Dental Insurance

Good oral health is important for your overall health – dental insurance can help!

What Does Dental Insurance Cover?

Dental plans typically cover four categories of services: preventive, diagnostic, basic and major care.

The list below includes examples and is not a complete list of coverages, exclusions and limitations.

Individual plans vary, so you’ll want to read the plan details closely to validate the coverage and benefits you’ve selected and limitations and exclusions that apply.

What Dental Insurance Covers

Cleanings + checkups
Extractions
X-rays
Fillings
Crowns, bridges + root canals

What Dental Insurance Does Not Cover

Anything after the plan’s annual maximum benefit amount has been reached
Elective cosmetic procedures (e.g., tooth-whitening)
Orthodontics (e.g., braces)
Implants
Prosthodontics (dental prostheses)
Oral care related to a medical condition (e.g., TMJ)
Prescription drugs + analgesia pre-medication

Dental Coverage is an ACA-Mandated Essential Health Benefit for Kids

Pediatric services, including oral and vision care, are part of the 10 essential health benefits for children 18 years of age and under. Adults, however, must obtain dental insurance if they want coverage and don’t have it through an employer.

Guaranteed issue – All applicants aged 18 to 99 are accepted regardless of health history (however, rates are based on age and location).
Covers pre-existing conditions – With the exception of missing teeth in some cases.
Apply year-round – There is no official open enrollment period and, in most cases, coverage begins the next day after you enroll online.
Flexibility – An indemnity plan affords you more provider options. A PPO plan can help lower your out-of-pocket expenses by using an in-network provider. Either way, it’s your choice.
Options for every budget – Varying amounts of coverage range from 50% to 100%, which means you can find a plan with the level of coverage you need at the right monthly premium rate for your budget.
Low deductibles – With annual deductibles generally around $50,^[1] most people will be able to access their dental plan’s full benefits without paying a significant amount out of pocket first.

Waiting periods – You may have to put off dental services until you’ve had your plan for 6-12 months to take advantage of your benefits for certain services like fillings and root canals.
Calendar-year maximums – Unlike ACA plans that don’t have annual maximums for essential health benefits, dental plans have annual caps on how much the plan will pay per year (e.g., $1,000). Even with dental insurance, you will be responsible for the costs of services that exceed the annual limit.
Not ACA-qualifying major medical coverage – Dental insurance is a form of supplemental health insurance, not ACA-qualifying major medical coverage.

Find Answers to Dental Insurance Questions

Dental insurance provides a benefit payment for a designated set of covered procedures related to teeth and gums, as outlined in your plan’s Schedule of Benefits. Reviewing your Schedule of Benefits enables you to plan how and when to receive care by showing:

- What services are covered

What your out-of-pocket costs will be
Whether benefits vary based on selecting an in-network or out-of-network provider

Depending on the plan you select, your policy may include:

Annual maximum – the maximum amount your plan will pay towards covered services in a calendar year
Co-pay – a fixed amount you pay each time you visit your dental provider
Co-insurance – the portion of each covered service for which you are responsible to pay
Deductible – the amount you must pay before the plan provides payment for covered services
Waiting period – the amount of time you must wait before your plan will pay for diagnostic, basic and/or major dental procedures. Waiting periods vary by state.

Note that routine preventive services, such as exams and cleanings, may not be subject to your plan’s deductible. Learn more about how dental insurance works.

Generally, if you need major services, you can ask your dentist to submit a proposed treatment plan to your insurance company. That can help you determine what your out-of-pocket costs for services will be. If you have additional questions, be sure to contact your insurance company for specific details about your plan benefits.^[2]

A PPO dental plan offers a network of dental providers. If you visit an in-network provider, your out-of-pocket costs are typically lower.^[3] That’s because dentists within the network have agreed to a negotiated dollar amount for each covered charge with your insurance company. Out-of-network dentists may charge fees either higher or lower than the insurance plan allows; excess fees are usually your responsibility to pay.^[4] Typically under an HMO dental plan, you must receive covered services from a contracted network provider for the plan to pay benefits.^[5]

All Dental Insurance FAQs