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How In-Network vs Out-of-Network Dentists Work in a Dental Plan

By Michael LaPick Healthcare Writer

Michael LaPick Healthcare Writer

Michael LaPick is a Healthcare/Medicare data researcher for HealthCare.com and its web properties.  Previously, he has written investigative stories for the Poughkeepsie Journal and WAMC NPR Albany, keeping an eye on how Americans spend their money.

Updated on March 1st, 2024

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Understanding the difference between in-network and out-of-network dentists can lead to significant savings in dental care. Here’s some tips:

  • Ask the Right Question: Instead of asking, “Do you take this insurance?” when making an appointment, ask, Is this Dentist in-network with my dental insurance company?” The difference is crucial for cost savings.

Each doctor is enrolled individually, not the dental office as a collective. Dentists at certain practices are usually in the same network, but things can shake up when they move to new practices.

In-Network vs Out-of-Network:

In-Network: These dentists have agreements with insurance companies for lower rates. Your insurance plan usually covers a higher percentage of in-network services, reducing your out-of-pocket costs.

Out-of-Network: These providers can accept your insurance but may charge standard rates, leading to higher personal expenses. There’s often a cap on out-of-network reimbursements.

Jonathan Jones from New York City shares his experience: “A regular check-up with my dentist, who ‘took my insurance’ but wasn’t in-network, used up all of my dental insurance benefits for routine check-ups, not even procedures for me and my family.”

Confused about Health Insurance terminology? Explore our glossary guide.

Quick Reminder:

  • Dental insurance is a type of health insurance designed to pay a portion of the costs associated with dental care. It typically covers routine check-ups, cleanings, x-rays, and sometimes a percentage of more extensive procedures like root canals or orthodontics.
  • Dental coverage comes in two forms:
    • Combined health and dental plans:
      • Some Marketplace health plans include dental coverage, with a single premium covering both.
    • Separate dental plans:
      • Also available in the Marketplace, these require an additional premium on top of your health plan.

Howard Yeh, co-founder of Healthcare.com, adds, “The time and effort for finding an in-network dentist can save some financial stress. Understand your dental insurance coverage, including limits and caps for both in-network and out-of-network services.”

Key Takeaway: Verify if a dentist is in-network with your insurance to avoid unexpected high costs and maximize dental benefits.

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