You’re sitting in the dentist’s chair, the overhead light is blinding, and you’re staring at a poster of a smiling golden retriever while a hygienist scrapes at your molars. The big question floating in your head isn't usually about the plaque; it’s about the bill. Specifically, how much does Ameritas dental insurance cover before you have to swipe your own card?
Honestly, the answer is a bit of a moving target. Dental insurance doesn’t work like medical insurance, which you’ve probably figured out by now if you've ever tried to get a crown. It’s more like a discount club with a spending cap. Ameritas is one of the heavy hitters in this space, and while they’re generally pretty generous, there are some weird quirks in their plans that can catch you off guard if you aren't paying attention.
💡 You might also like: Nail Fungus Pictures: Why Your Toes Look Like That and What to Do Next
The 100-80-50 Standard (And Where It Fails)
Most Ameritas plans—especially their PPO options—follow a classic math formula. You’ll hear brokers call it the "100-80-50" structure. Basically, it means they cover:
- 100% of Preventive Care: This is your cleanings, exams, and those bitewing X-rays that make you gag.
- 80% of Basic Procedures: Think fillings and simple extractions.
- 50% of Major Work: This is the heavy stuff—crowns, bridges, and root canals.
But here is the catch. That "100%" isn't always 100% of what your dentist charges. It’s 100% of what Ameritas thinks the procedure should cost in your zip code. If your dentist is a high-end specialist in downtown San Francisco charging $400 for a cleaning, and Ameritas says the "Usual and Customary" (U&C) rate is $200, you might still end up paying the difference. This is called balance billing, and it’s the number one reason people get grumpy with their insurance.
The Network Effect
If you stay "in-network," this problem mostly disappears. Ameritas has one of the largest networks in the country, and those dentists have already signed a contract saying, "Fine, I’ll take your lower rate." When you go out-of-network, Ameritas usually pays based on the 90th U&C percentile, which is actually better than many competitors who pay at the 80th or 50th. It means they cover what 9 out of 10 dentists in your area charge. Still, that 10th dentist could be yours.
Those Sneaky Waiting Periods
You can't just buy a plan on Monday and get a $1,500 porcelain crown on Tuesday. Well, you can, but Ameritas probably won't pay for it.
Most individual plans have waiting periods. For basic fillings, you might wait 6 months. For major work like bridges or dentures, it’s often 12 months. However, there’s a workaround. If you’re coming off another plan (like leaving a job where you had dental), Ameritas will often waive these waiting periods if you can prove you had "prior continuous coverage."
Also, if you're getting Ameritas through an employer, these waits are almost always non-existent. Employers want you productive, not nursing a toothache for a year.
The Secret Weapon: Dental Rewards
This is something Ameritas does that's actually pretty cool and kind of unique. Most dental plans have an annual maximum—usually between $1,000 and $2,000. If you hit that limit in August, you’re on your own until January.
Ameritas has a feature called Dental Rewards. If you visit the dentist at least once a year and your total claims stay below a certain threshold (usually $500 or $750), they let you roll over a portion of your unused maximum into the next year.
- Example: If your max is $1,500 and you only use $300 for a cleaning and a small filling, you might get to "bank" $250 for next year.
- The PPO Bonus: If you saw an in-network dentist, they might toss in an extra $100 or $150 bonus on top of that.
Over a few years, you could technically build up a "dental war chest" of $3,000 or more. This is huge if you know you’re going to need an implant or some major cosmetic work down the road.
What About the "Hard" Stuff?
Let’s talk about the things people actually worry about:
- Implants: Historically, dental insurance hated implants. They called them "cosmetic." Ameritas has moved away from that. Many of their newer 2026-era plans cover implants at the 50% "Major" rate, though they usually have a lifetime maximum for them.
- Orthodontics: Braces aren't just for kids anymore. Some Ameritas plans offer adult ortho, but it’s usually an "add-on" or a specific "PrimeStar" tier. Expect a $1,000 to $1,500 lifetime limit here. Once it’s gone, it’s gone.
- Teeth Whitening: Forget about it. Almost no traditional insurance covers whitening or veneers. That’s purely on you.
The "Late Entrant" Trap
If you skip open enrollment and try to sign up later in the year because your tooth suddenly hurts, Ameritas might label you a "late entrant." In some cases, this means they’ll only cover preventive care for the first 12 months. It’s their way of making sure people don't just "buy" insurance when the house is already on fire.
Real Talk on Costs
You're probably looking at a monthly premium between $25 and $60 for an individual. Family plans can easily hit $150.
📖 Related: How to Save a Life When Every Second Actually Counts
Is it worth it?
If you just go for two cleanings a year, you’re basically breaking even or losing a little money. But the insurance isn't for the cleanings; it’s for the $800 root canal you didn't see coming. Ameritas is solid because their "U&C" rates are generally higher than budget carriers, meaning less "surprise" math at the checkout desk.
Actionable Steps to Maximize Your Coverage
To get the most out of an Ameritas plan, stop treating it like a "set it and forget it" thing.
First, always ask for a "Pre-Treatment Estimate" for anything that costs more than a filling. Your dentist sends the plan to Ameritas, and Ameritas sends back a letter saying exactly what they’ll pay. This prevents that "I thought you covered 50%!" argument later.
Second, check your "Prior Coverage" status. If you are switching plans, get a "Certificate of Creditable Coverage" from your old insurer. Hand that to Ameritas immediately so they can kill those waiting periods.
🔗 Read more: How to drop water weight fast without ruining your metabolism
Third, stay in the network. Even if your favorite dentist is out-of-network, ask if they’ll match the Ameritas PPO fee schedule. Some will do it just to keep a loyal patient. If they won't, you’re paying the "freedom of choice" tax, which can be hundreds of dollars per visit.
Finally, use the Dental Rewards. Even if your teeth feel fine, go in for that December cleaning. If you don't file at least one claim, you might lose the ability to roll over your unused maximum, and that's just leaving money on the table.