Dental Insurance – What You Need to Know

Dental insurance, which is often offered as a supplemental component of health plans, is designed to pay for procedures that improve and maintain oral health. Each private plan has its own set of features, including deductibles, co-pays, and annual coverage maximums.


Most follow a 100/80/50 coverage structure, where routine services are covered at 100% and major pro韓国歯列矯正 cedures are covered at 80% after the policy deductible is met.

Preventive care

Dental insurance helps make often-expensive tooth care more affordable. It can reduce costs for preventive services like bi-annual dental cleanings and dental X-rays, helping keep your teeth and gums healthy. Dental insurance also can cover other procedures that help improve or maintain your oral health, such as fillings and dentures.韓国歯列矯正

Unlike medical insurance, where deductibles and copays are usually required before the plan kicks in, most dental plans have no such requirement for preventive care. That helps to encourage regular visits that can help identify and treat problems early on when they are more manageable and less expensive to fix.

While many people get dental coverage as part of a larger healthcare plan through their employer, it can also be purchased as a stand-alone policy. There are a variety of individual and family dental policies to choose from, including Indemnity plans, Preferred Provider Networks (PPO) and Dental Health Maintenance Organizations (DHMO).

Before enrolling in any type of individual or group dental insurance, it is important to understand the restrictions associated with the plan. These typically include a list of procedures covered, the annual limit on coverage and how much is paid out of pocket before a deductible or coinsurance kicks in. It is also important to determine whether the dentists you prefer to use are included in the policy’s network.

Basic care

Most dental insurance plans are based on the principle of paying a percentage of a certain procedure’s cost. The amount that the plan will pay varies from plan to plan. Preventive procedures such as cleanings and X-rays typically do not require any out-of-pocket expenses.

Most indemnity and PPO dental insurance plans cover basic services at a rate of 70 to 80% after the insurance company’s deductible has been met. Major services are covered at a lower rate and can be more expensive, depending on the plan and underlying contract (UCR or Employer Table of Allowance).

Some dental plans have waiting periods. These can be as long as two years for some procedures such as root canals and crowns. These are meant to discourage people from obtaining insurance coverage just for routine services.

Some dental insurance plans have an annual maximum, which is the limit of how much the insurer will pay for any one year. When the annual maximum is reached, the patient will have to pay for all subsequent treatment. Most plans provide this information in the form of a chart.

Major care

The cost of major procedures, such as dental implants or dentures, is not covered by most dental insurance plans. But they do cover some of these services, often at 50% of the “reasonable and customary” fees or a set amount (called an annual maximum). The policyholder is responsible for the remaining fee after the insurance provider has paid its deductible. The annual maximum is usually listed in the summary of benefits or on the front of the card for each individual service.

Most dental plans divide procedures into three categories: preventive, basic, and major. Preventive and diagnostic procedures (like exams, x-rays, and cleanings) are typically covered at 100%. These services help prevent problems or catch them early, so they don’t become more expensive later.

Some insurance plans require a waiting period before covering certain procedures, including Basic services (like fillings) and Major procedures (like crowns and root canals). These time frames vary by plan type.

Many people get dental coverage through their employer or as a rider on their health plan. However, it’s important to compare the benefits and costs of different plans before purchasing one. Consider factors such as the deductible, annual limits, and waiting periods when evaluating plans. You may want to choose a plan with higher limits and shorter waiting periods, even if you have to pay a slightly larger premium.


Many dental insurance plans have limits and exclusions, but these restrictions are designed to keep premium costs low and ensure that the plan is financially sustainable. Most insurance companies set a maximum for the amount they will pay per year and a deductible, which is the amount that the policyholder must pay before the plan begins to cover procedures. Preventive treatments such as dental cleanings and exams typically do not require a deductible.

Other limitations include time limits on specific procedures, such as two cleanings a year or a limited number of x-rays per year. Additionally, some plans exclude certain types of treatment, such as cosmetic treatment like teeth whitening or veneers. These restrictions are intended to discourage overuse of the plan and prevent people from delaying needed procedures.

Generally, class I procedures (diagnostic and preventative services) are covered at the highest percentage. Class II procedures (basic services) are reimbursed at a lower percentage. In some cases, the maximums for each category are reset at the beginning of each year, while in other cases they remain the same throughout the life of the plan.

When a patient goes to the dentist, they will be asked for their insurance card and will need to verify their coverage. The office will then submit a request for payment to the insurance company, which will respond with an explanation of benefits (EOB) that explains how much they have paid toward the procedure and what portion of the bill the patient must pay.