How Does Dental Insurance Work? Types and Coverage
Dental insurance works similarly to other types of insurance, but it focuses specifically on covering the costs associated with dental care and treatments.
Preferred Provider Organization (PPO): PPO plans allow you to choose from a network of dentists who have agreed to provide services at a discounted rate. You can also visit dentists outside the network, but you'll typically pay higher out-of-pocket costs.
Health Maintenance Organization (HMO): HMO plans require you to choose a primary care dentist from a network of providers. You must receive all your dental care from this dentist or obtain a referral from them to see a specialist.
Exclusive Provider Organization (EPO): EPO plans are similar to PPO plans but offer coverage only for services provided by dentists within the plan's network. You typically won't have coverage for out-of-network care unless it's for emergency treatment.
Indemnity or Fee-for-Service Plans: These plans allow you to visit any dentist of your choice and typically reimburse you for a percentage of the cost of covered services. You may need to pay upfront for services and then submit a claim for reimbursement.
Preventive Care: Most dental insurance plans cover preventive services such as routine cleanings, exams, and X-rays at 100% with no out-of-pocket costs for the insured individual.
Basic Services: Basic dental services, including fillings, extractions, and emergency care, are usually covered at a percentage of the cost, such as 80% or 90%, with the remaining balance paid by the insured or subject to a copayment.
Major Services: Major dental services like root canals, crowns, bridges, and dentures are typically covered at a lower percentage, such as 50%, and may have annual or lifetime maximums.