You usually find out what your dental plan really covers at the worst possible moment. You’re in the chair with a cracked molar, and the front desk tells you the crown is $1,400. Your plan pays half. Maybe. After the waiting period.
Most people pick dental coverage by looking at one number, the monthly premium. Knowing how to choose a dental insurance plan comes down to a few other numbers that matter more once you need real work done. Here’s what to look at, in plain English, so you make the decision instead of the fine print making it for you.
How to Choose a Dental Insurance Plan: Start With Your Mouth, Not the Premium
Before you compare a single plan, think honestly about what you’ll likely need in the next year or two.
If you only need cleanings and checkups, a plan that covers preventive care at 100% may be all you need. If your dentist has already mentioned a crown, root canal, or implant, look closely at waiting periods and the annual maximum before anything else. If you have kids, check the orthodontic benefit. And if you have a dentist you love, start by finding out which plans they accept.
Your answers narrow the field quickly. A plan that’s a great deal for one person can be a poor fit for the next.
The Three Main Types of Dental Plans
Dental HMO (DHMO)
Dental HMOs usually have the lowest premiums. In exchange, you choose a primary dentist from the plan’s network and need a referral for specialists. Many use set copays instead of percentages, so you know what a filling or cleaning will cost upfront. If you see a dentist outside the network, the plan typically pays nothing.
Dental PPO
Dental PPOs are the most common type. You can see any dentist, but you pay less when you stay in the network. You’ll usually have a deductible, the plan pays a percentage of each service, and the plan has a yearly cap on what it pays.
Indemnity (Fee-for-Service) Plans
Indemnity plans let you go to any dentist. The plan pays a percentage of what it considers a “usual and customary” fee, and you pay the rest, including any amount your dentist charges above that fee. These plans offer the most freedom and usually cost the most.
A quick note on discount dental plans: These are memberships that get you reduced rates at participating dentists. They aren’t insurance, and they don’t pay claims. They can be useful, but you should know what you’re buying. If you have questions about a dental plan or the company selling it, the Texas Department of Insurance can help.
The Numbers That Matter More Than the Premium
The Annual Maximum
This is the most the plan will pay in a year. Many PPO plans cap out somewhere between $1,000 and $2,000. After you reach the cap, you pay the rest. A single root canal plus a crown can use up most of a year’s maximum by itself.
How the Plan Pays: Preventive, Basic, and Major
Many plans follow a 100-80-50 pattern. Preventive care (cleanings, exams, routine X-rays) is covered at 100%. Basic care (fillings, simple extractions) is covered at around 80%. Major care (crowns, bridges, dentures) is covered at around 50%. Check where each plan puts specific procedures. Root canals, for example, are “basic” on some plans and “major” on others, and that changes what you pay.
Waiting Periods
Many individual plans make you wait before certain benefits begin. Preventive care usually starts right away. Basic care often has a waiting period of about six months, and major care can be 12 months. If you need a crown now, a plan with a 12-month wait won’t help you this year. Plans offered through an employer often shorten or waive waiting periods.
The Deductible
Dental deductibles are usually small and charged per person. Many plans waive the deductible for preventive care.
The Fine Print That Catches People
Missing tooth clause. If you lost a tooth before your coverage started, some plans won’t pay to replace it with an implant or bridge.
Frequency limits. Plans usually cover two cleanings a year and limit how often you can get X-rays. If you need extra cleanings for gum disease, they may not count the same way.
Downgrade clauses. If you get a tooth-colored filling on a back tooth, some plans pay only what a silver filling would cost, and you pay the difference.
Orthodontia. When braces are covered, there’s usually a separate lifetime maximum. Many plans cover children only.
Cosmetic work. Whitening and veneers are generally not covered.
So What’s the Best Dental Insurance?
The honest answer is that no single plan is the best dental insurance for everyone. The best plan for you covers the work you need, includes your dentist, and pays when you need it, not a year later.
A few common situations:
- Healthy, cleanings only: A lower-cost PPO or DHMO is often enough.
- You want to keep your dentist: Choose a PPO they’re in-network with.
- You have work coming up: Look for the shortest waiting period and the highest annual maximum, then do the math.
- You have kids who may need braces: Compare orthodontic benefits and lifetime maximums side by side.
Do the math, especially on an individual plan. Plans you buy on your own tend to be thinner than plans offered through an employer. They usually have longer waiting periods, lower annual maximums, and less coverage for major work.
“Individual dental plans are tougher and less robust than group plans. If your dentist doesn’t take the plan, you may be better off paying your dentist directly than paying premiums and then still having to pay the dentist.”
Susana Gibb, owner, GIBB Insurance Services
Add up a year of premiums, plus the deductible, plus your share of the work you expect. Compare that total with what your dentist would charge you directly. Many dental offices offer cash-pay pricing or in-house membership plans, so ask. For some people, a plan is still worth it for fully covered cleanings that catch problems early. You just want to buy one knowing what it does and doesn’t do.
Ask Your Dentist’s Office One Question First
Before you sign up, call your dentist’s front desk and ask: “Which dental plans are you in-network with, and which ones give your patients the fewest problems?” They handle dental claims every day, and five minutes on the phone can save you a year of frustration.
For Business Owners: Adding Dental to Your Benefits
Dental is one of the benefits employees ask about most, and it costs far less to offer than health coverage. Group dental plans are generally stronger than what employees can buy on their own, often with shorter or waived waiting periods and better coverage for major work. You can choose to pay part of the premium, or you can offer dental as a voluntary benefit that employees pay for themselves.
If you’re building a benefits package from scratch, start with our guide to group health insurance for small business.
Get Help Choosing the Right Plan
GIBB Insurance Services is an independent agency, so we compare plans across multiple companies instead of selling you one company’s lineup.
Ready to compare dental plans?
Not sure how to choose a dental insurance plan for your family or your team? We’ve helped families and employers in DFW and The Woodlands since 1997.