Employer PPO plans
A Preferred Provider Organization (PPO) plan lets you see any provider, but you pay less in-network. You usually do not need a referral to see a specialist. Watch your deductible (what you pay before the plan pays) and coinsurance (your share after that). Out-of-network care costs more and may be “balance billed” in some situations.
HMO and EPO plans
Health Maintenance Organizations (HMOs) generally only cover in-network care except in emergencies, and often require a referral from your primary care doctor to see a specialist. Exclusive Provider Organizations (EPOs) also limit you to the network but usually without referrals. Always check the network before booking.
Medicare and Medicare Advantage
Original Medicare (Parts A and B) generally does not cover routine dental care such as cleanings, fillings, extractions or dentures. Many Medicare Advantage (Part C) plans include some dental, vision and hearing benefits, but coverage levels and annual limits vary widely. Read does Medicare cover dental? and our 2027 open enrollment guide.
Medicaid and CHIP
Medicaid and the Children’s Health Insurance Program (CHIP) must cover dental services for children. Adult dental coverage under Medicaid is optional for states, so it ranges from comprehensive to emergency-only. Find dentists who accept Medicaid through your state Medicaid agency or InsureKidsNow.gov. Also see our update on Medicaid work requirements.
ACA Marketplace plans
Plans bought through HealthCare.gov or a state exchange must cover essential health benefits, including pediatric dental. Adult dental is optional and often sold as a separate stand-alone plan. See ACA open enrollment for 2027 and what changed with premium subsidies.
Dental insurance: PPO and DHMO
Dental plans work differently from health insurance. Many plans cover preventive care at or near 100%, basic care (fillings) at a lower percentage and major care (crowns, bridges) at a lower percentage still, with an annual maximum on what the plan will pay and possible waiting periods. DHMO plans use a set network and fixed copays. Read how dental insurance works.
Dental savings plans
A dental savings (discount) plan is not insurance: you pay a membership fee and get reduced prices from participating dentists. There are usually no annual maximums or waiting periods. Compare them in dental savings plans vs insurance.
No insurance / self-pay
Uninsured? You still have options: community health centers that charge on a sliding scale, dental school clinics, in-house membership plans offered by many dental practices, and your right to a Good Faith Estimate before scheduled care. See free and low-cost dental care.
How to check a provider is in-network
- Find the exact plan name on your insurance card (the insurer name alone is not enough).
- Use your insurer’s online provider directory, or call the member services number on your card.
- Call the practice and confirm they are in-network for your specific plan.
- For big treatments, ask the practice to submit a pre-treatment estimate (predetermination) to your insurer.
Major carriers’ directories include Delta Dental, MetLife, Cigna, Aetna, UnitedHealthcare, Humana, Guardian and Blue Cross Blue Shield.
CareCompass is independent and not affiliated with any insurer. Coverage depends on your specific plan.
Last updated: 15 October 2026
