Dental insurance is coverage that pays part of the cost of dental care, usually all or most of preventive visits and a smaller share of fillings, crowns and other work, up to a yearly limit. You can get it inside a health plan, as a separate dental plan, through work, or through Medicaid or CHIP in some cases.
Updated October 2026 for the 2027 plan year
Key facts (2027 plan year)
- Dental coverage is an essential health benefit for children 18 and under; it must be available with Marketplace coverage, but you don’t have to buy it (HealthCare.gov).
- Adult dental is not an essential health benefit, so Marketplace health plans don’t have to offer it (HealthCare.gov).
- You can’t buy a Marketplace dental plan unless you buy a Marketplace health plan at the same time (HealthCare.gov).
- Separate dental plans can have waiting periods for adult services, and you pay premiums during the wait (HealthCare.gov).
- Medicaid must cover dental care for children, but each state decides what dental benefits adults get (Medicaid.gov).
- Original Medicare doesn’t cover routine cleanings, fillings or extractions (Medicare.gov).
- Discount health care programs, including dental discount cards, are not insurance (Texas Department of Insurance).
What is dental insurance?
Dental insurance is a type of coverage that helps pay for care from a dentist. You pay a premium, and the plan pays an agreed share of covered services.
The National Association of Insurance Commissioners (NAIC) notes that dental insurance is regulated by your state insurance department. That means plan rules, filing requirements and consumer protections can differ from state to state.
It is usually separate from your medical coverage: a health plan pays for doctors and hospitals, a dental plan for exams, cleanings and dental work. If you are new to the vocabulary, our health insurance terms glossary defines premiums, deductibles and coinsurance in plain English.
The main types of dental plans
The NAIC describes four common designs:
- Dental PPO (DPPO): you can see a range of dentists and specialists; in-network care usually costs you less.
- Dental HMO (DHMO): you use dentists under contract with the plan, at set rates, and often pick a primary dentist.
- Dental indemnity: you can see any dentist, pay the bill, and file a claim to be paid back.
- Discount or savings plans: participating dentists offer a reduced rate, and you pay that rate yourself. These are not insurance (more on this below).
How does dental insurance work?
Most dental insurance sorts care into tiers and pays a different share for each. Preventive care is usually covered in full, basic work at a lower share, and major work at the lowest share. Plans also cap what they pay each year.
The NAIC says most plans cover 100 percent of preventive care, such as cleanings, routine exams, X-rays and sealants. Basic care includes fillings, extractions and some gum treatment. Major care includes crowns, bridges and dentures, covered at a lower percentage.
| Tier | Typical services | Common plan share |
|---|---|---|
| Preventive and diagnostic | Exams, cleanings, X-rays, sealants | Often 100% |
| Basic | Fillings, simple extractions, some root canals | Often 80% |
| Major | Crowns, bridges, dentures, some implants | Often 50% |
| Orthodontics | Braces, retainers | Often a separate rider, if covered at all |
The 100/80/50 pattern is how Delta Dental of Tennessee describes most dental benefit plans. Many plans differ, and some classify root canals or implants as major work. Always read the plan’s own summary.
Annual maximums, deductibles and coinsurance
An annual maximum is the most the plan will pay for your care in a plan year. After the plan reaches it, you pay the rest yourself until the next plan year. The California Dental Association explains that most plans control costs by placing a cap on benefits or limiting the number or type of covered services.
Dental plans can also have a deductible, the amount you pay before the plan starts sharing costs. Preventive care is often exempt. Your share after that is usually coinsurance, a percentage of the bill. In a dental HMO, it is more often a flat copay.
Medical vs. dental limits: ACA health plans have an out-of-pocket maximum that protects you from huge bills. Adult dental plans work the other way: the yearly limit caps what the plan pays, not what you pay.
Can you get dental insurance on the Marketplace?
Yes, in two ways. Some Marketplace health plans include dental coverage, and in some areas you can add a separate dental plan. But you can’t buy a Marketplace dental plan on its own; you must buy a health plan at the same time (HealthCare.gov).
