Dental insurance helps pay for dental care—from routine cleanings and exams to more expensive procedures like crowns, root canal therapy, and dentures. Unlike primary medical insurance, dental plans typically focus on preventive care and have lower annual benefit limits.
Regular dental care isn't just about your teeth. Research shows that oral health is linked to overall health, with poor dental health associated with conditions such as heart disease, diabetes, and respiratory infections. Dental insurance makes it easier to maintain regular checkups and address problems before they become serious—and expensive.
Dental insurance is a cost-sharing arrangement between you and your insurance company. Here's how the key components work:
Premiums
Your premium is the monthly amount you pay to maintain coverage. Typical costs in 2026:
• Individual plans: $20–$50 per month
• Family plans: $50–$150 per month
• DHMO plans: Often on the lower end ($14–$30/month)
• PPO plans: Typically higher ($30–$50/month)
• Indemnity plans: Highest premiums ($40–$60/month or more)
Deductibles
The deductible is the amount you pay out of pocket before your insurance starts covering costs. Dental deductibles are typically low:
• Individual: $25–$100 per year
• Family: $75–$150 per year
• Preventive care is often exempt from the deductible
Copays and Coinsurance
Copays: A fixed dollar amount you pay for specific services (e.g., $10–$50 per visit). Common in DHMO plans.
Coinsurance: The percentage of costs you pay after meeting your deductible. For example, if your plan pays 80% for basic services, you pay the remaining 20%—Standard in PPO and indemnity plans.
Annual Maximum
This is the most your insurance will pay for covered services in a year. Once you reach this limit, you pay 100% of any additional costs until the plan year resets.
• Most plans: $1,000–$2,000 per year
• Some premium plans offer $2,500–$5,000 or higher
• DHMO plans often have no annual maximum
Note: The American Dental Association has noted that many annual maximums haven't increased in decades, despite rising dental care costs. A $1,000 limit today covers far less than it did 40 years ago.
Dental plans typically organize coverage into three tiers, often called the "100-80-50" structure:
Preventive Services (Usually 100% Covered)
These services help maintain oral health and prevent problems:
• Routine exams (typically 1–2 per year)
• Teeth cleanings (typically 1–2 per year)
• X-rays (bitewing, panoramic)
• Fluoride treatments (usually for children)
• Sealants (usually for children)
Most plans cover preventive care with no deductible and no waiting period.
Basic Services (Usually 70–80% Covered)
These address common dental problems:
• Fillings (amalgam and composite)
• Simple extractions
• Root canals on front teeth
• Periodontal scaling (gum treatment)
• Emergency treatment for pain relief
Basic services may have a waiting period of 3–6 months before coverage begins.
Major Services (Usually 50% Covered)
These are more complex and expensive procedures:
• Crowns
• Bridges
• Dentures (full and partial)
• Root canals on molars
• Oral surgery
• Inlays and onlays
Major services often have waiting periods of 6–12 months.
Cosmetic Procedures:
• Teeth whitening
• Veneers (unless medically necessary)
• Tooth contouring/reshaping
• Cosmetic bonding
Orthodontics (Braces/Invisalign):
• Some plans include orthodontic coverage, especially for children
• Typically covered at 50% up to a lifetime maximum of $1,000–$1,500
• Adult orthodontics is less commonly covered
• Often has a separate waiting period (12–24 months)
Dental Implants:
• Not covered by all plans
• When covered, typically at 50% as a major service
• Often has a 6–12 month waiting period
• Some plans with no waiting periods are available
A waiting period is the time between when your coverage starts and when your plan will pay for certain services. This prevents people from signing up only when they need expensive work.
Typical Waiting Periods:
• Preventive care: Usually no waiting period
• Basic services: 3–6 months
• Major services: 6–12 months
• Orthodontics: 12–24 months
• Implants: 6–12 months (if covered)
Tip: Some plans offer reduced or no waiting periods if you had prior dental coverage. Look for plans that waive waiting periods with proof of continuous coverage within the past 63 days.
Dental PPO (Preferred Provider Organization)
The most common type of dental plan.
• Can see any dentist, but pay less for in-network providers
• No referrals needed for specialists
• Higher premiums but more flexibility
• Has deductibles and annual maximums
Best for: People who want flexibility to see any dentist or keep their current provider
Dental HMO (DHMO)
A lower-cost option with more restrictions.
• Must choose a primary care dentist from the network
• Must stay in-network for coverage (except emergencies)
• Lower premiums than PPO plans
• Often no deductibles or annual maximums
• Pay set copays for each service
Best for: Budget-conscious individuals comfortable with a smaller network
Dental Indemnity Plans
Traditional fee-for-service insurance.
