How to read a dental insurance plan: deductibles, maximums and waiting periods

A few terms explain most of how a dental plan pays:

• Premium – what you pay each month for the plan.
• Deductible – what you pay before the plan starts sharing costs. Preventive care is often exempt.
• Coinsurance by category – many PPO plans use a tiered structure in which preventive care is covered most generously, basic care (such as fillings) less, and major care (such as crowns) least. Check your own plan’s percentages.
• Annual maximum – the most the plan pays in a year. After that, you pay the rest. This is a big difference from medical insurance.
• Waiting periods – time after enrollment before certain services are covered.
• Frequency limits – how often services like cleanings or X-rays are covered.
• Missing-tooth clause – some plans exclude replacing a tooth lost before coverage started.
• Network – PPO plans pay more in-network; HMO/DHMO plans often require you to use their dentists.

Our dental insurance glossary defines these and more. To see whether a plan makes sense for your expected care, try the dental plan calculator, and the dental cost factors page explains why treatment prices vary.

General education only, not a diagnosis or treatment advice. Please see a licensed dentist about your own situation. For a medical emergency (trouble breathing or swallowing, heavy bleeding, a major injury or rapidly spreading swelling), call 911 or go to the nearest ER.