Dental Insurance: What’s Covered, What’s Not

Written by Kate Ashford, Rita Colorito, Amy Gopal
Medically Reviewed by Sarah Goodell on February 16, 2026

Dental insurance is insurance that covers dental health and care. Because dental health, also called oral health, is important to your overall health, you may want to get dental insurance to help you pay for the cost of your dental care. You can purchase dental insurance as part of a medical insurance health plan or as a separate policy through a dental insurer, the Health Insurance Marketplace, or a private insurance broker.

When shopping for insurance, you may see the term "dental benefits," which is different from dental insurance.

An insurance plan is meant to absorb risk (for instance, the risk that you’ll need to have a tooth pulled, or to get a root canaland it covers costs accordingly.

A benefits plan provides discounts on common dental services, but doesn’t cover other things at all. It’s meant to be helpful, but it’s not a catch-all.

If you have dental benefits, do you know what’s in the fine print and what type of plan is best for you?

Most Americans (83%) have some type of dental benefits, either insurance or a benefit plan, the National Association of Dental Plans (NADP) says. Most people have private coverage, usually from an employer or group program. Large employers are more likely to offer dental benefits than small employers, and high-wage workers are more likely to receive them than low-wage workers. Medicare doesn’t cover dental care, and most state Medicaid programs cover dental care only for children.

To make the most of your benefits, you need to know these things. When you shop for dental coverage, make sure you understand what type of plan you are choosing and what it covers.

Dental insurance plans are similar in some ways to health insurance plans, but different in other ways. You’ll generally have the following options:

Preferred provider organization (PPO)

As with a health insurance PPO, these plans come with a list of dentists and other oral health care providers that accept the plan. These are referred to as in-network providers. Going to an in-network provider offers you the lowest out-of-pocket cost. You may have the option of going out of network, but your out-of-pocket costs will be higher than the costs incurred using an in-network provider.

Dental health maintenance organization (DHMO)

Like a health insurance HMO, DHMO plans provide a network of dentists that accept the plan for a set co-pay, or no fee at all. However, you may not be able to see an out-of-network dentist. If you do, you may have to pay the full amount on your own.

Discount or referral dental plan

A discount or referral dental plan offers you a discount on dental services from a select group of dentists. Unlike health insurance, this type of plan doesn’t pay anything for your care. Rather, the dentists who participate agree to give you a discount for the care you receive. These plans are also called access plans or savings plans.

How Americans Get Dental Insurance

Employer-Sponsored dental insurance

LIke health insurance, the majority of Americans get their dental insurance through their employer. If you do not have dental insurance coverage through your or your spouse’s employer, you may have other options.

Individual dental insurance

Private dental insurance is insurance you purchase on your own, and not through an employer. You can purchase private dental insurance directly through a dental insurer, HealthCare.gov, or an insurance broker.

Medicare

Medicare doesn't cover dental services such as routine cleanings, fillings, or tooth extractions. It also doesn’t cover items such as dentures. You pay 100% of non-covered dental services unless you purchase a supplemental or Medigap plan with dental coverage or receive dental benefits through a Medicare Advantage plan.

Medicare Advantage Plans (Part C)

Medicare Advantage Plans provide all your Medicare Part A and B benefits and other benefits not covered under Medicare. Depending on the plan you choose, it may cover dental services, such as routine checkups or cleanings. Your monthly premiums, deductibles, coinsurance, and co-payments vary based on which plan you join. Once you pay the plan’s yearly out-of-pocket limit, it pays 100% for covered health services for the rest of the year.

Medicare supplement insurance

Also called Medigap, Medicare supplement insurance is extra insurance that helps you pay your out-of-pocket costs associated with Original Medicare. You can buy a Medigap policy from a private insurance company. Because all Medigap policies are standardized, they offer the same basic benefits no matter where you live or from which insurance company you buy the policy. Price is the only difference between the 10 different types of plans offered by most states. Medigap policies generally don’t cover dental care.

Medicaid

Some people with limited income and resources may qualify for Medicaid, a joint federal and state program that helps cover medical costs generally not covered by Medicare. Each state sets its own rules to determine who is eligible for Medicaid. Under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit, states are required to cover dental services for people enrolled under the age of 21. Most states provide emergency dental services for adults in their Medicaid programs, but less than half of the states provide comprehensive dental care.

Predetermination of costs

Some dental insurance plans encourage you or your dentist to submit a treatment proposal to the plan administrator before receiving any care or treatment. The administrator may determine your eligibility, the eligibility period, services covered, your co-payment, and the maximum limitation. This is called predetermination. Some plans require predetermination for treatment over a specified dollar amount. This is also known as preauthorization, precertification, pretreatment review, or prior authorization.

Annual benefits limitations

To help contain costs, your dental insurance plan may limit benefits by the number of procedures or dollar amount in a given year. In most cases, especially if you've been getting regular preventive care, these limitations allow for adequate coverage. By knowing what and how much the plan allows, you and your dentist can plan treatment that will minimize out-of-pocket expenses while maximizing compensation offered by your benefits plan.

Peer review for dispute resolution

Many dental insurance plans have a peer review mechanism through which disputes among third parties, patients, and dentists can be resolved, eliminating many costly court cases. Peer review aims to ensure fairness, individual case consideration, and a thorough examination of records, treatment procedures, and results. Most disputes can be resolved satisfactorily for all parties.

