Dental insurance in the United States pays part of the cost of dental care. It usually covers preventive care, basic treatment and major work, but it is structured differently from medical insurance.
Thank you for reading this post, don't forget to subscribe!Main types of plan
- PPO (Preferred Provider Organization): the most popular type. You can see network or out-of-network dentists, but staying in the network usually costs less.
- DHMO (Dental Health Maintenance Organization): network dentists only, and generally the lowest cost. Out-of-network care is usually not covered.
- Indemnity (fee-for-service): you can see any dentist. The plan pays a percentage of the charges, and this is generally the most expensive option.
Discount dental plans are a separate category. They are not insurance, and they offer reduced rates from participating providers instead of coverage.
What is usually covered
The ADA describes a typical plan design:
- Preventive and diagnostic care (cleanings, exams, X-rays): 100% covered.
- Basic restorative care (fillings, for example): 80% covered.
- Major restorative care (crowns, for example): 50% covered.
- Orthodontics: 50% covered, with a separate lifetime maximum of $1,000.
- A $50 annual deductible applies to most services, except preventive and orthodontic care.
- A $1,000 annual maximum applies to most services, except orthodontics.
These are typical figures, not a guarantee. Individual plans vary, and some have waiting periods, frequency limits or different maximums.
Before you choose a plan
Check the plan booklet or the insurer’s website for the annual maximum and the deductible, whether your dentist is in the network, any waiting periods for major work, and the orthodontic coverage and its lifetime limit.
Editor’s note: an earlier version of this article gave premium and maximum figures that could not be confirmed against a published source. Those figures have been replaced with the typical plan design published by the American Dental Association.
Sources
- American Dental Association, Dental Benefits: An Introduction (typical plan design): https://ebusiness.ada.org/assets/docs/2201.PDF
- Fair Health, Dental Plans: What You Need to Know: https://fhonline.fairhealth.org/documents/Dental%20Plans%20-%20What%20You%20Need%20to%20Know.pdf