Understanding Dental Insurance: What’s Covered and How It Works
Published on 5/9/2025
There’s no denying insurance can be confusing. You might think health and dental insurance are one in the same, but they’re not. Thankfully, Dentologie is here to clear the air about dental insurance’s nuances.
We likely won’t be able to get specific about every available dental health insurance plan on the market. But we can offer guidance about plan types and dental insurance coverage as a whole. With these insights, you’ll be equipped to find the right plan for you when it comes time to undergo a procedure.
How Does Dental Insurance Work?
Most individual dental insurance plans are intended as a means of lowering your out-of-pocket costs. But they also serve as an income stream to your dentist.
However, not all dental plans are alike. In truth, there are four main categories of dental coverage available to most folks:
Dental HMOs
Members using these plans pay monthly premiums to enjoy a lower cost of overall care. HMOs are designed as budget coverage for cost-conscious members. However, that affordability comes with a limitation. Members must visit a dentist that is within their particular HMOs network to be covered by this insurance.
Dental PPOs
Members under these plans can visit any dentist they like. However, they’ll enjoy added discounts if they visit a dentist that operates within their PPO network. These plans typically come with higher premiums and higher deductibles than traditional HMO plans.
Dental Indemnity Plans
This coverage is akin to “traditional” insurance. Members pay into a deductible along with a co-insurance premium.
Plan payments cover a percentage of the cost of the covered dental services. The insurance company is then tasked with covering the rest. Members are then reimbursed by the insurance provider for services that are covered under the plan.
Dental Savings Plans
These membership programs come without deductibles, premiums, or annual limits. Patients can shop around to find the plan that most meets their needs and then pay an annual fee to remain in the plan. Patients then pay out of pocket (often at a discounted rate) directly to the in-network dentist.
Don’t Have Dental Insurance?
Consider alternative coverage options like Dentologie Plus. This premium yearly coverage offers countless benefits, including:
- No cost routine care,
- No deductibles, waiting periods, or denial of claim
- Discounts on common procedures,
- And much more.
This is an exclusive dental plan that simplifies coverage, direct to patients like you. And it’s ideal for those who want an alternative to traditional dental insurance plans. Learn more here.
What is Covered by Dental Insurance?
Obviously, the nitty gritty of each plan’s coverage and exemptions is too nuanced to cover here. But there are a few categories of dental care services that are often covered:
- Routine and Preventative Services – Including cleanings, check-ups, and more.
- X-Rays – With some limitation on how often they are done.
- Fillings – With some limitation, per plan, on materials used.
- Extractions – With consideration given to the complexity, severity, and emergency nature of the tooth issue.
- And more.
What is Not Covered by Dental Insurance?
Every individual dental insurance plan’s allowances are going to be different. However, there are a few main categories where patients are often expected to cover costs out of pocket:
- Cosmetic Procedures, such as tooth whitening
- Veneers
- Orthodontics (in the case of some plans)
- Dentures and Implants
- And more
Learn About Your Coverage from a Dentist You Trust
When it comes to dental health insurance, the devil’s in the details. That’s why we recommend working with a trustworthy dentist to render your dental work reliably and affordably.
At Dentologie, we work with patients to ensure they understand the coverages and allowances their dental plan offers. If you ever have a question about an upcoming procedure, we’re here to walk you through it.