Top 6 Things to Look for in a Dental Insurance Plan

Choosing the right dental insurance plan isn’t just about picking the one with the lowest monthly premium. Whether you're an individual shopping for your family or an employer building a benefits package, dental coverage plays an important role in keeping healthcare costs manageable and promoting overall health.

But with so many plans out there, how do you know what to look for?

Here are the top six things to consider when evaluating dental insurance plans—so you can make an informed choice that fits your needs and your budget.

1. Coverage for Preventive, Basic, and Major Services

Not all dental plans are created equal. Be sure to understand what types of care are covered and at what percentage:

• Preventive care: cleanings, exams, and x-rays (usually covered at 100%)

• Basic care: fillings, extractions, and root canals

• Major services: crowns, bridges, dentures, and sometimes implants

Tip: A good plan will fully cover preventive care and provide reasonable coverage levels for basic and major services.

2. Annual Maximum Benefit

This is the maximum dollar amount your dental insurance will pay in a calendar year. Once you hit this cap, any additional dental expenses come out of your pocket.

Common annual maximums range from $1,000 to $2,000. If you anticipate needing extensive dental work, a plan with a higher annual maximum may be worth the slightly higher premium.

3. Network of Dentists (PPO vs. DHMO)

Dental plans usually fall into one of two categories:

• PPO (Preferred Provider Organization): More flexibility to see out-of-network dentists, often higher reimbursement

• DHMO (Dental Health Maintenance Organization): Lower cost, but requires choosing a primary dentist and getting referrals

Make sure your current dentist is in-network, or check if you're comfortable switching providers. If freedom of choice is important to you, a PPO plan may be the better fit.

4. Reimbursement Schedule: MAC vs. UCR

This is how the plan determines how much it will pay toward your dental bill:

• MAC (Maximum Allowable Charge): Based on negotiated rates with in-network dentists; if you go out-of-network, you may pay more

• UCR (Usual, Customary, and Reasonable): Pays based on average fees in your area, even for out-of-network care

Understanding the difference between MAC and UCR can save you from surprise bills. If you prefer to stay in-network, MAC might be fine. If your dentist isn’t in-network or you want more flexibility, UCR is often the better option.

5. Waiting Periods and Exclusions

Some dental plans impose waiting periods for certain services—especially major ones like crowns or bridges. You might have to wait 6–12 months before coverage kicks in for those treatments.

Also, be sure to review:

• Missing tooth clauses (some plans won’t cover replacement if the tooth was lost before the policy began)

• Cosmetic procedure exclusions

• Orthodontic coverage, if needed

Knowing these details ahead of time can help you avoid frustration later.

6. Premiums, Deductibles, and Copays

Dental insurance is usually more affordable than medical coverage, but it’s still important to look at the total cost:

• Monthly premium: What you pay each month, even if you don’t use the plan

• Deductible: The amount you must pay out-of-pocket before benefits apply

• Copays/Coinsurance: Your share of the cost for services after the deductible is met

Look for a plan that offers a good balance between cost and coverage—especially if you or your family need more than just cleanings.

Final Thoughts

Dental insurance is about more than just cleanings and cavities—it’s about protecting your long-term health and finances. By paying attention to the details of what each plan offers (and doesn’t), you’ll be better equipped to choose coverage that’s truly worth it.

And if you're an employer, offering the right dental plan shows your team that you care about their well-being—while also helping them save money on essential care.