Dental Insurance Plans: PPO, DHMO, and Indemnity Coverage
Author: Disabled World (DW)
Updated/Revised Date: 25 Jul 2026
Table of Contents:
Synopsis - Definition - About This Section - FAQs - Publications - Subtopics
Synopsis
How dental insurance works, including PPO, DHMO, and indemnity plans, individual, family, and group coverage, deductibles, annual maximums, and typical costs.
At a Glance
- 1 - DHMO coverage often costs between $5 and $15 a month.
- 2 - Indemnity dental plans let you choose any dentist who accepts the coverage, though deductibles and annual maximums still apply.
- 3 - In a DHMO, network dentists are paid a fixed monthly fee, and plans may add an enrollment fee or require a full year of premium up front.
- 4 - There is no industry standard annual maximum, deductible, or copay, since each insurer files its own limits with the state insurance department.
Topic Definition
- Dental Insurance
Dental insurance is a contract that pays part of the cost of dental treatment in exchange for a monthly or annual premium, and it works differently from major medical coverage in one important respect: it is built around a yearly spending ceiling rather than protection against catastrophic bills. Most plans pay generously for the cheap work and sparingly for the expensive work, covering routine cleanings, exams, and x-rays at or near full cost, then splitting the bill on fillings and extractions, and paying a smaller share of crowns, bridges, and dentures once any waiting period has passed. Plans come in three basic shapes, a PPO that discounts care through a contracted network while still allowing outside dentists, a DHMO that assigns you to a network office in return for very low premiums and fixed copays, and an indemnity policy that leaves the choice of dentist entirely to you. Coverage can be bought individually, arranged for a family, or supplied as a group benefit through an employer, and because each insurer files its own deductibles, exclusions, and annual maximum with state regulators, two policies at the same price can differ sharply in what they actually pay.
About This Section
Nowadays, it seems like there are more medical expenses than ever before that aren't covered by health care plans. If you don't have a company health plan, you could face substantial medical costs in some situations, or limit yourself to minimal health and dental care when you need it most.
Dental insurance is insurance designed to pay a portion of the costs associated with dental care. From cleanings to braces, dental plans help you and your family control the costs of dental care. There are several types of individual, family, or group dental insurance plans, grouped into three primary categories:
- Preferred Provide Network dental plans (PPO).
- Indemnity (generally called: dental insurance) that allows you to see any dentist you want who accepts this type of coverage.
- Dental Health Managed Organizations (DHMO) in which you are assigned or select an in-network dentist and in-network dental office and use the dental benefits in that network.
In general, a dental insurance plan covers a percentage of the dental charges incurred at a dental office. There is a wide range of coverage options which may include free preventive services such as teeth cleaning, routine treatments including check-ups, hygiene and x-rays, as well as planned treatments such as fillings, root canal work and crowns - also called remedial and restorative treatment.
There are several types of individual, family, or group dental insurance plans for purchase - some of which may be acquired through an employer, a local licensed insurance agent - broker, or an online website that is licensed to sell dental insurance products. Example of coverage plans include:
- Dental discount plans
- orthodontic insurance
- Family dental insurance
- Individual dental insurance
- Full coverage dental insurance
- Supplemental dental insurance
- Group dental insurance coverage
- Individual full coverage dental insurance
Dental Indemnity Insurance
Dental indemnity insurance plans gives you a free choice of any dentist you want. There may be deductibles and annual maximums with these plans, too. There is no industry standard annual maximum limitation, deductible, or co-pay. Such coverages and benefit limitations are determined by each insurance company as filed with the department of insurance.
Dental Health Maintenance Organization
A dental health maintenance organization (DHMO) is an organized system of dental health care in which a network of highly qualified dentists, who receive fixed monthly fees, provides comprehensive and affordable care for individuals or families at a low monthly premium with services at either no cost or a reduced price. Some services may require a co-payment. Features of these types of plans may include:
- Annual dollar cap
- Co-payments for office visits
- Free preventive or routine care
- May have an initial enrollment fee
- Your average monthly cost: $5 to $15
- You must select from an approved network of dentists
- Monthly premiums (some require you to prepay a year's worth)
- Companies selling these plans are regulated by state insurance departments.
Frequently Asked Questions
What does the 100-80-50 structure in a dental plan mean?
It describes the share the insurer pays by service category, typically 100% for preventive care such as cleanings and x-rays, 80% for basic work like fillings and simple extractions, and 50% for major services including crowns, bridges, and dentures. Your coinsurance is the remaining percentage, and every payment counts against the plan's annual maximum.
How long are dental insurance waiting periods?
Preventive care is usually available immediately, while basic restorative work commonly carries a waiting period of about six months and major services often require twelve months of continuous coverage. Some group plans waive waiting periods entirely, and insurers may shorten them if you show proof of comparable prior coverage.
Does dental insurance cover braces and other orthodontics?
Orthodontic benefits are normally an optional rider rather than a standard feature, and when included they pay around half the cost up to a separate lifetime maximum that is often between $1,000 and $2,500. Many plans limit orthodontic coverage to dependent children under a stated age, so adults seeking treatment should confirm eligibility before starting.
What happens when I reach my annual maximum?
Once you hit the yearly ceiling, commonly $1,000 to $2,000, you pay the full negotiated cost of any further treatment until the benefit year resets. Dentists can often stage a long treatment plan across two benefit years so part of the work falls under each year's maximum.
Does Medicare pay for dental care?
Original Medicare does not cover routine dental services such as cleanings, fillings, dentures, or most extractions, though it may pay for dental work that is an inseparable part of a covered medical procedure. Many Medicare Advantage plans include a dental allowance, and adult dental coverage under Medicaid varies widely from one state to another.
Is a dental discount plan the same as dental insurance?
No, a discount or savings plan is a membership program that gives you access to reduced fees negotiated with participating dentists, and the plan pays nothing toward your bill. The trade-off is that there are no deductibles, waiting periods, or annual maximums, which can suit people who need immediate work or who have already exhausted an insurance maximum.
Are dental implants and cosmetic procedures covered?
Purely cosmetic treatment such as whitening and veneers is excluded from virtually every policy, and implants are either excluded or paid at the major services rate subject to the annual maximum. Watch for a missing tooth clause as well, since many plans refuse to pay for replacing a tooth that was already gone before the coverage started.
Curated and edited by Ian C. Langtree, Founder & Editor-in-Chief, Disabled World. This section is maintained by the Disabled World editorial team.
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