Dental Blog / Open Enrollment | 7 Terms You Should Know for Dental Insurance

Open Enrollment | 7 Terms You Should Know for Dental Insurance

Open enrollment begins for millions of people across the country. Open enrollment allows people to purchase new health care plans or change their current coverage. There is a set enrollment period, and for most people this year, it’s November 1 through December 15.

Dental insurance can be purchased at any time of year, but for a lot of people, open enrollment puts dental insurance top-of-mind as they’re researching the options that are available to them. 

Dental insurance, for the most part, act as health care plans do. Let’s look into some important terms to gain a better understanding as you’re looking for dental insurance.  


A deductible is the total amount you pay before the dental benefits carrier begins to pay for dental treatment costs. Once your deductible is met, insurance kicks in to help cover the costs. These deductibles can range from $25 annually to a one-time lifetime $100 deductible, and some plans don’t require a deductible at all. 

Preventive, Basic & Major Coverage

Once your deductible is taken care of, you can now look at dental insurance to cover three main categories: Preventive, Basic & Major. Preventive is typically covered at or near 100 percent. From there, basic and major coverages will vary per plan. We get into this with coinsurance below, but let’s take a look at what these three categories cover: 

Preventive coverage typically includes exams, cleanings, sealants and fluoride treatments. 
Basic coverage might include things like fillings, gum treatments, root canals and extractions. 
Major coverage usually includes bridges, implants and dentures.


Now that we’ve defined the three major categories dental insurance covers, let’s dive into how coinsurance aligns with them. Coinsurance is the cost that you and the benefits carrier share. We mentioned above that preventive is usually covered at 100 percent. For basic coverages, you can expect to pay around 20 percent of the cost. For major services, you can expect to pay around 50 percent of the cost. 

Some plans offer graduating percentages that increase by the year. Also called loyalty benefits, one such plan may cover 50 percent of the cost in the first year and increase to 65 percent the second year and 80 percent by the third year. Assessing your situation and what dental work you may need in the future will play a large part in which dental insurance you choose. 

Annual Maximum

The annual maximum your plan offers is the amount your carrier will pay per year. Unlike health insurance, for dental, once your maximum is met, the rest of the cost will be up to you to cover. If you’re planning for dental work in the future, here are some things to take into consideration to help lower the cost: 

• Are you visiting in-network dentists to receive lower rates? 
• Does your coinsurance increase the following year? 
• Does your annual max increase as well? 

People rarely hit their annual max unless they’re in need of major dental work. Finding the right plan that fits your time schedule is essential for getting the most value. 

Waiting periods

Most dental insurance plans require a waiting period for basic and major work. But some do not. When accidents happen, or pain hits from out of nowhere, some insurance plans offer no waiting periods for you to get in and get the work done that gets you on your way faster. Most of preventive care is taken care of right away. For basic and major procedures, research which plan fits with your needs. 

Looking for an easy way to shop? Check out Direct Benefits Marketplace!

 The Direct Benefits Marketplace makes it easy to compare dental insurance plans to ensure you pick the right one for you and your family. You can compare different policies side-by-side to clearly see what they have to offer, and you can get a better picture of what your out-of-pocket costs will be based on the level of coverage that’s provided by each insurer.

Have questions? Our consumer advisors are standing by to answer the short questions and the long questions. They’re here to provide you with ultimate service and guidance.