How Does Dental Insurance Work? A Complete Guide

HealthPlans of NC

Separate from health insurance, dental Insurance is a type of medical insurance that covers procedures and services regarding your teeth and gums. It is important to understand what a dental insurance plan is and how it works. By doing so, you will be well-informed about what is best for you and your family.

What is Dental Insurance and How Does It Work?

Dental insurance helps you pay for certain procedures. This could include cleanings, exams, and X-rays. Depending on your plan, you may be able to have more expensive procedures such as root canals or endodontics covered. Most times, individuals will receive their dental insurance through their employer. However, in instances of unemployment or where an employer does not support dental insurance, you can buy individual or family dental insurance plans directly from insurance companies. 

While health coverage and dental coverage may seem similar, there are key differences. Usually, dental insurance plans are not paired with health insurance plans.


Typically, you will pay a monthly premium to your dental insurance company. This will be determined by the company’s dental insurance policy structure. Depending on your employer, there may not be a premium or the monthly premium will be deducted from your paycheck. It is important to make sure that your premium is affordable. If you miss a payment, you may suffer a lapse in coverage.

Out-of-Pocket Costs: Deductibles, Coinsurance, and Copays

A deductible is the amount of money you have to pay for covered dental services and procedures. You must reach the deductible before your insurance company will begin to cover services.

A copay is a fixed amount you must pay to your dentist for services.

Alternatively, coinsurance is the percentage split between both you and your insurance provider. This occurs after you meet your deductible. The rate is determined through dental insurance policies. As stated by Forbes, a common split is 20/80. You will pay for 20% of your procedure and your insurance company will cover the remaining 80%.

Annual Maximum Benefit

Annual coverage maximums are the total dollar amount your insurance provider will pay for services. Usually, this is within a calendar year. Once annual coverage maximums are exceeded, you will have to pay in full for dental benefits. After a new term begins, annual coverage maximums will reset.

What Expenses Does Dental Insurance Pay For?

Typically, dental insurance plans cover three different types of services: preventive, basic, and major services. Each service has a different coverage percentage.

The percentages listed below are based on what is most common. Based on your coverage plan, the numbers may vary.




100% Covered

80-100% Covered

50-80% Covered

This is a Class I procedure. These are routine services such as cleanings, checkups, and annual X-rays.

This is a Class II procedure. These are non-surgical restorative procedures like root canals, fillings, and extractions for example. 

This is a Class III procedure. These are more expensive restorative services including dentures, bridges, crowns, and inlays/on lays.

What Dental Procedures Are Not Covered by Insurance?

Most often, dental insurance plans will not cover cosmetic procedures. This is determined by the company’s dental insurance policies. For example, teeth whitening, veneers, and tooth shaping are not covered, even if done by in-network dentists. Since these are not considered medically necessary, you will have to pay the entire cost. 

Orthodontics (braces) may be covered in dental plans, but this is not common.

What Do In-Network and Out-of-Network Mean?

In-network refers to the providers your dental insurance company has a contract with. Usually, network dentists will be more affordable. Out-of-Network means that your insurance company does not have a contract with them and services will be more expensive. Depending on dental insurance policies and the available dental plans,  network dentists may be required. Unlike health insurance, there is not a large variance in fees. However, there still is a difference and it’s worth noting as a means of keeping dental insurance affordable.

Networks, PPOs, and HMOs Explained

A network is the group of dentists your insurance company has a contract with. 

PPO stands for Preferred Provider Organization. If you like going to your primary care dentist, PPO dental insurance plans may be right for you. In this scenario, you will be able to see your preferred dentist whether or not they are in-network. 

HMO stands for Health Maintenance Organization. If you are not partial to a specific primary care dentist, HMO dental insurance plans might be best. With this option, you typically have lower costs but a smaller selection of network dentists.

How Do I Get Dental Insurance If I Don’t Get It Through My Employer?

