Most families in Colorado Springs carry some form of dental health coverage. Few know exactly what it pays for when their child actually needs a filling, a crown, or even just a first exam. That gap between having a plan and understanding it tends to show up at checkout, which is not a comfortable moment for anyone.
At Otter Kids Pediatric Dentistry, we work with ten insurance plans so that as many families as possible can access quality pediatric dental care without financial uncertainty. Our front desk team verifies benefits before your child’s appointment, walks you through expected costs, and helps you get the most out of your dental insurance coverage before treatment begins.
This guide covers every insurance plan we accept, what pediatric dental benefits generally look like under each one, and what you should know before scheduling your child’s visit. We also cover how full coverage dental plans actually work, what Medicare dental coverage does and does not include for children, and what your options are if your child’s care exceeds your annual benefit. Coverage terms vary by individual plan, employer, and enrollment type, so always verify your child’s specific benefits directly with your insurer.
How Dental Insurance Coverage Works for Children
Dental insurance coverage for children follows a tier structure that most plans share, even if the percentages differ across insurers.
Preventive services sit at the top of that structure. Exams, cleanings, fluoride treatments, and X-rays are generally covered at the highest rate, often at 100% when an in-network provider sees your child. You typically pay nothing out of pocket for these visits, which is exactly why we encourage families to bring children in twice a year even when nothing seems wrong. Early detection during a routine cleaning is far less costly than treating a cavity that has had time to grow.
Basic restorative services, such as dental fillings, fall in the middle tier. Most plans cover these after a deductible, with the insurer paying a percentage and the family covering the rest. Major services like crowns, extractions, and space maintainers have the highest cost share. Some plans also impose waiting periods before major service coverage activates, particularly for new enrollees.
Most private dental plans set an annual maximum benefit per child, typically somewhere between $1,000 and $2,000. Once your child reaches that cap in a given year, additional covered treatment becomes an out-of-pocket expense until the benefit year resets. Government programs like Medicaid and the TRICARE Dental Program operate differently and do not apply a dollar cap on the annual maximum in the same way private plans do.
Why In-Network Status Matters More Than Plan Type
When you bring your child to Otter Kids, you are already working with an in-network provider across all the plans we accept. That distinction has a real dollar impact on your family.
In-network providers have agreed to contracted fee schedules with insurers. When your child’s treatment is billed against that schedule, your insurer pays its portion of the contracted rate, and your cost share is calculated based on that lower amount. If you take your child to an out-of-network provider, the insurer still pays its percentage, but it applies that percentage to a different, often lower, allowable amount. The provider then bills you for the difference. That gap is called balance billing, and it can add significantly to what you owe.
Staying in-network is one of the simplest ways to keep your child’s dental costs predictable. We make that easy across all ten plans we accept.
1. Delta Dental: Colorado’s Largest Pediatric Dental Network
Delta Dental of Colorado is the state’s leading dental benefits company and a nonprofit focused on improving oral health statewide. For families in Colorado Springs, that means a wide network of providers and consistent in-network access to routine and specialized pediatric dental care.
On individual Delta Dental plans, preventive care is generally covered at 100% in-network. Your child’s exams, cleanings, X-rays, and fluoride treatments are included at no out-of-pocket cost. Restorative and major services are covered at lower percentages, depending on the plan tier you are enrolled in.
One provision worth knowing if your child is young: Delta Dental of Colorado’s Right Start 4 Kids program provides 100% in-network coverage for enrolled children up to their 13th birthday. Dental coverage is also free for enrolled children under age five. If you have been putting off scheduling your toddler’s first dental visit because of cost concerns, this program removes most of that barrier.
2. Anthem Blue Cross Blue Shield: No Waiting Periods on Pediatric Essentials
In Colorado, Anthem Blue Cross and Blue Shield is the operating trade name of Rocky Mountain Hospital and Medical Service, Inc., making it the state’s primary Blue Cross Blue Shield affiliate. Many Colorado Springs families access their dental health coverage through employer-sponsored Anthem group plans.
What sets Anthem’s pediatric dental coverage apart for new enrollees is the absence of waiting periods on services included in the Pediatric Dental Essential Health Benefit. Most adult dental plans impose a waiting period before basic or major services are covered. With Anthem’s pediatric plans, your child’s covered essential services are available from the first day of coverage, which matters when your child needs care right away.
Pediatric essential health benefits through Anthem are covered for children up to age 18 in Colorado. If your child has ongoing treatment needs, such as care related to cleft lip and palate or another longer-term condition, confirm benefit eligibility with Anthem before their 18th birthday so care can continue without interruption.
