Having healthy teeth and gums is vital for a variety of reasons, from feeling comfortable with your smile to preventing tooth decay. Poor oral health has been linked to chronic conditions like diabetes and heart disease. Your oral health may also play a role in serious health conditions, such as heart disease and pneumonia.¹ Dental insurance serves as an important tool to help make dental care affordable.

Dental insurance often provides free preventive care, like regular cleanings and dental x-rays, and a reduced rate for basic and major procedures, like fillings or crowns.² However, details like what kind of treatments are covered, the percent of the total cost that is covered, and how much you pay out of your own pocket will differ depending on the specific dental plan you have.

When deciding what dental plan is right for you, it’s important to consider the overall cost, coverage, and accessibility. Make sure that you will be able to afford the yearly deductible and the co-pay for various services. Check to see if that plan covers the dental care you need, and that the dentists you like accept the dental plan.³

Understanding dental insurance coverage 

When you first review dental plans, some of the terms might be a bit confusing. Here are some of the most common terms and what they mean:

• Co-pay: A fixed amount you pay for each dentist visit or service. Your co-pay amount will be listed in your dental insurance policy and possibly on your dental insurance card.⁴
• Deductible: The amount you’ll need to pay before your dental insurance begins to cover costs. Usually, the deductible resets each calendar year.⁴
• Annual maximum: This sets a limit on the cost your dental insurance provider will cover each year. However, the National Association of Dental Plans notes that only 3-5% of people with dental insurance hit this annual maximum.⁴
• UCR: This stands for “usual, customary, and reasonable” and refers to what a standard cost is for certain procedures. Insurance companies use this to calculate reimbursement and how much you’ll pay for dental services.⁴

You might be wondering exactly what does dental insurance cover. Most dental insurance policies will structure the kinds of care they cover into three levels: preventive, basic, and major services.

• Preventive care includes cleanings, oral exams, x-rays, and other routine office visits, and may include sealants for specific age groups. Most dental insurance plans will cover 100% of the costs for preventive services.²
• Basic procedures include things like extractions, fillings, root canals, and gum disease treatment. These treatments are usually partially covered by dental insurance — for instance, a filling might cost $100, and your dental insurance would cover 80% of that, leaving you to pay the remaining $20.²
• Major procedures include dental care like crowns, bridges, inlays, and dentures. These are usually partially covered by dental insurance, but often at a smaller percentage than basic care. For example, if your bill for a crown is $200, your dental insurance may cover 50% of that, leaving you to pay the remaining $100.²

In some cases, your dental insurer might not cover a dental treatment at all. These are called non-covered charges or non-covered services and should be listed in your insurance plan.⁴ These often include things like teeth whitening or implants, which might be considered cosmetic.⁵

The type of insurance plan you choose impacts what is covered and how you access dental care. Here are the three common types of dental insurance plans and how they differ:

PPO: A dental PPO, or preferred provider organization, plan doesn’t tie you to a single primary care provider. Instead, you can see any dentist, although the costs are typically less if you use an in-network provider. PPO plans usually have deductibles and will allow you to see dental care providers outside the network as well, though it might cost a bit more than in-network. If you have a PPO plan, instead of needing a referral to go to a specialist for an extraction with anesthesia, you could just book the appointment at will.⁶

DHMO: A dental HMO, or health maintenance organization, plan works a lot like traditional insurance, but rather than going to any dentist that accepts your plan, you’ll have to choose a single dentist as your primary care provider. 

This dentist will handle most of your care, but if you need a specialized treatment they can’t provide, they will give you a referral. If, for example, you need an extraction with anesthesia, and your primary care dentist can’t perform that procedure, they will refer you to a practice that can. HMO plans don’t usually have deductibles.⁶

In-network versus out-of-network: Your dental plan has contracts with specific dental service providers, and you will generally pay a lower rate by going to see these providers. This is called in-network. Out-of-network refers to providers that are not on your dental insurance plan. You’ll usually pay more to see out-of-network providers.⁴

Discount dental plan: These are not insurance plans. Rather, you join the plan to gain access to discounted rates for dental procedures from participating providers. You pay the discounted rate directly to the dentist.²

Before you decide on a dental insurance policy, make sure you read and understand it to avoid any surprise bills. Remember to review the deductible and co-pay amounts to determine if they are within your budget, and make sure the services covered are ones you expect you will need.

