Dental Coverage for Everyday Care and Bigger Needs
Dental insurance can help reduce out-of-pocket costs for preventive care and may also provide benefits for fillings, crowns, root canals, periodontal services, oral surgery, dentures, implants, and other covered services depending on the plan.
Benefits, waiting periods, deductibles, annual maximums, provider networks, covered procedures, and cost sharing vary by plan and state.
Dental Insurance Is More Than Cleanings
Preventive Care
Exams, cleanings, and routine X-rays.
Basic Services
Fillings, some extractions, periodontal treatment, and other basic restorative care.
Major Services
Crowns, bridges, dentures, root canals where classified as major, and implants where covered.
How a procedure is classified varies by plan.
Dental Plans Work Differently From Major Medical Insurance
Dental insurance commonly uses annual benefit maximums, procedure classifications, coinsurance percentages, deductibles, waiting periods, frequency limits, and network fee schedules.
A dental plan's annual maximum is generally the maximum amount the plan may pay toward covered dental services during the benefit year, not the maximum amount the member could ever owe.
What Is an Annual Maximum?
Many dental plans place a limit on how much the plan will pay for covered dental services during a calendar or policy year.
Example: If a plan has a $2,000 annual maximum, the insurance company generally will not pay more than that amount toward eligible services during the applicable benefit year, subject to policy terms.
Certain procedures may also have separate inside limits or lifetime limits.
Dental Deductibles
A deductible is the amount the member may need to pay before the plan begins paying benefits for certain categories of care.
Preventive services may sometimes be exempt from the deductible, depending on the plan.
What Does 100% / 80% / 50% Mean?
Dental plans often pay different percentages depending on the type of service. For example, a plan may pay a higher percentage for preventive care and a lower percentage for major services.
The percentage generally applies to the plan's allowed charge or negotiated fee, not necessarily the dentist's full retail charge.
Using an In-Network Dentist Can Matter
Dental PPO plans may allow members to see both in-network and out-of-network dentists, but using an in-network provider may reduce out-of-pocket costs because participating dentists agree to negotiated fee schedules.
Out-of-network reimbursement and balance-billing exposure vary by plan.
Do not assume a dentist who accepts MetLife participates in every MetLife dental network.
Dental network participation can change, so verify your dentist's current network status before non-emergency treatment.
Some Dental Plans Have Waiting Periods
A waiting period is a period of time after enrollment before benefits for certain services become available.
- Preventive may be immediate
- Basic may be immediate or delayed
- Major may be immediate or delayed
- Implants may have a separate waiting period
Waiting periods vary significantly by plan.
Are Dental Implants Covered?
Some dental plans include implant benefits, but coverage may be subject to waiting periods, separate annual maximums, inside limits, replacement rules, frequency limitations, medical necessity requirements, or other contract terms.
What About Braces or Orthodontics?
Orthodontic benefits may be included in certain plans, often with separate lifetime maximums, age limits, treatment requirements, and waiting periods.
What About Cosmetic Dentistry?
Dental insurance generally focuses on medically or functionally necessary dental care. Cosmetic-only procedures — such as teeth whitening or veneers done only for appearance — are often not covered.
Some procedures may have both restorative and cosmetic purposes, so coverage depends on the plan, the reason for treatment, and how the service is classified.
Read the Limitations Carefully
Some dental plans may have limitations involving missing teeth, replacement of prior dental work, frequency of crowns or dentures, alternate-benefit provisions, or other contract restrictions.
Plan documents should be reviewed before beginning expensive dental treatment.
Before Major Dental Work, Ask for a Pre-Treatment Estimate
For more expensive procedures, a dentist may submit a proposed treatment plan so the member can receive an estimate of how benefits may apply.
A pre-treatment estimate is not a guarantee of claim payment because eligibility, remaining maximums, plan status, procedure coding, and other factors can change.
This is especially useful for crowns, implants, bridges, dentures, periodontal treatment, and larger cases.
What If I Have a Dental Emergency?
If you have severe dental pain, swelling, trauma, uncontrolled bleeding, or another urgent dental problem, contact a dentist or emergency provider as soon as possible.
Coverage for emergency dental treatment depends on the plan, the type of service, and whether the provider is in-network. Deductibles, coinsurance, annual maximums, and other plan limits may still apply.
For non-emergency care, checking network participation before treatment can help avoid unexpected costs.
Dental Insurance and Dental Discount Plans Are Different
Dental Insurance
An insurance policy or insured benefit plan may pay part of covered dental expenses subject to deductibles, coinsurance, annual maximums, exclusions, and other terms.
Dental Discount Plan
A discount plan generally provides access to negotiated provider discounts but does not pay insurance benefits.
Routine Visits Are the Foundation
Many plans are designed so preventive visits are the easiest benefit to use, helping catch small issues before they become larger, more expensive procedures.
Who May Consider Dental Coverage?
Dental insurance is not necessarily the lowest-cost solution for every person.
Reviewing a Treatment Plan Together
For crowns, implants, and other major work, a dentist can walk through the recommended treatment before it begins — a natural moment to also request a pre-treatment estimate.
Common Dental Insurance Mistakes
- Choosing only by premium
- Ignoring annual maximum
- Not checking the dentist network
- Assuming all major work is immediately covered
- Ignoring implant or orthodontic limits
- Misunderstanding deductible vs. annual maximum
- Starting expensive treatment before reviewing benefits
- Assuming a pre-treatment estimate guarantees payment
- Confusing discount plans with insurance
Coverage for the Whole Family
Family dental plans may cover a policyholder and eligible dependents, often with per-person and family-level annual maximums. Dependent eligibility requirements and age limits vary by plan.
