Dental Insurance Checklist

What to compare in a dental plan before you enroll: network, cost, limits and what it covers.

A real, editable checklist below — tick, tap a line to rewrite, drag to reorder.

  • Dental Insurance Checklist
  • Pick a plan type
  • Confirm your dentist is in-network
  • Search the plan's dentist directory
  • Check employer coverage first
  • Compare monthly premiums
  • Find the deductible
  • Note the coinsurance split
  • Look up copays
  • Check the annual maximum
  • Read the waiting periods
  • Confirm preventive coverage
  • Check basic and major coverage
  • Ask about orthodontics
  • Read exclusions and limitations
  • Compare discount plan fees
  • Consider an FSA or HSA
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Network access affects cost. The ADA says a PPO plan will typically pay a larger share of the cost when you see an in-network dentist, and a DHMO may not pay for care outside its network. Humana puts a typical dental premium at $20 to $50 a month for an individual and $50 to $150 for a family. Also read the limits: deductibles, annual maximums and waiting periods. Delta Dental's Utah Premium PPO plan, for example, waits 12 months before covering major services. This list assumes you are comparing individual or employer plans in the US. It leaves out Medicaid and Medicare Advantage.

Why these items are on the list

  1. Pick a plan type. PPO, DHMO and indemnity plans pay and limit dentist choice differently; a discount plan is not insurance.
  2. Confirm your dentist is in-network. A PPO typically pays a larger share in-network. A DHMO may pay nothing outside its network.
  3. Search the plan's dentist directory. Delta Dental's Find a Dentist tool filters by specialty, languages spoken, office hours and new-patient acceptance.
  4. Check employer coverage first. Employers may pay part or all of the premium, often deducted from pay. A spouse's plan may cover you.
  5. Compare monthly premiums. Humana cites $20 to $50 a month for one person and $50 to $150 for a family as typical.
  6. Find the deductible. It is what you pay before benefits start. Most PPO dental plans have one; most DHMOs do not.
  7. Note the coinsurance split. MetLife's example: with 70%/30% coinsurance, the plan pays 70% of costs after the deductible; you pay 30%.
  8. Look up copays. A set fee paid at the visit. DHMO plans use fixed copays for procedures.
  9. Check the annual maximum. The most the plan pays yearly. Delta Dental's Utah PPO plans list $1,000 and $2,000; some plans have none.
  10. Read the waiting periods. Delta Dental's Utah PPO plans wait 6 months on fillings; Premium waits 12 months on root canals or crowns.
  11. Confirm preventive coverage. Humana says many plans cover preventive care in full; without insurance, a cleaning and exam may cost $200 or more.
  12. Check basic and major coverage. Humana says plans can cover up to 80% of basic restorative work and up to 50% of surgery.
  13. Ask about orthodontics. Humana: plans typically cover up to 50% of pediatric braces, $1,500 lifetime maximum per child; usually not over age 18.
  14. Read exclusions and limitations. Not every plan covers every procedure, including whitening, dentures or braces. Check the plan booklet or policy.
  15. Compare discount plan fees. Humana says discount plans are not insurance, with annual fees typically under $150 for individuals; you pay the dentist directly.
  16. Consider an FSA or HSA. An FSA through work uses pre-tax pay for dental costs. Self-employed people can look at an HSA.

Keep the plan documents open beside the list and tick as you find each answer. Whatever stays unticked is what to ask the insurer, and you can run the list again for a second plan.

When to use it

Use it at open enrollment or when you buy individual coverage.

Sources

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