The 100-80-50 model
| Category | Examples | Plan usually pays |
|---|---|---|
| Preventive | Cleanings, exams, X-rays | 100% |
| Basic | Fillings, extractions, some root canals | 70-80% |
| Major | Crowns, bridges, dentures, implants | 50% |
Key terms
- Premium: what you pay monthly ($15-$60 for individual plans is common).
- Deductible: usually $50-$100 per person per year; often waived for preventive care.
- Annual maximum: the most the plan pays in a year: commonly $1,000-$2,000.
- Waiting periods: often 6 months for basic work and 12 months for major work on new individual plans.
- Frequency limits: e.g., two cleanings a year, one crown per tooth every 5 years.
- Missing tooth clause: may exclude replacing teeth lost before coverage started.
PPO vs HMO (DHMO)
PPO plans let you see any dentist, with lower costs in network. DHMO plans have lower premiums and set copays, but you must use their dentists.
What’s usually not covered
Cosmetic work like whitening and veneers, and often adult orthodontics.
Estimate your share: dental cost estimator.
