Dental insurance.

Standalone dental insurance covers a share of your cleanings, fillings, and bigger work like crowns, usually on a 100-80-50 structure: 100% of preventive care, 80% of basic work, 50% of major work, after any deductible and once waiting periods clear. You buy it on its own because medical plans, ACA marketplace plans, and Original Medicare do not include routine dental. Watch the annual maximum, which is the ceiling on what a plan will pay in a year. The cheapest plans cap around $1,000 to $1,500, and a single crown can burn through most of that in one appointment. We are independent and licensed in Arizona, Alabama, and California, with more states coming, and our help costs you nothing because the carriers pay us. Call 623-292-4360 and we will line plans up against the dental work you actually expect to need.

What it pays for: the 100-80-50 rule

Almost every PPO dental plan sorts work into three buckets and pays a different percentage on each. Preventive care (cleanings, exams, routine X-rays) comes in at 100%, usually with no waiting period, so you can use it the month coverage starts. Basic work (fillings, simple extractions) typically runs 80% after the deductible. Major work (crowns, bridges, dentures, and root canals on some plans) sits at 50%.

Here is where that 50% gets complicated. It shares a ceiling with your annual maximum. A crown in 2026 runs roughly $800 to $2,500 depending on the material. The plan covers half, but if your max is $1,500, one crown can eat most of your yearly benefit before summer.

The annual maximum is the number that matters

The lowest premium almost always comes with a $1,000 or $1,500 annual maximum. That feels fine until the year you need a crown and a root canal, and the rest lands on you. Mid-range plans run $2,000 to $3,000. Some premium plans reach $5,000 or higher.

If cleanings are all you ever expect, a low max is fine. If you know restorative work is coming, the higher max usually earns its keep. Read the max first, then the premium.

PPO or DHMO: how to actually pick

A PPO costs more per month, carries a deductible and an annual maximum, and lets you see any dentist. In-network costs you less, out-of-network costs more but is still covered. A DHMO costs less per month, has no deductible and no annual maximum, but ties you to a primary dentist in its network and requires a referral to see a specialist.

• Already attached to your dentist? Call their office and ask if they take a DHMO. If they do, a DHMO is often a lot cheaper with no annual cap, and most people never think to ask.
• Want the freedom to shop dentists or travel? A PPO is the safer fit.

Waiting periods, and the no-wait option

Most plans cover preventive care from day one, then make you wait before they pay for bigger work, commonly around 6 months for basic services and 12 months for major. Enroll planning to get a crown next month and you may be told to sit out the better part of a year. Some carriers also run a separate waiting period for conditions you already have when you sign up, so if you know work is coming, ask about that one specifically before you buy.

For someone with a crown or bridge already on the calendar, ask about no-waiting-period plans. They exist, the premium is higher, and for known upcoming work they often still come out ahead.

Why medical and Medicare leave a dental gap

ACA marketplace medical plans do not include adult dental. It is a separate purchase, and a lot of people learn that at their first cleaning. Original Medicare is tighter still: Part A and Part B exclude routine dental by statute, so cleanings, fillings, crowns, and dentures are not covered, except in narrow hospital-connected cases like jaw surgery tied to a covered procedure.

Medicare Advantage plans usually fold in some dental, but the average annual cap sits around $1,300, which stretches to cleanings and not much more. Wear dentures or have a crown coming and that cap empties fast, which is why a lot of Medicare members add a standalone dental plan. Medigap plans do not help here at all, since they only cover cost-sharing on Original Medicare.

Who actually buys standalone dental

This makes the most sense for people without a group plan behind them: the self-employed and freelancers, early retirees not yet on Medicare, anyone on an individual ACA medical plan, and Medicare members who want more than their Advantage plan's dental allowance.

A straight caveat, since we would rather you hear it now. If you truly only go in for two cleanings a year, your premiums plus deductible can land close to what those cleanings would cost in cash. Standalone dental clearly wins once you are using it for fillings, crowns, or bigger work, which most people eventually need. We will run that math with you and tell you plainly if a plan is not worth it. Call 623-292-4360.