In some instances, your employer may not provide dental insurance. While unfortunate, there are still ways to purchase dental benefits. You can purchase coverage from a selection of dental plans through the health benefits exchange. Every state has this program with the goal of helping families with varying income levels.

There are also individual dental insurance plans, which can be purchased directly from insurance companies. It is important to research their dental insurance policies, so you can understand the different plans they provide. And, as always, the support of a licensed insurance professional will make all the difference when choosing the right dental plans.

Does Medicare Include Dental Coverage?

No, Medicare will typically not include dental benefits. You will have to fully pay for non-covered services and procedures. However, Medicare Advantage can provide certain oral healthcare through a selection of network dentists. There are also singular dental plans designed for senior citizens.

Is There Dental Coverage for Veterans?

Yes, there is dental coverage for veterans. This is done through VADIP, or the VA Dental Insurance Program. This provides affordable dental insurance plans for Veterans and their family members. 

To be eligible for VADIP, you must meet one of three requirements.

  1. You are a Veteran and enrolled in VA Health Care.

2. You are a current or surviving spouse of a Veteran. 

3. You are a dependent child of a Veteran.

For numbers 2 and 3, you must be enrolled in CHAMPVA or the Civilian Health and Medical Program of the VA.

What About Dental Coverage For Children?

Recently, dental coverage for children has dramatically improved. The ACA (Affordable Care Act) states that pediatric dental care is an essential health benefit. Each state must offer dental benefits for children.  

Are Braces Covered by Dental Plans?

If your child needs braces, it is important to research dental plans that offer the addition of orthodontic benefits. All dental plans are different and will have unique dental insurance policies. Therefore, it would be wise to clarify what discount and coverage you will be receiving.

How Important is Dental Care?

Dental care and proper oral health are essential to your well-being. Poor oral health and hygiene can lead to serious illnesses and issues later in life like diabetes and heart disease. Unfortunately, many Americans avoid going to the dentist. Having proper dental coverage with dental benefits should encourage people to visit their primary care dentist regularly.

how dental insurance works

Review of How Dental Insurance Works

Dental benefits are vital to your overall health and well-being. All dental plans cover preventive procedures and basic/major restorative procedures. However, cosmetic services are not covered. Network dentists are less expensive.

There are annual coverage maximums, which limit the amount of money your dental plan will pay for services within a term. In addition, you will have to pay deductibles, coinsurance, and copay. This should be factored into your budget, as your dental coverage should be affordable.

Dental Insurance FAQs

How do I decide whether or not to buy dental coverage?

Dental insurance plans and oral healthcare are important. Therefore, receiving dental benefits is worth paying for. When deciding on a plan, you should consider your financial circumstances and dental health history.

Can I get dental insurance even if I don’t have health insurance?

Yes, dental plans are separate from health insurance plans. You can purchase coverage from a variety of stand-alone dental insurance plans. 

Will dental insurance cover preventive care?

Yes, dental plans will cover preventive care. This is a standard of all dental insurance policies. Primarily, they will cover up to 100% of the costs for these services.

I have medical coverage - does it include dental insurance?

If you receive medical insurance through your employer, you may also receive dental benefits. 

However, if you do not receive medical coverage from your employer, you would need to purchase a dental plan from a dental insurance company. Most health plans do not offer dental benefits. Unfortunately, it is not deemed an essential health benefit for individuals 18 and older. 

Will there be a waiting period before my dental coverage begins?

This will depend greatly on your dental plan. Group plans typically don’t have a waiting period. However, individual dental insurance plans do, even if you choose to visit network dentists. This can be anywhere from 6 to 12 months. In addition, major restorative procedures may have a waiting period of up to 2 years.

Want to Learn More? Contact Us

We understand that the health of you and your family is one of your utmost priorities. If you would like to learn more about dental plans give us a call at 800-797-0327. Or, request a free quote and hear from one of our licensed professionals today. We look forward to helping you.

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