Short answer: Most dental plans follow a 100/80/50 structure: preventive care (cleanings, exams) covered at 100%, basic work (fillings) around 80%, and major work (crowns, bridges) around 50%, subject to an annual maximum benefit (often $1,000 to $2,000) and sometimes waiting periods. DHMO plans are cheaper but network-restricted; PPO plans cost more but offer more flexibility.
Dental insurance is structured differently from medical insurance. Coverage is usually tiered by service type:
- Preventive (cleanings, exams, X-rays): often covered at 100% and not subject to the deductible, to encourage routine care.
- Basic (fillings, simple extractions): commonly around 80% after a deductible.
- Major (crowns, bridges, dentures): commonly around 50%.
The defining quirk is the annual maximum: unlike medical insurance, which caps your spending with an out-of-pocket max, dental plans cap the plan’s payout, often at $1,000 to $2,000 per year. Once you hit it, you pay the rest. Many plans also impose waiting periods (e.g., 6 to 12 months) before major work is covered, and orthodontia is usually a separate benefit with its own lifetime maximum.
DHMO vs. PPO: a dental HMO (DHMO) has lower premiums but requires you to use network dentists and a set fee schedule; a dental PPO costs more but lets you see any dentist, with better benefits in-network.