Aetna Dental® Direct Preferred PPO

Aetna Dental has over 50 years of experience offering dental benefits. With Aetna Dental Direct, you’ll get the coverage you need to keep your teeth healthy. The plan offers preventive treatment at 100% with no out of pocket cost. You can choose from one of the more than 420,000 dentist locations in the Aetna Dental PPO network. Caring for your teeth should never feel out of reach with Aetna Dental Direct.

Here are some dental insurance plan benefits.

Preventive care

100% coverage for preventive services when you see an in-network dentist (waiting periods waived)

Basic procedures

Basic services are covered at 80% with in-network dentist (after deductible)

Major procedures

Major services are covered at 50% with in-network dentist (after deductible)

Annual maximum benefit

$1,250 per person in-network or $1,000 to $1,250 out of network, depending on state

Annual deductible

$50 per person; $150 per family, per calendar year (waived for preventive care)

Waiting periods

6 months for basic services*; 12 months for major services (waived with prior dental insurance)

Additional savings

Access to CVS® ExtraCare Plus™ membership at no extra cost including a $10 monthly reward* (Available in most states)

Choose any dentist

See dentists both in and out of network

Virtual dental care through Dental.com

 Using SmartScan™ technology, and access to oral health products.

Now let’s see what this dental insurance plan includes.

Dental insurance plans are underwritten by Aetna Life Insurance Company.

This is only a summary of the plan’s exclusions and limitations. See the insurance policy for details.

Charges for services or supplies

Provided by an out-of-network provider in excess of the recognized charge.
Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider.
Rendered before the effective date or after the termination of coverage, unless coverage is continued under the Special coverage options after your plan coverage ends section of your policy.
Cancelled or missed appointment charges or charges to complete claim forms.
For which you have no legal obligation to pay.
In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits.
That would not be made if you did not have coverage.
That are cosmetic in nature. Teeth whitening and facings on molar crowns and pontics will always be considered cosmetic.
That are experimental or investigational.
That are not medically necessary.
For prescribed drugs, pre-treatments or analgesia.
That are provided by a family member.
For work-related conditions.
For work that began before you were covered under the plan

The following dental services and supplies

Acupuncture, acupressure and acupuncture therapy
Crown, inlays and onlays, and veneers unless for one of the following:
– It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material
– The tooth is an abutment to a covered partial denture or fixed bridge.
Dental implants, false teeth, prosthetic restoration of dental implants, plates, dentures, braces, mouth guards, and other devices to protect, replace or reposition teeth and removal of implants
Dental services and supplies made with high noble metals (gold or titanium) except as covered in the Eligible Dental Services section of your insurance policy
Dentures, crowns, inlays, onlays, bridges, or other appliances or services used for the purpose of splinting, to alter vertical dimension, to restore occlusion, or correcting attrition, abrasion, or erosion
First installation of a denture or fixed bridge, and any inlay and crown that serves as an abutment to replace congenitally missing teeth or to replace teeth all of which were lost while the person was not covered
General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service
Instruction for diet, plaque control and oral hygiene
Orthodontic treatment except as covered in the Eligible Dental Services section of your insurance policy
Replacement of a device or appliance that is lost, missing or stolen, and for the replacement of appliances that have been damaged due to abuse, misuse or neglect and for an extra set of dentures
Replacement of teeth beyond the normal complement of 32
Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services
Surgical removal of impacted wisdom teeth when only for orthodontic reasons
Temporomandibular joint dysfunction/disorder.

Aetna Dental Direct PPO Plans are Subject to the Following Rules:

Replacement Rule

The replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if specific criteria are met.

Tooth Missing But Not Replaced Rule

Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures, fixed bridgework and other prosthetic services are:

needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and
are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years.

Alternate Treatment Rule

If more than one service can be used to treat a covered person’s dental condition, Aetna may decide to authorize coverage only for a less costly covered service. If treatment is being given by a participating dental provider and the covered person asks for a more costly covered service than that for which coverage is approved, the specific copayment for such service will consist of:

the copayment for the approved less costly service; plus
the difference in cost between the approved less costly service and the more costly covered service.

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Aetna Dental® Direct Preferred PPO FAQ

What is dental insurance?

Dental insurance is a type of health insurance designed specifically to cover costs associated with dental care. It typically covers a portion of the cost of preventive care, diagnostics, and treatments, helping to reduce out-of-pocket expenses for dental services.

How does dental insurance work?

Dental insurance plans usually involve paying a monthly premium in exchange for coverage. These plans often come with a deductible, which is the amount you pay out-of-pocket before your insurance starts to cover costs. After meeting the deductible, you may still be responsible for a co-pay or a percentage of the service cost (coinsurance), depending on the plan’s structure.

What is a dental insurance waiting period?

A waiting period is the time you must wait after purchasing dental insurance before you can use certain benefits. Don’t wait until you need dental insurance to purchase it, as you may have to wait 6-12 months to access savings on all dental procedures. Waiting periods can vary by plan, are associated with PPO dental insurance, and are typically for basic and major procedures, there is no waiting for preventive care such as checkups and cleanings. The waiting period may be waived with proof of prior dental insurance.

Can I see any dentist with an Aetna Dental® Direct Preferred PPO insurance plan?

Yes, this is a PPO dental insurance plan, so you can see any dentist that accepts your insurance. But you will save more if you see a dentist who is in-network. With more than 420,000 dentist locations in the Aetna Dental PPO network, it should be easy to find a dentist near you.

Can I use an Aetna dental savings plan if I need emergency dental care?

Yes, Aetna dental savings plans are an excellent way to manage the costs of emergency dental procedures. Since, unlike dental insurance, there are no waiting periods, you can use the plan within 72 hours of joining (emergency activations may also be available.)

How does the plan help members manage their benefits?

The Aetna Dental® Direct Preferred PPO plan provides tools through Aetna-affiliated websites to help members review plan benefits, check claims, and find in-network dentists, ensuring a smooth experience.

Can this plan be used alongside other insurance coverage?

Yes, this plan allows for coordination of benefits with other dental insurance plans. This process helps determine the portion of costs covered by each plan, potentially reducing your out-of-pocket expenses. Please note that the other plan you are coordinating with must also allow for coordination of benefits.

How can I find an in-network dentist?

Members can access a list of participating dentists via DentalPlans.com’s directory or Aetna directly. Visiting a network dentist ensures you receive the full benefits of the plan while keeping costs as low as possible.

Are treatment codes used to determine coverage?

Yes, treatment coverage is determined using standardized codes, including CDT codes where applicable. These codes help define what is covered under the plan and ensure consistency in processing claims.

Does the plan offer any additional benefits or discounts?

Yes, plan members can access virtual dental care for emergencies and preventive screenings through Dental.com. Members also gain access to the CVS ExtraCare Plus™ program, offering exclusive savings on select health and wellness products, as part of their plan membership.

Aetna Dental® Direct Preferred PPO

Individual plan benefits

Annual maximum: $1,250
Earliest activation: TBD
Annual deductible: $50 Individual / $150 Family
No waiting periods for preventive

Join this plan

Aetna Dental® Direct Preferred PPO

Individual plan benefits

Annual maximum: $1,250
Earliest activation: TBD
Annual deductible: $50 Individual / $150 Family
No waiting periods for preventive

Join this plan

Prices may vary by age and ZIP code.

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Here are some dental insurance plan benefits.

Now let’s see what this dental insurance plan includes.

Want this information in an email?

Aetna Dental® Direct Preferred PPO FAQ

Let's find a plan near you.

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO

Aetna Dental® Direct Preferred PPO