Dental insurance helps cover routine cleanings, fillings, and major dental work. Here's what you need to know about costs, coverage, and finding the right plan in North Carolina.
Dental insurance is a type of health coverage specifically designed to help pay for dental care. Unlike medical insurance, dental coverage focuses on preventive care, basic procedures such as fillings, and major work such as crowns and root canal therapy.
Without dental insurance, costs add up quickly. A routine cleaning and exam can cost $200 or more. A filling might run $100-$250. A crown can cost $800 to $2,500 per tooth. Dental insurance helps manage these expenses by covering preventive care and sharing the cost of treatments.
At Health Plans of NC, we help North Carolina residents find dental coverage that fits their needs and budget—whether through the ACA Marketplace, standalone dental plans, Medicare Advantage, or employer coverage.
Most dental insurance plans organize coverage into three categories, each with different coverage levels:
Preventive Care (typically covered at 100%)
• Routine cleanings (usually two per year)
• Oral exams
• X-rays
• Fluoride treatments (especially for children)
Basic Procedures (typically covered at 70-80%)
• Fillings
• Simple extractions
• Root canals on front teeth
• Periodontal scaling (deep cleaning)
Major Procedures (typically covered at 50%)
• Crowns
• Bridges
• Dentures
• Root canals on molars
• Oral surgery
This 100/80/50 structure is common, though exact percentages vary by plan. Some plans have waiting periods before basic or major services are covered—often 6 months for basic procedures and 12 months for major work.
Dental insurance premiums vary based on plan type, coverage level, location, and age. Here are typical costs in 2025:
Individual coverage: $20-$50 per month (average around $30/month)
Family coverage: $50-$150 per month
Costs by plan type:
• DHMO plans: $20-$30/month individual, $60-$100/month family (lowest cost, limited network)
• DPPO plans: $30-$50/month individual, $90-$150/month family (more flexibility, larger network)
• Indemnity plans: $40-$60/month individual, $100-$180/month family (most flexibility, highest cost)
Other costs to consider:
Deductible: Typically $50-$150 per person annually. This is what you pay before insurance kicks in (preventive care is often covered before the deductible).
Annual maximum: Most plans cap benefits at $1,000-$2,000 per person per year. Once you hit this limit, you pay 100% of the additional costs.
Coinsurance: Your share of costs after the deductible (e.g., 20% for basic procedures, 50% for major procedures).
Dental HMO (DHMO)
DHMO plans have the lowest premiums but require you to choose a primary dentist from a limited network. You typically need referrals to see specialists. There are usually no deductibles, and you pay set copays for services. The trade-off is less flexibility—if you want to see an out-of-network dentist, you'll likely pay the full cost.
Dental PPO (DPPO)
DPPO plans are the most popular option. They offer a larger network of dentists, and you can see out-of-network providers at a higher cost. You don't need referrals for specialists. Premiums are higher than those of DHMO plans, but you have more flexibility in choosing providers.
Indemnity Plans (Fee-for-Service)
Indemnity plans offer the most flexibility—you can see any licensed dentist. The plan reimburses a percentage of "reasonable and customary" charges. However, these plans have higher premiums, and you often pay upfront and then submit claims for reimbursement. They're less common today but may appeal to those who want maximum provider choice.
Dental Discount Plans (Not Insurance)
Dental discount plans are not insurance—they're membership programs that provide discounted rates at participating dentists. You pay an annual fee (often $100-$200) and receive 20-60% off dental services. There are no deductibles, annual maximums, or waiting periods. These can be useful if you can't afford traditional insurance or need immediate coverage for a specific procedure.
Under the Affordable Care Act (ACA), pediatric dental coverage is one of the 10 essential health benefits. All children under 19 have access to dental coverage through the Health Insurance Marketplace.
Pediatric dental coverage options:
Embedded in a health plan: Many ACA health plans include pediatric dental coverage. Dental costs may apply toward your medical deductible.
Standalone pediatric dental plan: You can purchase a separate dental plan for children through the Marketplace. These plans have lower out-of-pocket limits.
Out-of-pocket limits for ACA pediatric dental (2025-2026):
For standalone pediatric dental plans purchased through the Marketplace:
• 2025: Maximum $425 per child ($850 for two or more children)
• 2026: Maximum $450 per child ($900 for two or more children)
There's no cap on medically necessary pediatric dental benefits—the plan pays regardless of how much care your child needs.
Note: Premium tax credits may or may not apply to standalone dental plan premiums. If pediatric dental is embedded in your health plan, the premiums are included in your overall health plan subsidy calculation.
Original Medicare does not cover routine dental care. Medicare Part A and Part B do not pay for cleanings, fillings, extractions, dentures, or most other dental services. Medicare only covers dental procedures when they're integral to another covered medical treatment (for example, extracting teeth before heart valve surgery or radiation treatment).
