Frequently Asked Questions About Dental Insurance

By: Redmond Signature Dentistry
April 19, 2026

According to the National Association of Dental Plans, approximately 66% of Americans have some form of dental insurance coverage. If you’re one of the 211 million with dental coverage, you’re probably making the most of those benefits—or maybe you’ve got questions about how your plan actually works.

Dental insurance can feel complicated with all the co-pays, deductibles, annual maximums, and coverage limits. But here’s the thing: understanding your benefits means you can take full advantage of what you’re already paying for. Whether you’re wondering about the basics or trying to maximize your coverage before the end of the year, we’ve got you covered.

Common Dental Insurance Questions

What Is an Insurance Deductible?

Your deductible is the dollar amount you pay out of pocket before your insurance coverage kicks in. During your benefit period (which is typically a year), you need to satisfy this portion before your insurance will cover the cost of treatment. Deductibles vary depending on the plan, so check your coverage to find yours.

For example, if you have a $50 deductible and need a filling that costs $200, you’d pay the first $50, and then your insurance would cover a percentage of the remaining $150 based on your plan’s coverage level.

What is a PPO?

PPO stands for Preferred Provider Organization (sometimes called a Preferred Provider Network). A PPO insurance plan allows you to choose your dentist. No matter which dentist you choose, services from an in-network provider are covered at a higher level than from an out-of-network provider.

For example, a cleaning may be covered 100% if you choose an in-network dentist, but perhaps only covered 80% if you visit a dentist that’s not in-network. Prior to your appointment, check with your specific plan to find out if your dentist is in-network to ensure you’re getting the most out of your coverage.

Do I Get Two Free Cleanings a Year with my Insurance?

Often, yes, but it does depend on your plan. Typically, 80-100% of the cost of your hygiene check-ups is covered twice during your benefits period. If your plan covers 100%, then your cleanings will be free. However, if your plan pays less than 100% or if you’ve used your yearly maximum toward other treatments, you may have a co-pay for your cleaning.

Here’s an important reminder: dental benefits don’t roll over to the new year. If you’ve been putting off a cleaning or recommended treatment, it’s a good idea to schedule it before your benefits reset so you can maximize what you’ve already paid for.

What Is a Dental Maximum?

Most dental insurance plans have an annual maximum—the total dollar amount your insurance will pay for dental care within your benefit period (usually a calendar year). Common annual maximums range from $1,000 to $2,000, though some plans offer higher limits.

Once you reach your annual maximum, you’re responsible for 100% of any additional dental costs until your benefits reset the following year. That’s why timing matters when planning treatments.

What If I Don’t Have Dental Insurance?

If you don’t have dental insurance, you still have options to make dental care affordable. Financing is available through CareCredit, a healthcare credit card that enables you to finance treatment for 6-24 months, possibly even with no interest if treatment is paid in full during your promotional period.

We also offer payment plans and can work with you to prioritize treatments based on your budget and dental health needs.

How to Maximize Your Dental Insurance Benefits

You’re already paying for dental insurance, either through premiums or as part of your employee benefits package. Here’s how to make sure you’re actually using what you’ve paid for.

Schedule Your Preventive Care Appointments

Preventive appointments, including exams and cleanings, are typically fully covered by insurance. Most plans cover two cleanings per year at 80-100%. If you haven’t visited your dentist twice this year for your cleanings yet, call now to get on the schedule. These appointments don’t just maximize your benefits—they help catch small problems before they become expensive ones.

Check Your Deductible Status

The money you’ve already spent toward your deductible resets to zero on January 1st. Call your insurance provider to find out what you’ve spent so far this year toward your deductible and whether any treatments you’re considering are covered.

If you’ve met or are close to meeting your deductible for this year, you may be able to save money by completing a treatment before the end of the year instead of waiting until benefits reset.

Don’t Forget About FSA and HSA Funds

Do you have a healthcare flexible spending account (FSA) or health savings account (HSA)? Many FSA plans have a “use it or lose it” policy—any unused funds expire at the end of the year or during your plan’s grace period. FSA and HSA funds can be used for your dental care, including co-pays, deductibles, and treatments.

If you have funds sitting in these accounts, now is the time to schedule any recommended treatments or complete care you’ve been putting off.

Address Small Problems Before They Become Big Ones

Delaying or avoiding simple treatments now could potentially cost more later. A small cavity that could be filled today might require a crown or root canal if left untreated. Prevent costly and serious treatments by making use of your dental insurance benefits before they reset.

Take Action Before Your Benefits Reset

Time moves fast, especially as the year winds down. If you want to maximize your dental insurance benefits, here’s what to do:

Call your insurance provider: Familiarize yourself with:
1. The benefits you’ve already used this year
2. How much of your annual maximum remains
3. What’s covered under your plan
4. Whether any benefits will be reduced next year
Schedule your preventative appointments: If you haven’t had your two dental exams and cleanings yet this year, call our office at (425) 883-1253 as soon as possible and book appointments for you and your family members before the end of the year.
Review recommended treatments: If you’re considering any dental treatments that may be covered partially or in full by insurance, talk to your dentist’s treatment coordinator about the best way to complete the treatment and maximize your benefits for the year.
Check your FSA/HSA balances: If you have flexible spending or health savings accounts, confirm your remaining balance and deadline to use funds.