• See any licensed dentist with no network restrictions
• Pay upfront, then submit claims for reimbursement
• Plans reimburse a percentage of "usual and customary" rates
• Highest premiums of all plan types
• More paperwork for claims
Best for: People who want maximum flexibility and don't mind higher costs
Dental Discount Plans (Not Insurance)
An alternative for people who can't afford or don't want traditional insurance.
• Pay an annual or monthly membership fee ($10–$20/month)
• Receive discounts of 20–60% on dental services at participating dentists
• No waiting periods, deductibles, or annual maximums
• Not insurance—you pay the discounted price directly
Best for: People who need occasional dental care and want immediate savings without insurance restrictions
In-Network Dentists: Dentists who have contracted with your insurance company to provide services at pre-negotiated rates. You'll pay less out of pocket when using in-network providers.
Out-of-Network Dentists: Dentists without a contract with your insurer. With PPO plans, you can still see them, but you'll typically pay higher coinsurance and may be responsible for any charges above the plan's "usual and customary" rate.
Tip: Before choosing a plan, check if your current dentist is in the network. Most insurers offer online provider directories.
Through Your Employer:
Many employers offer group dental insurance, often at lower rates than individual plans. Some employers pay part or all of the premium.
Individual or Family Plans:
If you don't have employer coverage, you can purchase dental insurance directly from insurance companies (Blue Cross NC, Delta Dental, Cigna, Humana, etc.) or through a licensed insurance broker.
Health Insurance Marketplace:
Standalone dental plans are available through HealthCare.gov during Open Enrollment (November 1 – January 15) or during a Special Enrollment Period.
Children (Under 19):
Pediatric dental care is an essential health benefit under the ACA. All marketplace health plans must include dental coverage for children, or you can purchase a standalone pediatric dental plan.
Medicare Beneficiaries:
Original Medicare (Parts A and B) does not cover routine dental care—no cleanings, fillings, or dentures. However:
• About 97% of Medicare Advantage plans include some dental benefits
• Coverage varies widely—from preventive-only to comprehensive including implants
• You can also purchase standalone dental insurance for seniors
• Some Medicare Advantage plans offer up to $2,500–$6,000 in annual dental benefits
Veterans:
Eligible veterans can enroll in the VA Dental Insurance Program (VADIP), which offers discounted dental coverage through Delta Dental and MetLife.
Medicaid Recipients:
NC Medicaid includes dental benefits for children. Adult dental coverage under NC Medicaid is limited to emergency extractions and dentures in most cases.
Without insurance, you're responsible for the full cost of dental services. Average costs include:
• Routine cleaning and exam: $200+
• Composite filling: $90–$250
• Tooth extraction: $75–$300 (simple) or $150–$650 (surgical)
• Crown: Up to $2,000 per tooth
• Root canal: $700–$1,100 (front tooth) or $1,200–$1,800 (molar)
• Dental implant: $2,000+ per tooth
• Dentures: $600–$3,000+
Is dental insurance worth it?
For most people, yes. Dental insurance typically covers 100% of preventive care, which alone can be worth the annual premium. If you need any basic or major work, insurance helps significantly reduce out-of-pocket costs. However, if you only need occasional cleanings and have healthy teeth, a dental discount plan might be more cost-effective.
Can I get dental insurance without health insurance?
Yes. Dental insurance is completely separate from health insurance. You can purchase a standalone dental plan at any time, regardless of whether you have medical coverage.
When can I enroll in dental insurance?
Unlike health insurance, most individual dental plans are available year-round—you don't have to wait for Open Enrollment. Employer plans typically have annual enrollment periods.
What if I need dental work right away?
Look for plans with no waiting periods or reduced waiting periods. Some plans cover preventive care immediately and basic/major services after a shorter waiting period (or no waiting period with proof of prior coverage).
Does dental insurance cover braces?
Some plans include orthodontic coverage, usually for children. Coverage is typically 50% up to a $1,000–$1,500 lifetime maximum. Adult orthodontics is less commonly covered. Most orthodontic benefits have a 12–24 month waiting period.
At Health Plans of NC, we can help you find the right dental insurance for your needs—whether you're looking for individual coverage, family plans, or dental options to complement your Medicare or health insurance.
We Offer:
• Blue Cross NC Dental Blue and Blue 20/20 plans
• Standalone dental plans for individuals and families
• Dental coverage through Medicare Advantage plans
• Help comparing plans, networks, and costs
Contact Health Plans of NC today for free, personalized guidance on dental insurance options in North Carolina.
