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Need dental care right away? Learn about plans that don't have delays before expensive treatments like crowns are covered.
Knowing what makes dental insurance a bad match for you is the best way to avoid enrolling in the wrong dental plan.
During the height of the COVID-19 pandemic, many dental offices across the nation were closed. Even after they re-opened, there were many Americans delaying dental care. Regardless of the reason, puttingoff necessary dental care presents a risk of deteriorated oral health since conditions may worsen or contribute to additional problems with the teeth or gums. In the interests of exploring the matter more fully, DentalInsurance.com commissioned a nationwide survey investigating multiple factors that may lurk behind postponed dental care.
"It was a pleasure to speak with the agent who was courteous and very informative, as a result I now can make an appointment with the dentist of my choice, I would highly recommend their services, I am now a happy camper."
"Please tell your friends and family if they are in need of coverage than this is the site to use. Very affordable plans and a wide range to choose from to fit your budget. This is the first site that I can say I give a A+ for organization and professionalism."
"Thank you for a pleasant experience. I got signed up for Dental Insurance and your Representative made it very easy and explained everything very well. His name was Reuben and his product knowledge helped me to pick the right plan for my needs."
Dental insurance is about more than a pretty smile, though that’s certainly important. Quality dental coverage encourages you to visit your dentist regularly for routine care and an evaluation of your oral health. Poor oral health can negatively affect your overall physical health. For example, periodontitis, more commonly known as gum disease, is linked as a risk factor to several other health problems such as diabetes, heart disease, and lung disease.
Good oral health, in contrast, can help reduce the risk of dental problems in the future that can be painful as well as expensive to treat. Given the number of inexpensive dental plans available across the nation, getting coverage makes sense from the perspective of your finances as well as your health and wellness.
Dental plans have many similarities to traditional health insurance but also some significant differences. Like medical insurance, dental insurance charges a monthly premium for the plan’s benefits. These benefits often come with a minor deductible amount that needs to be paid out-of-pocket before the plan begins sharing in the costs of covered dental procedures. However, some plans have waiting periods that delay the coverage of certain services for a time period after you enroll and your plan becomes active. Often dental services that have waiting periods are for more expensive procedures such as crowns or root canals. If you have some dental care you need in the near future and you are shopping for a dental plan, be certain to review the Summary of Benefits to make certain that the care you need is eligible for coverage immediately.
Like most health insurance plans, many dental plans have networks of providers from whom an enrollee can choose to receive care. In HMO dental insurance, dental care received from an out-of-network dentist is typically not covered. Dental PPO plans cover out-of-network care but your out-of-pockets are higher than is the case for in-network dentists. For a more thorough discussion of the trade-offs between these two types of coverage, see our article Dental PPOs vs Dental HMOs.
Dental discount plans, which are not insurance but provide reduced rates on dental services, only work through in-network dentists. Indemnity dental plans are not restricted to a network. You can see any dentist you wish and a set reimbursement is given to you toward money spent on covered dental services.
You care about your teeth so you should care about the way you shop for dental coverage. Don’t consider the monthly premium alone. Instead you should compare dental insurance plans available in your area to see how each plan:
For a more comprehensive discussion of dental plan options and considerations, read our Dental Insurance 101 article. It covers all the major plan types, dentist networks, premiums, and out-of-pocket costs.
Use the chart below to understand the differences among your coverage options so you can make the best choice for your circumstances.
| Discount Plans/Cards |
Dental HMO Plans (DHMO) |
Dental PPO Plans (DPPO) |
Indemnity Plans |
|
|---|---|---|---|---|
|
Choice of Dentists |
||||
|
Must use an in-network dentist |
Yes |
Yes |
No |
No |
|
Must obtain a referral in order to get specialty (e.g. oral surgery) dental care |
No |
Yes |
No |
No |
|
Must select a primary care dentist (or dental facility) |
No |
Yes |
No |
No |
|
Can use any licensed dentist |
No |
No |
Yes |
Yes |
|
Plan Benefits |
||||
|
Dental services may be subject to an annual deductible |
No |
No |
Yes |
Yes |
|
Certain dental services may have a waiting period before the plan will share in costs |
No |
No |
Yes |
Yes |
|
Minimum waiting periods between routine oral exams & teeth cleanings |
No |
Yes |
Yes |
Yes |
|
Total payments by the dental plan for covered dental services has an annual limit |
No |
No |
Yes |
Yes |
|
No annual limit on services |
Yes |
No |
No |
No |
|
Dental Costs |
||||
|
Out-of-pocket costs for most dental care |
Yes |
Yes |
Yes |
Yes |
|
Contracted rates for covered specialty services from participating specialists |
Yes |
Yes |
Yes |
No |
|
Payment for services received due up front unless otherwise negotiated with dentist |
Yes |
No |
No |
Yes |
|
Some routine care may have no out-of-pocket costs |
No |
Yes |
Yes |
No |
|
Claim forms required for out-of-network care |
Not applicable |
Not applicable |
Yes |
Yes |
Insurance purchased by individuals is sometimes referred to as private dental insurance or a stand-alone dental plan. Group dental insurance, in contrast, is purchased by a company and is restricted to a company's employees (and possibly their family members) Group plans also have the possibility of a premium subsidy provided by the employer.
