Selecting a dental plan can feel overwhelming when you’re trying to balance quality coverage with a tight budget. The right plan should fit your budget and provide the coverage your household needs.
This guide shows you how to evaluate your options, including comparing DHMO vs. PPO plans, so you can confidently select a dental plan that meets your oral health and financial needs.
Start by assessing your household’s dental needs
Before comparing plans, make sure you have a clear picture of what your family needs from dental coverage.
Consider how many family members need coverage. Individual, couple and family plan costs differ considerably, so account for everyone who needs coverage. Think about the types of care your family requires and what treatments they may need soon. There’s a difference between a household that needs routine cleanings and one that anticipates fillings, orthodontic treatments or oral surgery.
To determine your future needs, look back at the past one to two years: how many visits occurred, what treatments were needed and did anyone required care beyond routine cleanings? Families with children may also want to prioritize plans that cover pediatric services like fluoride treatments and sealants. If a family member needs a crown, extraction or orthodontic work in the near future, make sure you know and understand each plan’s restrictions and waiting periods.
Understand the main types of dental plans
The two of the most common dental plan types are Dental Health Maintenance Organization (DHMO) and Dental Preferred Provider Organization (DPPO). DPPO products cover 89% of total enrollment in commercial dental plans1. These plan types are available both through employers and on the individual market, though availability, cost and enrollment rules can differ between the two. It’s important to research each plan type to understand how they differ in both cost and flexibility.
What is a DHMO plan?
A DHMO plan typically has lower monthly premiums and predictable copays. However, it also requires you to select a primary dentist within a designated network, and referrals are generally needed for specialist care.
What is a DPPO plan?
A DPPO plan usually has higher monthly premiums than a DHMO but gives you more flexibility. For example, with a DPPO, you can visit most any dentist of your choice, though you’ll likely pay less if you stay in network.
How to decide which plan type fits your household
If keeping monthly costs low is your priority and you’re comfortable staying in network, a DHMO may serve you well. On the other hand, if provider flexibility matters or if you travel frequently and want more options, a DPPO may be worth the higher premium.
Compare the key costs of each plan
Dental plan costs involve more than monthly premiums. To get an accurate picture of what each plan type will cost you, you’ll need to look at the full set of cost components.
Monthly premiums
This is the fixed amount you pay each month to maintain coverage. Always keep in mind that a lower premium doesn’t necessarily mean lower overall costs.
Deductibles
This is the amount you pay out of pocket before your insurance kicks in for covered services. If your family expects to use coverage beyond routine visits, compare deductible amounts carefully across the plans you’re considering.
Copayments and coinsurance
A copay is a fixed amount you pay per visit. Coinsurance is a percentage of the covered service’s cost that you’re responsible for. Let’s say your new plan covers 50% of major services, and you need a crown that costs $1,200. With coinsurance, your share would be $600 before factoring in your deductible or annual maximum.
Annual maximum
The annual maximum is the most your plan will pay toward covered services in a given year. Once you reach that limit, you’re responsible for any remaining costs.
Look closely at each plan’s coverage
Dental insurance coverage varies by plan, so be sure to review their details closely.
Preventive care coverage
Most dental insurance plans cover preventive services such as cleanings, exams and X-rays at or near 100% when you use in-network providers. Some plans also cover children’s preventive services like fluoride treatments and sealants, which is worth confirming if you have kids.
Basic and major services
Basic services like fillings and simple extractions are commonly covered at around 70% to 80%. Meanwhile, major services like crowns, bridges, dentures and root canals are typically covered at a lower rate, often around 50%.
Orthodontic coverage
Not all dental insurance plans include orthodontic coverage, and those that do often apply a separate lifetime maximum. This is especially relevant if you have children who may need braces. Also, confirm whether orthodontic benefits extend to adults.
Waiting periods
Many plans impose waiting periods before they cover basic or major services, typically six months to one year. Preventive care is usually available from day one. If you or a family member needs a specific procedure soon, make sure you factor in the plan’s waiting period before making a choice.
Evaluate the plan’s network
Check whether your current dentist is in network.
You may not even need to change dentists when switching plans, but it depends on your new dental insurer’s network. Before enrolling in a new plan, confirm your dentist’s status through the insurer’s provider directory, by calling the insurer or by asking your dental office. Note that specialists may have different network statuses than your general dentist, even within the same practice.
Assess network size in your area
Picking a plan with a large network of providers gives you more options if you move, change jobs or require a specialist. A DHMO with a limited local network may not be practical if there are only a handful of in-network providers within a reasonable distance.
Understand the cost difference between in-network and out-of-network care.
In-network dentists have pre-negotiated rates with the insurer, which keeps your costs lower and more predictable. Out-of-network visits can result in higher out-of-pocket costs, less predictable billing, and, in some cases, no coverage at all. Make sure to weigh network flexibility against any cost differences, especially if provider choice is a priority for your family.
Calculate what you’re likely to spend in a year
To compare dental plans accurately, estimate your total yearly costs rather than focusing only on monthly premiums. Determine the total cost of your annual premiums, expected deductible expenses and likely copays or coinsurance for the dental care your family may need. Then compare those totals across plans. If several family members will need treatment, review how individual and family annual maximums work together.
Questions to ask before you enroll
Before you commit to a plan, get clear answers to the following questions:
- Does this plan cover my current dentist as an in-network provider?
- What is the waiting period for basic and major services?
- What is the annual maximum, and does it apply per person or per family?
- Are orthodontic benefits included, and what is the lifetime maximum?
- How does this plan handle out-of-network care?
- What preventive services are covered at 100%?
Choose a plan that works for your whole household
Balancing coverage, costs and provider access will help you choose a plan that meets your household’s ongoing dental needs. A well-matched plan helps reduce out-of-pocket expenses and encourages preventive care.
Source
- National Association of Dental Plans. NADP Report Shows Continued Decline in Dental Benefits Enrollment. https://www.nadp.org/nadp-report-shows-continued-decline-in-dental-benefits-enrollment/. Accessed June 25, 2026.
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