Choosing a dental plan from the multitude of available options can be confusing. You may be tempted to simply focus on the plan with the lowest monthly premium. However, the least expensive premium doesn’t always mean it’s the most cost-effective plan. This guide explains the main types of dental insurance, including DHMO and PPO plans, as well as what each plan entails.
What dental insurance covers
Dental insurance divides services into tiers, knowing how they work helps you compare plans accurately
How dental coverage is typically organized
Most dental plans divide services into three tiers.
- Preventive care, such as cleanings, exams and X-rays, is covered at 100% or close for in-network visits.1
- Basic services, such as fillings and simple extractions, are typically covered at 70%–80%.
- Major services, including crowns, bridges, dentures and root canals, are typically covered at around 50%.
These percentages apply after you’ve met your deductible, and if your treatment falls within the plan’s annual maximum.
What dental insurance generally does not cover
Cosmetic procedures like teeth whitening, elective reshaping and veneers are generally not covered by dental insurance. Orthodontic coverage varies by plan and often has a separate lifetime maximum. Some plans may also impose waiting periods or exclusions for pre-existing conditions. Because coverage rules and exclusions vary by plan, it’s important to review the exclusion section carefully before enrolling.
Types of dental plans
Premiums, deductibles, networks and benefits vary by plan; the right plan for you depends on your specific oral health care needs and which dentists you want to see.
Dental health maintenance organization (DHMO) plans
A DHMO uses a primary in-network dentist to coordinate your care, and you usually need a referral to see a specialist. Out-of-network care is typically not covered except in emergencies. DHMO premiums are lower and fixed, with predictable copayments.
Dental preferred provider organization (DPPO) plans
DPPOs give you the freedom to see any licensed dentist without selecting a primary provider or having to get a referral to see a specialist. But visiting an in-network dentist will generally cost less because they have pre-negotiated rates with the insurer. Out-of-network visits may still be partially covered, but you’ll typically pay more and may have to handle your own claims.
Premiums are generally higher than a DHMO, and costs can vary depending on the procedure and provider.
Indemnity (fee-for-service) plans
Indemnity (fee-for-service) plans allow you to visit any dentist with no network restrictions. The insurer pays a set percentage, and you cover the rest. This is usually the most expensive coverage option.
Discount dental plans
These are membership programs, not insurance, that give you access to reduced fees at participating dentists. They can be useful as a supplement for people without coverage, but don’t mistake these plans for insurance when you’re comparing your options.
Understanding dental health plan costs
Monthly premium
This is the amount you pay each month to keep your insurance plan active. It’s one cost among many, like deductibles, coinsurance and annual maximums, which all play a part in determining what you pay for your oral health care.
Deductibles
This is the amount you pay out of pocket before your insurance starts contributing to covered services. For example, if your deductible is $100 and your first dental visit costs $170, the remaining $70 may be covered, subject to coinsurance or copayments.
Copayments and coinsurance
A copayment is a fixed amount you pay for a dental visit or procedure, which you’ll most often see with DHMO plans. Coinsurance is your share of a covered service cost, expressed as a percentage, and is more common with DPPO plans.
Annual maximums and out-of-pocket maximums
The annual maximum is the most your plan will pay for covered services in a benefit year. Once you reach it, you pay all additional costs until the year resets. For families, individual limits can be exhausted quickly if multiple members need dental care.
Some dental plans also include an out-of-pocket maximum, which limits what you pay before the plan covers 100% of remaining costs. The annual maximum limits what the insurer pays, while the out-of-pocket maximum limits what you pay.
What waiting periods mean for your coverage
Enrollment doesn’t always mean immediate coverage. Preventive care is usually covered immediately, while basic and major services may require waiting periods ranging from three months to one year.
If you need treatment soon, this could mean paying out of pocket. Some plans waive waiting periods if you had continuous prior coverage, so confirm this when enrolling.
Network considerations — how provider access affects your costs
An in-network dentist has pre-negotiated rates with your insurer, lowering costs and simplifying billing. Out-of-network care usually costs more, involves more paperwork and may not be covered in a DHMO.
To confirm whether your dentist is in-network, check the insurer’s provider directory or contact your insurer directly. Also, be sure to check whether specialists like orthodontists and oral surgeons are in-network.
Plan exclusions and limitations worth reading carefully
Common exclusions across most dental plans include cosmetic procedures, experimental treatments and services received before the plan’s effective date. Accident-related damage may require a separate medical or accident policy rather than dental insurance.
Key limitations to watch for include:
- Cleanings are limited to twice per year
- Pediatric benefits end at age 18 or 19
- Orthodontic coverage comes with a separate lifetime maximum
- Out-of-network reimbursement is capped at the plan’s “allowed amount” leaving you to pay any difference the provider charges
Before choosing a plan, review the Summary of Benefits or Coverage document. If anything is unclear, contact the insurer for clarification and keep a record of any confirmation.
Choose the plan that works for your situation
Before you enroll in a dental insurance plan, review the plan type and understand the full cost structure, including premiums, deductibles, coinsurance and annual maximums. Also confirm waiting periods for anticipated care, check network coverage for your current providers and read through the exclusions. Knowing exactly what each plan covers and what it doesn’t empowers you to make informed decisions.
Sources:
1 American Dental Association. Dear ADA: Annual Maximums. December 19, 2025. https://adanews.ada.org/ada-news/2025/december/dear-ada-annual-maximums/. Accessed June 25, 2026.