Options for dental coverage with Medicare:
Medicare Advantage (Part C): Most Medicare Advantage plans include dental benefits. Coverage varies by plan—some cover only preventive care, others include basic and major services. About 98% of Medicare Advantage plans offer some dental coverage.
Standalone dental insurance: You can purchase individual dental insurance regardless of whether you have Original Medicare or Medicare Advantage. Plans are available year-round from dental insurers.
Dental discount plans: Membership programs that offer discounted rates at participating dentists. Not insurance, but it can reduce costs for those who can't afford or don't qualify for traditional coverage.
Important: Medigap (Medicare Supplement) plans do not cover dental care. They only help pay out-of-pocket costs for Medicare-covered services.
If you're enrolled in Medicaid in North Carolina, you have access to dental services. NC Medicaid covers a range of dental services for both adults and children, including preventive care, fillings, extractions, and dentures.
Children enrolled in Medicaid receive comprehensive dental coverage as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, which covers all medically necessary dental services.
Adult Medicaid dental benefits in North Carolina include preventive, diagnostic, and restorative services. Check with your Medicaid managed care plan for specific coverage details and participating dentists.
ACA Health Insurance Marketplace
You can purchase dental plans through HealthCare.gov during Open Enrollment (November 1 – January 15) or during a Special Enrollment Period if you have a qualifying life event. Marketplace dental plans for children comply with the ACA pediatric dental rules. Adult dental plans are also available but must be purchased alongside a health plan.
Directly from Insurance Companies
You can buy standalone dental insurance directly from dental insurers at any time of year. These plans are not subject to ACA pediatric dental rules but are regulated by the North Carolina Department of Insurance. Blue Cross NC offers Dental Blue® for Individuals with multiple plan options.
Through Your Employer
Many employers offer dental insurance as part of their benefits package. Employer-sponsored dental coverage is often more affordable than individual plans because of group rates and employer contributions. If dental coverage is available through your job, it's usually your most cost-effective option.
Medicare Advantage Plans
If you're on Medicare, most Medicare Advantage plans include dental benefits. You can enroll during Medicare Open Enrollment (October 15 – December 7) or during your Initial Enrollment Period when you first become eligible for Medicare.
1. Check if your dentist is in-network
If you have a dentist you like, make sure they're in the plan's network before enrolling. Seeing out-of-network dentists costs significantly more.
2. Consider your dental health needs
If you have healthy teeth and only need cleanings, a basic plan with low premiums may work well. If you anticipate major work like crowns or bridges, a plan with higher coverage percentages for major services (even if premiums are higher) may save money overall.
3. Look at the annual maximum
If you expect significant dental work, check the plan's annual maximum. A $1,000 maximum won't cover much if you need multiple crowns or a bridge.
4. Check waiting periods
Many plans have waiting periods before they cover basic or major services. If you need immediate care, look for plans with no waiting periods or consider a dental discount plan for short-term savings.
5. Compare total costs, not just premiums
A low premium doesn't always mean the best value. Factor in deductibles, coinsurance percentages, and annual maximums to understand your actual potential costs.
Finding the right dental insurance can be confusing. Different plan types, networks, waiting periods, and coverage limits make it hard to compare options.
At Health Plans of NC, our licensed agents specialize in helping North Carolina residents find dental coverage that fits their needs. Whether you're looking for individual dental insurance, family coverage, pediatric dental plans, or dental benefits through Medicare Advantage, we can help you compare options and understand what you're getting.
Contact us at 1-800-797-0327 for a free consultation. We'll help you find dental coverage that works for your situation and budget.
How much does dental insurance cost per month?
Individual dental insurance typically costs $20-$50 per month, with an average of around $30/month. Family coverage ranges from $50-$150/month. DHMO plans are the cheapest ($20-$30/month for individuals), while PPO and indemnity plans cost more but offer greater flexibility.
Does Medicare cover dental?
No, Original Medicare (Parts A and B) does not cover routine dental care. However, most Medicare Advantage (Part C) plans include dental benefits. You can also purchase standalone dental insurance separately.
What is the difference between a DHMO and a DPPO?
DHMO plans have lower premiums but require you to choose a primary dentist from a limited network and get referrals for specialists. DPPO plans cost more but offer a larger network, no referral requirements, and partial coverage for out-of-network care.
Is dental insurance required under the ACA?
Pediatric dental coverage is an essential health benefit under the ACA and must be offered through Marketplace plans for children under 19. However, you're not required to purchase it, and there's no penalty for not having dental coverage. Adult dental coverage is not required.
Can I get dental insurance with no waiting period?
Yes, some dental plans have no waiting periods for any services. Others waive waiting periods if you had prior dental coverage. Dental discount plans (not insurance) also have no waiting periods. Ask about waiting periods when comparing plans, especially if you need immediate care.
What is an annual maximum in dental insurance?
The annual maximum is the most your dental plan will pay for covered services in a calendar year. Most plans have maximums of $1,000 to $2,000 per person. After you reach the maximum, you pay 100% of additional costs for the rest of the year.