The greatest advantage of individual dental insurance is the wide variety of plans and the opportunity to find the right combination of benefits, dentist coverage, out-of-pocket costs, and premium. Employer based dental coverage is often limited to one or two options while the private market may have several dozen options available in your region.
The four major divisions among individual dental coverage are PPO dental insurance, HMO dental insurance, indemnity dental plans, and dental discount programs. To see which plans on DentalInsurance.com are the bestsellers in your area, go to our Dental Plans in Each State page and click on the state where you live.
Family dental insurance is a dental policy that covers multiple individuals who are related. Eligible family relationships include a spouse as well as children (or other legal dependents). In some cases, all the people covered by a family plan may not live in the same household. For instance, a child may live way at college but still be covered under his parents’ dental plan. While not legally required to do so, many dental plans allow children to stay on a parent’s dental policy up to age 26, though some policies may exclude children who are married.
Some benefits in a family dental plan may be restricted to minor children. For example, a plan such as Guardian Direct's Advantage Diamond Plan limits its orthodontic benefits to "covered dependents under age 19 years old when the active orthodontic appliance is first placed." Likewise, plans may restrict topical fluoride treatments to children.
The premium for family dental insurance normally increases due to the number of people covered by the policy. A single individual may have a dental premium of $26.83 on a particular dental plan but that premium could raise to $53.65 if a spouse were added. An additional child could increase the premium to $85.84. While these premiums are hypothetical, they help illustrate the reality of premiums increasing by the number of enrollees. Since plans charge different rates, you should compare dental insurance options using premium quotes that reflect your family situation.
Deductibles may be assigned per enrollee (e.g. $50 per year per enrollee) within a family dental plan. Some dental plans cap the amount a family has to pay in deductibles per year. For example, a plan that charges a $50 deductible per family member may limit the family to a maximum of four deductibles annually ($200).
Orthodontists correct misaligned teeth and their services include braces (traditional, ceramic, etc.), headgear, and retainers. The majority of dental plans don't pay for orthodontic care, but there are some plans that do cover these services. These plans have differing levels of coverage and may have annual or lifetime limits on payments for orthodontic care. In some cases, orthodontic coverage may be restricted to children under the age of 18 on the dental plan. Additionally, there may be a minimum time of enrollment (e.g. 12 months) before a person may take advantage of orthodontic benefits. This minimum time of enrollment is known as a "waiting period."
For state-by-state examples of dental insurance plans, see "Does dental insurance cover braces?" Please note some plans with orthodontic benefits may have waiting periods before these benefits are active.
It depends on several issues. First, what teeth whitening method do you intend you use? Teeth whitening toothpastes and over-the-counter whitening kits are typically excluded from coverage. The second issue concerns which dental plan you use. Some dental plans do help pay for in-office whitening performed by a dentist. Third, the dental plans that cover teeth whitening may have conditions placed on the coverage such as a waiting period or the plans' annual limit on dental spending.
To confirm coverage or non-coverage of whitening, you need to review benefit explanation within the insurance's Plan Details, Plan Brochure, or Summary of Benefits. You can learn more about the different techniques for teeth whitening in our article "What's The Best Way to Whiten My Teeth?"
Dental benefits are not standardized, which means not every dental service is covered by every dental plan. A dental implant is considered major care. Dental plans that include coverage for major care like implants may still have a waiting period before the plan will pay for the service.
The total cost of a dental implant (plus the work to install it) can cost from $1,500 to several thousand dollars. Out-of-pocket costs for a dental implant are often a percentage of the complete cost of the implant. This percentage is called a "coinsurance fee." For example, if an implant costs $1,500 and your insurance's co-insurance is 50 percent then the fee you will pay $750 after the plan pays $750 to the dentist for the 50 percent it covers. Some plans have a set dollar amount it will contribute to a dental implant procedure. For example, if a plan will pay a maximum of $1,000 for a dental implant and the total cost is $2,100 then the patient will be responsible to pay $1,100.
We've assembled a guide and a list of plans in each state with implant coverage for consumers looking for dental insurance that covers implants.
For answers to other Frequently Asked Questions, visit our main FAQ page.
DentalInsurance.com pioneered internet dental insurance sales through value and high quality customer service. Launched two decades ago, DentalInsurance.com was the first coast-to-coast marketplace for comparing prices and buying dental insurance plans online. Our website was the internet’s original dental insurance marketplace and continues to lead the field because we put customers first. We earned an A+ rating from the Better Business Bureau as well as a top rating of “Excellent” (4.8 out of 5 stars) from TrustPilot, a website review company with 15 years experience and over 100 million consumer reviews of online businesses.
Get the answers you need on benefit rules, eligibility, and consumer protections. Visit AssociationHealthPlans.com.