Featured Dental Option: NCD by MetLife
Whitestone Insurance Services is contracted with NCD and can help clients review NCD by MetLife dental plan options where available.
NCD is a dental-plan marketing and enrollment organization. The dental insurance is underwritten by MetLife. NCD by MetLife plans use the MetLife PDP Plus network.
Multiple Annual Maximum Options
Current NCD by MetLife plan options may offer annual maximum benefits ranging from $750 to $10,000 depending on the specific plan and state. Plan designs, maximums, and availability can change.
Day-One Benefits on Certain Plans
Certain current NCD by MetLife plans provide immediate benefits for preventive and basic services, and some plans also provide immediate major-service benefits. Other NCD plans may use waiting periods or graduated benefit schedules. Implant coverage may be subject to separate waiting periods, inside limits, or other plan terms.
Large Network
NCD by MetLife plans use the MetLife PDP Plus dental network.
Member Support
NCD provides Member Care support and online member tools for benefit information, ID cards, payment information, and other plan administration.
Additional Wellness Benefits
Certain NCD/NWFA memberships may include additional wellness-related member benefits or discounts beyond dental insurance.
For NCD by MetLife dental plans, claims are managed and paid by MetLife. Rates and plan availability vary by state, age, household, and plan selected.
Ready to Compare NCD by MetLife Dental Plans?
Review current NCD by MetLife plan options and enroll directly online.
Shop NCD Dental PlansOr call Whitestone at (929) 292-8005 if you would like help reviewing the options before enrolling.
Dental Insurance FAQs
What does dental insurance cover?
Dental insurance may help with preventive care (exams, cleanings, routine X-rays), basic services (fillings, some extractions, periodontal treatment), and major services (crowns, bridges, dentures, root canals, and implants where covered). How a procedure is classified varies by plan.
What is an annual maximum?
An annual maximum is generally the maximum amount the plan may pay toward covered dental services during the benefit year — not the maximum amount the member could ever owe. Certain procedures may also have separate inside or lifetime limits.
What is a dental deductible?
A deductible is the amount the member may need to pay before the plan begins paying benefits for certain categories of care. Preventive services may sometimes be exempt from the deductible, depending on the plan.
What does 100/80/50 coverage mean?
Dental plans often pay different percentages depending on the type of service — commonly a higher percentage for preventive care and a lower percentage for major services. The percentage generally applies to the plan's allowed charge or negotiated fee, not necessarily the dentist's full retail charge.
Are implants covered?
Some dental plans include implant benefits, but coverage may be subject to waiting periods, separate annual maximums, inside limits, replacement rules, frequency limitations, medical necessity requirements, or other contract terms. Not every plan covers implants.
Do dental plans have waiting periods?
Many do. Preventive care may be immediate, while basic and major services may be immediate or delayed depending on the plan. Implants may have a separate waiting period. Waiting periods vary significantly by plan.
Can I use my current dentist?
It depends on the plan's network and your dentist's participation. Using an in-network dentist may reduce out-of-pocket costs. Do not assume a dentist who accepts a given carrier participates in every network offered by that carrier — confirm participation before your visit.
What is the MetLife PDP Plus network?
MetLife PDP Plus is the dental provider network used by NCD by MetLife plans. As with any network, participation should be confirmed for your specific dentist and plan before your visit.
Is NCD an insurance company?
No. NCD is not an insurance company. NCD markets dental and vision plans and uses NCD Agency LLC for enrollment, billing, and customer-service functions. Dental insurance benefits are underwritten by the applicable insurance carrier, including MetLife for NCD by MetLife plans.
Who underwrites NCD dental plans?
NCD by MetLife dental insurance is underwritten by MetLife. For these plans, claims are managed and paid by MetLife — not by NCD or Whitestone.
Can I enroll in NCD through Whitestone?
Yes. Whitestone Insurance Services is contracted with NCD. You can review and enroll in NCD by MetLife plan options directly online, or call Whitestone if you'd like help reviewing the options first.
What is a pre-treatment estimate?
For more expensive procedures, a dentist may submit a proposed treatment plan so the member can receive an estimate of how benefits may apply. A pre-treatment estimate is not a guarantee of claim payment because eligibility, remaining maximums, plan status, procedure coding, and other factors can change.
Is dental insurance the same as a discount plan?
No. Dental insurance may pay part of covered dental expenses subject to deductibles, coinsurance, annual maximums, exclusions, and other terms. A dental discount plan is not insurance — it generally provides access to negotiated provider discounts but does not pay insurance benefits.
Is the annual maximum the same as an out-of-pocket maximum?
No. A dental annual maximum is generally the most the plan will pay toward covered services during the plan year. It is not the most you could ever have to pay yourself. After the plan reaches its annual maximum, you may be responsible for additional covered dental costs.
What is coinsurance in dental insurance?
Coinsurance is the percentage of an allowed covered dental cost that you pay under the plan. For example, if a plan pays 80% for a covered basic service, you may be responsible for the remaining 20%, subject to the deductible, annual maximum, network rules, and policy terms.
Are braces or orthodontics covered?
Some dental plans include orthodontic benefits, but many do not. When included, age limits, waiting periods, separate lifetime maximums, and other restrictions may apply.
Can I buy dental insurance without health insurance?
Yes. Dental insurance is often available as separate coverage and does not always require you to have a medical health insurance plan. Availability and plan options vary by carrier and state.
In which states does Whitestone offer Dental Insurance?
New York, New Jersey, Connecticut, Pennsylvania, Ohio, Delaware, and South Carolina. Carrier and product availability varies by state.
Ready to Review Dental Coverage Options?
Our licensed agents can walk you through available dental plans, including NCD by MetLife, and help you understand how each one applies to the services you use most.