’s maximum allowed charge, reducing the patient’s out-of-pocket expense.

Copayments are fixed amounts that do not count toward the deductible, and they vary by plan. They provide a level of predictability for patients, but they also tend to be higher than the amount paid by in-network dentists who participate in a specific plan.

DHMOs have lower premiums than PPOs, and they often do not have a deductible. These plans require you to select a provider from a panel that has agreed to discounted fees for services. Depending on your needs, you might prefer a DHMO or a discount plan. However, you should consider the present financial state of your family and how much you can afford to spend on your dental care.


Dental insurance is reimbursement provided by your insurer to a dentist for the costs of services that the insurer deems medically necessary. These services are usually categorized as preventive and basic care. Preventive care aims to avoid problems such as tooth decay and gum disease. It typically includes bi-annual cleanings, oral screenings and routine X-rays. Basic care covers minor to moderate damage that has already occurred, such as fillings and tooth extractions.

Dental plans also cover a range of other procedures, such as root canals and orthodontics. However, most dental policies have limits on the amount of coverage they will pay in a year or lifetime. These limits help control expenses for consumers.

There are many types of dental plans available, and they differ by how much the plan pays for each service and whether you can visit out-of-network providers. Some plans use copays, while others have coinsurance. eHealth’s licensed agents can help you compare the cost and coverage options of various dental insurance policies. You can request a quote online or call us during business hours.