Comprehensive dental insurance typically covers some portion of these categories of dental care:

  • Preventive care:Dental experts recommend you get regular cleanings and checkups once every 6 months to maintain your oral health. Preventive care includes regular exams, cleanings, fluoride rinses, and oral cancer screenings. X-rays are also part of preventive care. These services help prevent dental issues from developing and catch issues early before they get worse. 
  • Basic or restorative care: This includes simple fillings, crowns, and tooth extractions to help treat cavities, gingivitis, or other oral infections. Most dental plans usually cover any X-rays needed to complete these procedures.
  • Major dental care: Some restorative care involves more complex invasive procedures that may require the use of anesthesia or oral surgery. Major dental care may cover:
    • Endodontics or root canals.
    • Periodontics, the care of the structures that support and surround the tooth. This includes scaling, root planing, and managing acute infections or lesions.
    • Prosthodontics, such as dentures and bridges.
    • Oral surgery, such as removing impacted wisdom teeth, performing tissue biopsy, and draining minor oral infections.
    • Some full-coverage dental insurance may even cover dental implants.
  • Orthodontic care: Some dental plans cover orthodontia, such as braces, retainers, or aligners, but usually only for children.

You’re usually covered for two preventive visits per year. If you get an individual policy, periodontics and prosthodontics may not be available in the first year of coverage.

Most plans follow the 100-80-50 coverage structure. That means they cover preventive care at 100%, basic procedures at 80%, and major procedures at 50%, or a larger co-payment. But a dental plan may choose not to cover some procedures, such as sealants, at all.

Does dental insurance cover braces?

A common question many people have about dental insurance is whether it covers braces and other types of teeth straightening. Coverage for orthodontics, such as bracers, retainers, and aligners, often requires a rider, in which you pay an additional fee, for any kind of policy. If you have crooked teeth or a misaligned bite, read the fine print on whether your plan covers orthodontia. Most full-coverage dental plans cover orthodontics only for children.

Dental insurance plans have limits on how much they pay during a plan year. That’s true even of full-coverage dental plans.

Annual caps

Every plan also has a cap on what it will pay during a plan year. For many, that cap is quite low. This is the annual maximum your plan will pay. You have to pay all expenses that go beyond that amount.

About half of dental PPOs offer annual maximums of less than $1,500. If that’s your plan, you would need to pay for all expenses above $1,500. If you need a crown, a root canal, or oral surgery, you can reach the maximum quickly. There’s generally a separate lifetime maximum for orthodontic costs.

Some plans may exclude certain services or treatments to lower their costs. You need to know what specific services the plan covers and excludes.

Exclusions

All plans exclude experimental procedures and services not performed by or under the supervision of a dentist, but there may be some less obvious exclusions. Sometimes, dental coverage and medical health insurance may overlap. Read and understand the conditions of your dental insurance plan. Exclusions in your dental plan may be covered by your medical insurance.

Along with knowing what types of care your plan covers, you should know when coverage for each type of care begins, and how often you can receive that type of care.

Dental insurance waiting period

With most dental plans, you can often begin receiving preventive care right away. But you may have a waiting period before the plan will begin covering certain types of care.

Depending on the plan and what dental care you need, you may need to wait 3-6 months or up to a year before the plan will pay for restorative or major dental care. You may need to hold the policy longer than a year before it will cover periodontics or prosthodontics. The orthodontics rider will have its own waiting period.

Dental care frequency

Experts generally encourage adults to see their dentists twice a year. Dental benefits policies support this, although the wording varies. It may be that your policy will pay for a preventive visit every 6 months (but not closer together), twice per calendar year, or twice in 12 months. Get to know your policy so you understand how it works. That will help you schedule your appointments.

There are usually time limits on other services as well, such as X-rays, fillings on the same tooth, crowns and bridges on the same tooth, or fluoride treatments for children. For instance, your policy may pay for a full series of X-rays only once every 3 years.

You may not be able to find a dental plan that covers conditions that existed before you enrolled. If that’s the case, you will have to pay any ongoing treatment costs out of pocket.

Before getting any dental procedure, read your dental policy closely to see whether your procedure is covered. Call your insurance company if you have questions.

If you need a major procedure, you can ask your dentist to submit a pretreatment estimate. This will help you know what you’ll likely owe after any coinsurance, deductible, and policy maximum.

Confirm with your dentist and insurance company whether you need any preauthorization for the dental procedure, and if your dentist has received it. The preauthorization will determine whether your dental procedure is covered by your plan and how much your plan will pay for it. A preauthorization can also confirm whether you meet the timing requirements for the procedure. Many plans won’t cover certain dental procedures unless your dentist receives preauthorization.

It’s also smart to understand how your dental plan handles emergencies. Many have provisions for urgent care or after-hours care, but you may owe a deductible, a co-pay, or a larger percentage of costs.

If your employer offers dental coverage, that’s an easy choice. It tends to be cheaper than getting a policy on your own. If you’re shopping for your own plan and you already have a dentist, your dentist may be able to recommend a plan based on your dental history. They can also tell you in which dental plans they serve as an in-network provider.

As you compare plans, try to find out the following things:

  • Whether your dentist and any specialists you may need are in-network
  • Total costs for the plan each year, including premiums, co-pays, and deductibles
  • Annual maximum
  • Out-of-pocket limit, if any
  • Limitations on preexisting conditions
  • Coverage for braces, if needed or anticipated
  • Emergency treatment coverage, including treatment if you’re away from home
  • Whether the plan covers diagnostic, preventive, and emergency services, and how much

If you are covered under two dental benefits plans, tell the administrator or carrier of your primary plan about your dual coverage status. In some cases, you may be assured full coverage, where plan benefits overlap and you receive a benefit from one plan where the other plan lists an exclusion.

If you have questions about coverage, contact your employer's benefits department, your insurance plan, or the third-party payer of your health plan.

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