If your health plan includes dental, one premium covers both. If you pick a separate dental plan, you pay a second premium on top of the health plan premium. HealthCare.gov shows each dental plan’s copayments, deductibles and covered services when you compare.
Under federal rules, a separate dental plan sold through an Exchange must cover at least the pediatric dental essential health benefit (45 CFR 155.1065). Coverage for adults in those plans varies by insurer.
When you can enroll and cancel
Marketplace dental follows the health plan calendar. You choose it during Open Enrollment for 2027 coverage, November 1, 2026 through January 15, 2027 in HealthCare.gov states, or during a Special Enrollment Period. See our 2027 open enrollment guide for deadlines.
You can cancel a separate dental plan at any time and keep your health plan. You can’t remove dental from a health plan that includes it; you would have to switch health plans during Open Enrollment or a Special Enrollment Period.
Outside the Marketplace, private insurers sell individual dental plans directly, and many employers offer group dental. For how on- and off-exchange health coverage fits together, see our guide to individual health insurance.
Is dental insurance required for children?
Dental coverage for children 18 and under is an essential health benefit, so it must be available with Marketplace coverage, either inside a health plan or as a separate plan. HealthCare.gov is clear that while it must be available, you don’t have to buy it. Adult dental is not an essential health benefit.
Some states have their own rules, so check what your state’s exchange requires when you enroll. Children who qualify for Medicaid or the Children’s Health Insurance Program (CHIP) get dental benefits through those programs. Our health insurance for kids guide explains CHIP and Medicaid for families.
The need is real. The Centers for Disease Control and Prevention (CDC) reports that by age 9, half of children have had a cavity, and about 1 in 5 adults ages 20 to 64 has at least one untreated cavity.
Do dental plans have waiting periods?
Many do. A waiting period is the time you must be enrolled before the plan pays for certain services. HealthCare.gov warns that separate dental plans can have waiting periods for adult services, and you still pay premiums while you wait.
Waiting periods most often apply to basic and major work and to orthodontics, not to cleanings and exams. They are common in individual plans, so people don’t buy a policy only once they need a crown.
Before you enroll: ask the insurer for the waiting period on each service tier, the annual maximum, and whether a waiting period can be waived if you had dental coverage recently. Get the answer in writing.
Orthodontic coverage deserves extra care. The NAIC notes that braces and retainers are generally covered through a rider, often at a lower percentage. Check whether the plan covers orthodontics for adults at all.
Honesty.AI compares health coverage, including supplemental options where available in your state.
Dental insurance vs. dental discount plans
A dental discount plan is not dental insurance. You pay a membership fee and get reduced rates from participating dentists, but the plan doesn’t pay any part of your bill. You pay the full discounted price yourself.
The Texas Department of Insurance states that discount health care programs are not insurance and that members pay the full discounted cost of care. It advises checking that your dentist accepts the program before you buy. The Illinois Attorney General adds that because these plans are not insurance, they are not regulated like insurance.
| Feature | Insurance | Discount plan |
|---|---|---|
| Is it insurance? | Yes, regulated by your state insurance department | No; a membership program |
| Who pays the dentist | The plan pays its share; you pay the rest | You pay the full discounted rate |
| Annual maximum | Usually yes | Generally no plan payments to cap |
| Waiting periods | Common for basic and major work | Typically none |
| Dentist choice | Network or any dentist, depending on plan | Participating dentists only |
A discount plan can make sense if you need work right away and can’t wait out a waiting period, or as a backup alongside insurance. It is not protection against a large bill. Many discount plans also bundle vision discounts; see our vision insurance guide for how that side works.
On its own site, Honesty.ai lists Medical Savings Plans that give discounts on dental, vision, prescriptions and telehealth, and describes them as a supplement to existing coverage, not a replacement for full insurance. Those are discount programs, not dental insurance.
Does Medicaid or Medicare cover dental?