If there are any terms you don’t know, you can check MetLife’s glossary of insurance terms for dental insurance terms you’re unsure of. The National Association for Dental Plans also offers a glossary of terms that includes both insurance and some dental terminology. 

Common procedures covered by dental insurance

Most dental insurance plans will cover these seven basic areas, according to the National Association of Dental Plans: preventive care, restorative care, endodontics, oral surgery, periodontics, and prosthodontics.2 Here are some of the most common covered procedures:

• Exams: Typically, regular exams are covered by dental insurance, though there may be limits on how often you can get them. At this exam, a dental professional will ask relevant questions, give your teeth a physical examination, and order X-rays as needed.⁷
• Cleanings: As with exams, dental insurance also typically covers cleanings; though again, limits on how often you can get them may apply. During a teeth cleaning, a dental hygienist will clean, polish, and floss your teeth and may offer additional treatments like a fluoride rinse, depending on your needs.⁸
• Fillings: If you have a cavity or other tooth damage, you might need a filling to restore your tooth’s structure.⁴ These are usually covered by dental insurance as basic care, but you will likely need to cover a portion of the cost of the procedure.
• Extractions: Sometimes a tooth will need to be removed, whether it’s because your teeth are overcrowded or the tooth itself is diseased or damaged.⁴ Extractions are generally considered basic care, but you may be expected to cover a portion of the cost.

It can be helpful to review your plan to see which services are considered preventive, basic, and major, and how the coverage varies for each category. Most insurance plans will cover 100% of preventive care, a percentage of the amount for basic care, and a lower percentage for major care. However, there are some areas that are not always or often covered by a standard dental insurance policy.

Orthodontics are a specific branch of dentistry that focuses on helping teeth fit together better, usually via treatments like braces or aligners.4 Orthodontics are often not included in standard dental policies, and orthodontic care under a standard plan might be restricted to patients under the age of 18 or to cases of medical necessity.

Dental insurance exclusions and limitations

What dental insurance covers can differ greatly from depending on the plan or carrier, but the following limitations are common:

• Preexisting conditions: If you already have an issue when you sign up for your dental policy, the provider might not cover your treatment. Missing teeth or untreated cavities can be considered preexisting conditions.³
• Cosmetic procedures: Services like whitening or dental implants are often not covered by standard dental insurance. They might be considered as nice-to-haves rather than medically necessary.³

These limitations may mean that you will have to pay for all or most of the bill for dental care that falls under these categories. When the dental plan does cover these things, you might need to be of a certain age to access treatment (such as being 18 or younger to receive orthodontic care), or you may need to wait for a pre-determined period before you become eligible for certain coverage.²

If you have a preexisting condition you’re hoping to address, you’ll want to seek out a plan that doesn’t exclude or heavily restrict your access to that care. You’ll also want to be aware that the cost of excluded or non-covered services won’t count towards either your deductible or annual maximum. Understanding exclusions and limitations and how they impact your coverage can help you choose the right plan.

For example, if you’re looking for a plan that helps you cover the cost of adult braces, you’ll want to find a plan that either covers adult orthodontia or offers a rider that will cover it. If you choose a plan that doesn’t cover adult braces, you’ll be covering the full cost out of pocket, and it won’t count towards your deductible.

Maximizing dental insurance benefits

There are several ways to get the most out of your dental insurance. First, use the full scope of preventive care services that are covered by your insurance plan. Preventive care, which is often 100% covered by insurance, typically includes regular cleanings, exams, and x-rays.

Review your insurance policy and proactively schedule these preventive treatments. Staying on top of preventive care also allows your dentist to catch issues early and address them before they need more extensive (and expensive) treatment. 

Once you fully understand your dental plan, consider timing expensive treatments strategically. For instance, if you’re about to hit your annual maximum, you may want to put off any treatments that aren’t time sensitive until it resets. 

