Dental Insurance Buying Guide

When shopping for dental insurance, consumers should consider the type of coverage they need. In general, DHMO plans offer the lowest cost and most predictable out-of-pocket expenses as their co-payments are stated as specific dollar amounts instead of percentages.


Dental benefits typically cover preventive services, basic procedures, and major restorative services. Consumers should also pay attention to annual maximums and deductibles.


The cost of dental insurance can vary from plan to plan. Choosing the right plan depends on your budget and dental needs. While a more comprehensive dental plan may cost more in monthly premiums, it can save you money over time by covering more procedures. In addition, there are cheaper alternatives to traditional dental insurance such as dental discount plans and self-pay options.

The majority of dental insurance companies offer a variety of different plans. Depending on your needs, you can choose a plan that offers a low annual maximum or one that has no limit. You can also select a plan with or without coinsurance, which is a percentage of the cost of the procedure.

In most cases, the annual maximum of a dental insurance plan will cover most or all of your costs once you reach it. Many of these policies will roll over a portion of the unused maximum into the next year. Some may not, so you should be sure to read your specific policy.


Many dental plans include a deductible, which is the amount you must pay before your insurance plan begins to cover costs. This deductible is generally in the range of $25 to $50, and is usually waived for preventive services. Some plans also have an annual maximum, which is the amount your insurance will pay toward treatment within a plan year. The maximum is typically reset at the beginning of a new year of coverage.

The deductible and annual maximum are important factors to consider when selecting a dental insurance plan. Most employer-sponsored or self-purchased dental plans have a deductible and coverage limits. In addition, you should consider whether the plan offers a wide network of providers and if it has a negotiated price for procedures.

You should also understand the differences between a deductible and a copay. While a deductible is a fixed amount, copays are calculated as a percentage of the total cost. Most PPO dental insurance plans have deductibles, while HMO plans do not. However, most people find that a deductible is well worth the trade-off for a wider network of providers and a lower monthly premium.


Almost 167 million Americans have dental insurance, and they pay for it with premiums, deductibles, and co-payments. These out-of-pocket expenses are important to consider when selecting a dental insurance plan. Generally, plans with higher monthly premiums have lower annual deductibles and coinsurance.

Many policies work on a 100/80/50 payment model, which means that they cover preventive procedures 100% and basic procedures 80%. They also cover major procedures at a 50% rate, with patients paying the rest of the cost. In addition, most dental insurance policies have a maximum coverage amount per year.

A dental exclusive provider organization (DEPO) is a type of dental HMO that requires you to visit in-network dentists for all services except for dental emergencies. It also typically requires a primary care physician and doesn’t allow referrals. On the other hand, a dental point of service (DPOS) plan combines elements of a DPPO and a DHMO. Its low dollar copayments are more affordable than coinsurance. However, you must visit a provider in-network to get the best value from your policy. Indemnity plans, on the other hand, don’t have networks and cover most procedures at a fee-for-service rate.

Out-of-pocket maximums

Dental insurance plans typically have annual maximums that are set in dollar terms. These maximums are based on a calendar year, and once the maximum is reached, the plan no longer pays for any additional treatment. This makes it important to address any pending or necessary treatments before the end of your annual maximum.

Most dental insurance plans also have a network of dentists to choose from. These networks have negotiated rates for certain services and are generally cheaper than going to an out-of-network provider. Many of these providers also offer discounts for patients that pay out-of-pocket, lowering your overall cost.

Some plans have a fee schedule that lists the types of services that are covered and the amount the plan will pay for each service. These fees are based on the plan’s contract with the dentist, and usually include items such as a cleaning or an exam. Some plans have frequency limitations, which limit the number of times a particular type of procedure can be covered in a year (for example, two cleanings or one panoramic x-ray every 12 months). These limitations are designed to encourage people to use their benefits wisely and avoid accumulating too many expenses.

Direct reimbursement

Direct reimbursement is a type of dental plan that reimburses patients for part or all of their treatment expenses. These plans are typically not governed by an insurance company and are not subject to the same rules and regulations as traditional dental insurance. Direct Reimbursement Plans are a great option for businesses that want to provide their employees with a high level of benefits at a lower cost.

Many of these plans offer low – or no – out-of-pocket costs for cleanings and exams, and cover a portion of the cost of fillings and extractions after a deductible is met. Most of these plans also cover more extensive work, such as root canals and crowns. In contrast, traditional dental insurance often requires a waiting period before covering these services.

In contrast, DHMO or capitation programs contract with dentists and pre-pay them a fixed amount on a monthly basis for each enrolled patient. These plans then limit contracted dentists to a pre-determined schedule of allowance for specific treatments. The difference between the plan’s allowed charge and the dentist’s fee is billed to the patient.