For children, Medicaid must cover dental care; for adults, each state decides. Original Medicare generally doesn’t cover routine dental care at all, though some Medicare Advantage plans add dental benefits.
Medicaid.gov states there are no minimum federal requirements for adult dental coverage, and states have flexibility to decide what adults receive. Separate CHIP programs must cover dental services needed to prevent disease and promote oral health. Check your state’s rules on our Medicaid eligibility guide.
Medicare.gov says Medicare doesn’t cover dental services like routine cleanings, fillings or tooth extractions, and dentures are usually excluded. If you are nearing 65, our Medicaid vs Medicare guide explains how the programs differ.
Supplemental vs. major medical coverage
A dental plan is a supplemental product: it adds to your health coverage but can’t replace it. Major medical coverage, such as an ACA plan, covers hospital stays, emergencies, prescriptions and the other essential health benefits.
| Question | Major medical (ACA plan) | Supplemental (dental, vision, critical illness, accident) |
|---|---|---|
| Covers hospital and emergency care? | Yes, essential health benefits | No, or only narrow benefits |
| Out-of-pocket maximum protects you? | Yes | No; many plans cap what the plan pays instead |
| Can replace health insurance? | It is health insurance | No; designed to sit alongside it |
| Who regulates it? | Federal ACA rules plus your state | Mainly your state insurance department |
Other supplemental products work differently again. Critical illness insurance and accident insurance pay cash benefits after specific events. Short-term health insurance is a different product altogether and usually excludes dental.
How to choose dental insurance
Start with the care you expect, not the premium. Two cleanings a year and a crown or braces call for very different plans.
- List the care you expect this year and next: cleanings, fillings, crowns, braces, dentures.
- Check your dentist’s network. Ask the office which plans it accepts before you buy.
- Compare the annual maximum against the care you expect. A low cap can be used up by one large procedure.
- Read the waiting periods for basic, major and orthodontic care.
- Check the deductible and coinsurance for each tier.
- Look for exclusions, such as cosmetic work, implants, or replacing a tooth lost before coverage began.
- Decide where to buy: with a Marketplace health plan, from an employer, or directly from an insurer.
If you have a health savings account, you can pay many dental costs with tax-free money; see what is an HSA. If you are also shopping for health coverage, start with health insurance quotes so you can see whether a plan with built-in dental makes sense.
Compare your 2027 coverage with Honesty
Honesty®, a licensed AI insurance agent from Honesty® Insurance Services, LLC (NPN 21094885), compares coverage for your family’s needs, including supplemental options where available in your state. It works for you, not the carriers. Chat, voice or text, 24/7.
Frequently asked questions
What does dental insurance usually cover?
Most dental insurance covers preventive care such as exams, cleanings and X-rays at or near 100 percent, basic care such as fillings at a lower share, and major care such as crowns and bridges at the lowest share, up to an annual maximum. Orthodontics is often a separate rider.
Can I buy dental insurance without health insurance?
Not on the Marketplace: HealthCare.gov only sells a dental plan if you buy a health plan at the same time. Outside the Marketplace, private insurers sell individual dental plans on their own, and many employers offer group dental.
Is dental insurance required for adults?
No. Adult dental is not an essential health benefit, so Marketplace health plans don’t have to offer it and you don’t have to buy it. Dental coverage for children must be available, but buying it is optional.
Do dental insurance plans have waiting periods?
Many do, especially for basic and major work and for orthodontics. HealthCare.gov warns that separate dental plans can have waiting periods for adult services, and you pay premiums during the wait. Ask the insurer before you enroll.
Is a dental discount plan the same as dental insurance?
No. A dental discount plan gives you reduced rates at participating dentists, but it doesn’t pay any part of the bill. State regulators such as the Texas Department of Insurance say discount health care programs are not insurance.
Does Medicaid cover dental for adults?
It depends on your state. Medicaid must cover dental care for children, but there are no minimum federal requirements for adult dental, so each state decides what adults receive.
Keep learning: vision insurance, critical illness insurance, accident insurance, individual health insurance and how Honesty.AI works.
