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What Does Dental Insurance Cover?

Understanding Dental Insurance Coverage


Whether you are selecting a plan for yourself or your family, it is important to ask questions to determine which plan is right for your unique needs. Since every dental insurance plan comes with a range of coverage options, we are here to help you navigate your choices.

How Does Dental Insurance Work?


While dental insurance has a monthly premium like health insurance, many plans have a coinsurance structure. That is why when researching dental insurance plans for yourself and your family, you may want to consider how much coverage you might need.


Typically, PPO plans use a 100/80/50 coinsurance structure. Here is how that breaks down:

  • 100% for preventive care including cleanings, exams, and X-rays

  • 80% for basic procedures, such as fillings

  • 50% for major procedures, such as crowns and dentures


Keep in mind, no two dental plans are alike. However, there are two main choices:


      1.   A medical plan that includes dental benefits (convenient, but may have coverage limitations)

      2.   A stand-alone dental insurance plan (more flexibility, more coverage options)

Some of the benefits of a stand-alone dental plan can include no dental insurance waiting periods so that you can take care of your dental health right away. Many stand-alone dental plans also include low deductibles and no copays for preventive care.



Know the Difference Between Basic Dental Plans and Full Coverage Plans


Most dental insurance plans cover the costs of preventive care, including routine exams, cleanings and x-rays. Some may also offer coverage for certain basic restorative services like fillings, but you pay more out of pocket.


While full coverage dental plans do not cover 100% of the costs, they do cover preventive care and a broader range of basic and major procedures.


Coverage may include:

  • Crowns, root canals, and surgical extractions

  • Dentures, dental implants, and veneers

  • Braces, clear aligners like Invisalign and other orthodontic treatments



What Does Dental Insurance Cost?


Most Americans pay about $360 a year for dental insurance.1 That amounts to between $15 and $50 a month for a dental insurance plan. Depending on your state and how much coverage you want included in your plan, rates will vary.


To balance the best coverage with your budget, keep in mind all the costs involved in your plan:


Premium – what you pay monthly for your plan

Deductible – what you may need to pay before the plan pays

Copay – what you pay with every visit to a dentist

Coinsurance – the percentage of costs you pay after you meet your deductible

Annual maximums – the most your plan will pay for coverage in a plan year



Compare Coverage And Dental Insurance Networks


Dental insurance plan networks vary by the availability of dental providers. Some plans offer broad networks, others are more restricted, but may cost less. Consider what type of dental insurance plan network meets your coverage needs.



Preferred Provider Organization (PPO)


Just like health insurance, PPO dental insurance provides a list of preferred dentists within the plan network. You can go out of network if you do not mind paying extra for a favorite dentist.



Dental Health Maintenance Organization (DHMO)


DHMOs provide a network of dentists that have agreed to set dental insurance rates, including copays. You avoid all the cost guesswork with a DHMO, but you are limited to in-network dentists. The best part is that you do not have an annual benefit maximum or a deductible. Some procedures have zero out-of-pocket costs.



Indemnity Or Fee-For-Service Dental Plans


Fee-for-service dental plans provide a broad network of dental providers. You pay a percentage for a specified dental service — the plan pays the rest. The percentage you pay depends on the procedure.



How To Choose The Best Family Dental Insurance Coverage


Choosing family dental insurance means thinking about all the “what ifs” for dental health. Besides providing preventive care, your dental insurance plan should cover all the possible dental health needs for different ages.


Dental insurance for kids requires a plan that addresses the potential need for braces or dental injuries due to sports activities and preventive benefits such as fluoride treatments, sealants, and space maintainers. Ask your dental plan insurer what coverage options will help protect your kids.


Older adults in the family may be prone to dental health issues that come with aging. Having a plan covering some of the costs for gum disease treatment, dentures, crowns and implants needs to be on your checklist.


Depending on the plan, you may also receive popular dental services that will brighten the smiles of the whole family, including cosmetic teeth whitening and composite white fillings.


Anthem offers a variety of affordable dental insurance plans that fit you and your family.



1 Money Under 30 website: Is Dental Insurance Worth It? (accessed April 2021).

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