Who it's for
- Anyone whose health plan doesn't include adult dental coverage
- Families who want to confirm or add children's dental coverage
- People who want routine cleanings and checkups covered
- People planning dental work who want to understand waiting periods first
- Anyone who wants to bundle dental with vision coverage
What it covers
Most dental plans group services into categories, often covered at different levels:
- Preventive: cleanings, exams, and X-rays, often covered at the highest level
- Basic: fillings, simple extractions, and some other routine treatment
- Major: crowns, bridges, dentures, and similar work, often covered at a lower level
- Orthodontics: included on some plans, often with age limits or separate maximums
Key things to know
Why dental coverage matters
Regular cleanings and exams can catch problems early, when they're often simpler and less costly to treat. Many plans cover preventive care at a high level to encourage those visits.
Adult vs. child dental under the ACA
Pediatric dental coverage is an essential health benefit under the ACA, so it's built into some Marketplace health plans or offered as a stand-alone dental plan. Adult dental usually isn't included in medical plans and is bought separately, through the Marketplace or directly from a carrier.
Dental PPO
Lets you see any dentist, but you'll usually pay less with dentists in the plan's network. A popular choice if you want flexibility.
Dental HMO / DHMO
You choose a primary dentist from the network and generally need referrals for specialists. Premiums are often lower, with less flexibility.
Indemnity (fee-for-service)
Lets you see any dentist and reimburses a set amount or percentage. These offer the most freedom but can involve more paperwork.
Coverage levels
Plans often pay a higher share for preventive care and a lower share for basic and major work. Checking these percentages helps you estimate what you'd pay for the care you expect.
Waiting periods
Many plans have waiting periods before basic or major services are covered. If you need work done soon, this is one of the most important details to check.
Annual maximums
Most adult dental plans cap what they'll pay in a year. Once you reach the cap, you pay the rest, so larger treatment plans are worth mapping out.
Dental discount plans aren't insurance
Discount programs offer reduced rates at participating dentists but don't pay claims. They can be useful, but it's important to know the difference.
Pairing dental and vision
Many people pick up dental and vision coverage together, since neither is typically part of adult medical coverage. Hollen can quote both at the same time.
Frequently asked questions
Does my health insurance include dental?
For children, dental coverage is an essential health benefit under the ACA, so it's included in or offered with Marketplace plans. Adult dental usually isn't included in medical plans and is bought separately.
Do I need dental insurance if my teeth are healthy?
Many people use dental coverage mainly for preventive care like cleanings and exams. Whether it's worth it depends on your expected care and the plan's costs.
Can I get coverage for work I need right away?
Some plans cover preventive care immediately but have waiting periods for basic and major work. Hollen can help you find plans whose rules fit your timing.
Is a PPO or HMO better?
It depends on whether you want flexibility or lower premiums, and whether your dentist is in the network.
Can I buy dental at any time?
Stand-alone dental plans bought directly from a carrier can often be purchased year-round. Dental plans bought through the Marketplace generally follow Marketplace enrollment periods.
Can you quote dental and vision together?
Yes. Just select both on the quote request form.
This page is general educational information, not a guarantee of coverage, eligibility, or cost. Benefits, availability, and rules vary by plan, carrier, and state. Contact Hollen for details on specific plans.