To find an in-network dentist, start with your dental plan type. A DHMO only covers dentists in its network, while a DPPO pays more when you stay in network. Search your dental carrier's directory for your exact plan, then call the office to confirm. Before any big procedure, ask for a pre-treatment estimate so you know your share in advance.
- Dental networks are separate from your medical network. Your doctor's network tells you nothing about your dentist.
- DHMO plans require in-network dentists and often a primary dentist. DPPO plans let you go out of network for a higher cost.
- Federal surprise-billing rules don't cover standalone dental plans, so out-of-network dentists can bill you the difference.
- Ask about waiting periods, your annual maximum and a pre-treatment estimate before major work.
How Dental Networks Work
Dental insurance runs on its own networks. Even when the same company sells your health and dental plans, the dentist list is different. So the first step is knowing which kind of dental plan you have.
| Feature | Dental HMO (DHMO) | Dental PPO (DPPO) |
|---|---|---|
| Out-of-network dentists | Usually not covered | Covered, but you pay more |
| Primary dentist | Usually required | Not required |
| Specialist referrals | Often required | Usually not required |
| Deductible | Often none | Usually yes |
| Annual maximum | Often none | Usually yes |
| Premiums | Generally lower, with set copays | Generally higher, with coinsurance |
Some plans work differently. For example, a "passive PPO" may pay the same benefit whether or not the dentist is in network. Your plan documents will say which design you have. Our guide to dental insurance explains each option. Medical plans have network types too, covered in our guide to types of health plans and networks.
5 Steps to Find an In-Network Dentist
Finding an in-network dentist takes about 15 minutes when you follow these steps.
1. Know your dental plan and network
Check your dental ID card or welcome packet for the plan name and network. Our guide to reading your insurance card shows where to look.
2. Search the dental directory
Next, search your dental carrier's directory and filter by your plan. Our dental and vision network search links to each major carrier.
3. Check location, hours and services
Then narrow the list by distance and hours. If you need braces, implants or oral surgery, check for in-network specialists too.
4. Call the office to confirm
After that, call with your member ID and plan name. Ask whether the specific dentist, not just the practice, is in network.
5. Ask for a pre-treatment estimate
Finally, before crowns, root canals or other major work, ask the office to send a pre-treatment estimate to your plan. It shows what the plan expects to pay and what you'll owe.
New dental plans often have waiting periods for basic and major work. Book your cleanings and exams first, since preventive care usually has no wait.
Dentist Search by Carrier
Each dental carrier has its own search tool and network names. Use the plan name on your card to filter results.
- Cigna dental. Cigna offers both DPPO and DHMO designs. Our Cigna provider network guide shows how its dental search works.
- UnitedHealthcare dental. Search by your dental plan name on UHC's directory. See our UnitedHealthcare provider network guide.
- Aflac dental. Aflac's dental plan covers in-network and out-of-network dentists. Learn more on our Aflac insurance page.
- Ambetter dental. If your Ambetter coverage includes dental, check the dental network in your plan documents first. Our Ambetter provider network guide can help.
Children's dental care is an essential health benefit under the ACA. It may come built into a Marketplace health plan or through a separate dental plan. Either way, check the pediatric dental network before your child's first visit.
Questions to Ask the Dental Office
- "Is Dr. [name] in network for [dental plan name]?"
- "Are you accepting new patients on this plan?"
- "Do you send pre-treatment estimates to my insurer?"
- "Are your specialists, like oral surgeons and orthodontists, in network too?"
- "What will I owe today for a cleaning and exam?"
Need help reading the answers? Call a licensed Vivna agent at 888-730-6001.
What In-Network Dental Care Costs
In-network dentists agree to set fees with your plan. As a result, your share is predictable. Many DPPO plans follow a simple pattern:
| Type of care | Examples | Common DPPO coverage |
|---|---|---|
| Preventive | Cleanings, exams, routine X-rays | Often covered at or near 100% |
| Basic | Fillings, simple extractions | Often around 70% to 80% |
| Major | Crowns, bridges, dentures | Often around 50% |
Most DPPO plans also have an annual maximum. That's the most the plan pays in a year, and many fall between $1,000 and $2,000. After that, you pay the rest. Your plan's summary lists your exact numbers. Compare designs on our dental and vision insurance page.
Tell us your dentist's name. A licensed Vivna agent will check which dental plans include them, at no cost to you.
If Your Dentist Isn't In Network
You still have choices. With a DPPO, you can stay and pay more. However, the dentist can bill you the difference between their fee and what the plan allows. Standalone dental plans aren't covered by the federal surprise-billing law, so ask for the full price first.
With a DHMO, routine out-of-network care usually isn't covered at all. In that case, compare a new in-network dentist against switching plans at your next enrollment window. If your dentist leaves the network mid-year, our guide on what to do when your doctor leaves your network covers similar steps.
Finding an In-Network Dentist: FAQs
Is my dentist in network if my doctor is?
Not necessarily. Dental and medical plans use separate networks, even from the same company.
Do I need a referral to see a dental specialist?
DHMO plans often require one from your primary dentist. DPPO plans usually don't.
Can I see any dentist with dental insurance?
With a DPPO or passive PPO, yes, though costs vary. With a DHMO, you usually must use in-network dentists.
What is a dental waiting period?
It's the time before certain services are covered. Preventive care often has no wait, while basic and major care may.
Does Vivna sell dental insurance?
Yes. We offer dental plans from carriers such as UnitedHealthcare, Cigna, Aflac and Aetna. Read our dental insurance FAQs to learn more.
Compare dental plans from top carriers with a licensed agent. Call Monday through Friday, 9am to 6pm.
Sources
- Aflac: Dental HMO vs. PPO plans
- CMS: No Surprises Act scope, including plans not covered
- HealthCare.gov: Dental coverage in the Marketplace
Vivna Insurance is a licensed, independent insurance agency (NPN 19168641). We are not affiliated with HealthCare.gov or any government agency. Dental plan designs, networks, waiting periods and annual maximums vary by plan and state. Coverage percentages shown are common examples, not a quote. Check your plan documents for exact benefits.