The 2026 Dental
Coverage Manual

As of 2026, the national average for individual dental insurance is $31.42 per month. However, this varies significantly by state: Alaska remains the most expensive at over $50/month, while West Virginia offers the lowest entry point at approximately $18/month.

This is the standard coverage tiering for PPO plans. 100% covers preventive care (cleanings, X-rays). 80% covers basic procedures (fillings, extractions). 50% covers major work (crowns, root canals). Patients are responsible for the remaining percentage once their annual deductible is met.

Reflecting inflationary pressure on dental procedures, many 2026 institutional plans have increased their annual maximums from the traditional $1,500 to $2,500 or even $5,000. Some premium plans now offer 'rolling maximums' where unused benefits carry over.

Most 2026 PPO plans classify implants as 'Major Restorative,' meaning they are covered at 50% only after a 6-12 month waiting period. Many plans also have a lifetime maximum for implants or specific exclusions if the tooth was missing prior to coverage effective date.

A PPO offers the freedom to see any dentist (with higher benefits for in-network providers), while a DHMO requires you to select a primary care dentist and does not cover out-of-network care. DHMOs are significantly cheaper ($10-$15/month) but offer less geographic and provider flexibility.

Unlike medical insurance, adult dental insurance rarely has a Maximum Out-of-Pocket limit. Once you exceed your 'Annual Maximum Benefit,' you are responsible for 100% of all costs. Only pediatric dental plans regulated by the ACA have a mandatory MOOP (typically around $375 per child).