On the other hand, if you are still nowhere near your annual maximum, but have already hit your deductible, it might be a good time to schedule a procedure. With a little planning and a deep dive into the details on your coverage, you can make sure you’re making the best use of your insurance benefits.

Choosing the right dental insurance plan

When choosing a dental plan, there are plenty of details to consider. Here are some of the most impactful:

• Premium: This is the cost you pay each month to access the plan. While this cost is an important consideration and should fit in your budget, it’s not the only consideration. Choosing the cheapest premium might end up costing you more to access dental care if the kinds of care you need are not covered in that policy.
• Coverage level: Look at the deductible you’ll need to meet, and the co-pay amounts for dental visits and procedures to determine if the cost of the plan and the level of coverage are right for you.
• Plan features: If you know that you’re looking for specific treatments, like adult braces or a dental implant for a missing tooth, you’ll want to seek out a policy that covers the relevant procedures at the lowest cost to you. 
• Family: When seeking family dental care, you will want to consider a wider range of needs. Children often have specific dental needs, including the need for braces or other corrective orthodontia as their adult teeth come in.
• Seniors: Seniors have unique dental needs, including a greater likelihood of requiring tooth extractions or dentures. Generally, Medicare doesn’t cover many aspects of basic dental care, such as regular cleanings, exams, or impacted tooth extractions, though these services may be available in some states or under some Medicare Advantage plans.⁹ Seniors should seek out dental plans that fit their unique needs.
• Flexibility and accessibility: It’s important to make sure that you can easily access the dental services you need with your insurance plan. If you don’t want to wait for referrals, you might prefer a PPO plan to an HMO. Or you might want to check how many in-network dentists are in your city or neighborhood to ensure you have multiple convenient options.

Understanding MetLife’s dental insurance plans

If you’re considering joining a MetLife Dental Insurance plan, here’s a look at some of the plans’ features:

• An expansive provider network: MetLife Dental has a national presence of dentists. MetLife highlights dentists who focus on preventive care with its SpotLite on Oral Health℠ program, which connects policyholders to dentists who meet criteria for improved oral health outcomes.
• Cost estimates: MetLife Dental allows policyholders to obtain personalized cost estimates prior to going to the dentist’s office. 
• Convenient care: Besides access to a large national. Network of dentists and specialist, MetLife Dental Insurance members have the ability to access dental care through teledentistry and smart scan tools.
• Helpful anytime online resources: MetLife’s MyBenefits portal for members allow you to: 
• Easily find providers near you.
• Download your dental ID card to have it on hand for your dental appointments.
• Get access to your plan’s covered amounts for exams, x-rays, cleanings, treatments, and procedures, plus pre-treatment estimates that can help you budget for upcoming care.
• View your current benefits usage and your annual maximum (if applicable). 
• Chat with a customer service representative to answer any additional questions you may have.

Navigating dental insurance for seniors

Adults 65 and older often deal with dental conditions associated with aging, like dry mouth, periodontitis, and root and coronal caries.¹⁰ They may also have trouble maintaining the same level of personal oral care at home if they lose mobility or suffer from other limiting conditions.

Because of these concerns, seniors should look for a dental plan that offers coverage for preventive and restorative care. Seniors should pay close attention to deductibles and co-pays to ensure those costs fit within their often fixed budgets.

Regularly seeing a dentist is important for seniors as they encounter changing dental needs. The right insurance policy can help them access that dental care in a cost-effective way.

Should you get dental insurance?

Before you purchase a dental insurance policy, you should feel confident in your understanding of the coverage options and features available. Knowing how dental insurance works and understanding the terminology will help you make the right choice about dental coverage and choose a policy that suits your needs without overpaying.

The right dental plan for you can ensure you get the dental care you need without breaking your budget. Dental insurance can help you access the preventive care that is essential to avoiding bigger problems down the road.

Once you have found and purchased the right policy for you, familiarize yourself with your benefits and the management tools available to you. For instance, MetLife’s MyBenefits portal allows users to manage and view their benefits online. You can track how far you are from meeting your deductible, get an estimate for the cost of a filling, see what dentists in your neighborhood are also in your network and more.