Dental Blog / How Does Dental Insurance Work?

How Does Dental Insurance Work?

Dental insurance provides patients with quality care at a low or no cost. How a specific policy works depends on the carrier, coverage, and area you live in. 

Continue reading to learn more about dental insurance and how to find a plan that fits your needs.  

What is dental insurance?

Dental insurance refers to policies that offer coverage for oral care services, from preventative exams and cleanings to more complex procedures like cavity fillings and crowns.

Few medical insurance plans include dental insurance, so you must enroll in a dental plan separately. 

How does dental insurance work?

Similarly to medical insurance, staying enrolled in a dental plan requires paying a monthly premium—or having it deducted from a paycheck, if you’re insured through your employer. 

Different carriers and types of plans cover different procedures and treatments, broken down by preventative, restorative, and orthodontic care (more on this below). Preventative care is typically covered in full, while others may be partially covered or not covered at all. Look through the specifics of your plan and contact customer service if you have any questions. It’s important to know what you’re paying for!

Also, some dental plans require you to select a primary dentist that is in network, which will require some further digging. If you already have a preferred practitioner, they should be able to tell you what insurance they take. 

Types of dental insurance plans

There are several types of dental plans, including:

  • Preferred Provider Organization (PPO): This type of plan has contracts with a network of dentists, who provide services for an agreed cost.
  • Dental Health Maintenance Organization (DHMO): This type of plan has contracted dentists, each of which has a certain “prepaid” amount per month for every patient.
  • Direct reimbursement: This is a self-funded plan that allows patients to see their preferred dentist, where they will pay for services out of pocket then submit a receipt for full or partial reimbursement.
  • Indemnity plan: This type of plan is where the insurance company pays claims based on what procedures are performed, allowing members to go to the dentist of their choice.

Dental insurance premiums

Your insurance premium is the amount you pay monthly to stay enrolled in your policy. Plans can run anywhere between $20 and $50 or more, all depending on where you live and the coverage you choose. Full coverage will come with a higher premium. 

Dental insurance networks

Depending on your insurance carrier and plan, you may be required to see dentists that are in-network. If you see a dentist that’s out-of-network, you’ll be responsible for paying for care.

Prior to making a dental appointment, check the details of your plan to determine whether you have flexibility in what dentists you see, and to ensure a certain provider is in-network.

Dental insurance waiting periods

Some dental plans have a waiting period, where you have to wait up to six months from enrolling for coverage to kick in. You’ll be covered for preventative exams and care during that time, but more extensive treatment or procedures may not be covered.

Dental insurance deductibles, copays and coinsurance

While dental insurance provides coverage for a variety of oral health services, there are some out-of-pocket costs holders may incur, such as:

  • Deductible: A set dollar amount you must meet for non-preventative care before your dental plan kicks in to assist. Most plans cover preventative care 100%.
  • Copay: Fees you pay when you visit the dentist for care, typically paid at the time of your appointment.
  • Coinsurance: How costs are shared between you and your plan once the deductible is met, shown as a percentage of what you will pay vs. what your plan will pay.

Dental annual maximums

Most dental insurance plans have a maximum, which is the most the plan will pay for dental care each year. Beyond this maximum figure, you will be responsible for paying for any care out of pocket.

What does dental insurance cover?

Plans can be categorized by what they cover: preventative care, restorative care and orthodontic services. The most basic plans cover routine exams, cleaning and X-rays. For a higher monthly premium, some plans will cover restorative care, like cavity fillings, tooth extractions, crowns, bridges and other procedures.

Full coverage plans may also cover orthodontic services, which include teeth alignment treatments like braces, aligners and retainers. These are typically part of oral health for children and teens.

What isn’t covered by dental insurance?

Just like with medical insurance, elective or cosmetic procedures are not covered by dental insurance. This includes treatments like teeth whitening and veneers — while they may make you feel better physically and emotionally, they’re not considered medically necessary, so you’ll have to pay out of pocket.

Additionally, some major work and orthodontics, including removable aligners and retainers, may not be covered, depending on your plan. Plan ahead and look through details of various insurance plans to make sure you and your family are covered now and in the future.

What are the benefits of dental insurance?

Dental insurance provides many advantages. With preventative care covered and lower out-of-pocket costs for more extensive treatments, you can keep your smile healthy without spending hundreds of dollars. Enroll in a plan and never skip the dentist for fear of overpaying again. 

How to get dental insurance

The best way to find the right dental insurance policy for you is to compare offerings from different carriers. Direct Benefits makes it easy. Browse available plans in your area and enroll with no waiting period!