3. United Concordia / TRICARE: Dental Insurance Coverage for Military Families
For military families stationed near Fort Carson, the TRICARE Dental Program (TDP) is the primary source of dental insurance coverage for dependents. If you have TRICARE medical coverage and assumed dental was included, it is not. Dental benefits require separate enrollment through TDP, and this is a detail many families miss when they first arrive at a duty station.
United Concordia administers the TRICARE Dental Program and covers eligible active-duty family members, as well as National Guard and Reserve members and their families. To be eligible, your sponsor must have at least 12 months remaining on their military commitment at the time of enrollment. Covered family members include spouses and children up to age 21, or age 23 for full-time students. Enrollment runs for a minimum of 12 months.
Costs include monthly premiums and cost-shares that vary based on your sponsor’s military status and the enrollment type you select. Staying within the United Concordia provider network keeps those cost-shares lower.
Dr. Ken Otterstedt serves as an active-duty Navy dentist. He understands what military families face, from managing benefits across duty stations to fitting appointments around deployment schedules. We welcome TRICARE families at our Colorado Springs locations and work with you to make the most of your TDP benefits.
4. Medicaid / CHP+: Full Coverage Dental Plans for Qualifying Colorado Children
If your child is enrolled in Medicaid in Colorado, their dental benefits are broader than most families expect. Medicaid is not a minimal-care program for children. It is one of the most comprehensive full-coverage dental plans available in the state for qualifying families.
Medicaid dental services for children in Colorado include routine cleanings and check-ups, fluoride applications, dental sealants, fillings, crowns, extractions, and other essential treatments. Two preventive visits are covered per year, with additional care available as needed based on your child’s clinical needs. There is no annual dollar cap, unlike private plans.
If your family income falls above Medicaid eligibility limits but private insurance is not affordable, your child may qualify for CHP+ (Child Health Plan Plus). CHP+ dental benefits, administered by DentaQuest, cover diagnostic services such as exams and X-rays, preventive services including cleanings, fluoride, and sealants, up to $1,000 per benefit year. Medically necessary orthodontic treatment is also covered after 12 continuous months of CHP+ enrollment.
We accept both Medicaid and CHP+ at our Colorado Springs locations. Children receiving care for special dental health needs are well served under both programs. Check your eligibility at Colorado’s PEAK portal.
5. MetLife: Full Coverage Dental Insurance with Tiered PPO Plans
MetLife is one of the largest dental networks in the United States and a plan that many Colorado Springs families access through employer benefits. For parents comparing full-coverage dental insurance options, MetLife’s tiered PPO structure lets you balance premium costs against benefit depth.
MetLife pediatric dental plans typically cover preventive services at 100% in-network, including cleanings, exams, fluoride treatments, and X-rays. Restorative treatments such as fillings, crowns, and space maintainers are covered at rates that vary by plan tier. MetLife also offers a rollover benefit on select plans, allowing unused portions of your annual maximum to roll over into the following benefit year. For families who anticipate restorative work in the near future, this can meaningfully increase the coverage available to them.
Waiting periods and annual maximums vary by tier and employer plan configuration. Confirm those details with MetLife directly before scheduling restorative treatment for your child.
6. Humana: Dental Health Coverage Built Around Preventive Care
Humana offers both PPO and DHMO dental plan options, and the structure of your coverage depends on which type your employer or marketplace enrollment provides.
On preventive services, Humana’s dental health coverage is consistent across most plan types. Two cleanings and exams per year, annual X-rays, fluoride treatments, and sealants are generally covered at no additional cost when your child is seen in-network. These services typically do not count toward a deductible, which keeps routine visit costs low and predictable for your family.
For restorative and major services, coverage percentages and annual maximums vary by plan. Humana’s federal employee dental plan has an unlimited annual maximum, but employer-sponsored and marketplace Humana plans have separate caps. Verify which plan type you carry and what annual maximum applies before scheduling any restorative treatment.
7. UnitedHealthcare: In-Network Pediatric Dental Health Coverage
Otter Kids is an in-network provider under UnitedHealthcare. Families with UHC dental benefits can access our full range of pediatric dental services without out-of-network cost penalties.
UnitedHealthcare’s Essential Health Benefit plans, established under the ACA, include dental care for children generally up to age 19. UHC pediatric dental plans typically cover preventive services such as cleanings, exams, fluoride, and sealants, as well as restorative care, including fillings, crowns, and space maintainers. Specific percentages, annual maximums, and waiting periods depend on your individual UHC plan.
Our team will verify your child’s UHC benefits before the appointment so you know what to expect before any treatment begins.
8. Aetna: Dental Insurance Coverage with Strong Preventive Benefits
Aetna offers both PPO and DHMO dental plan options, and families with employer-sponsored Aetna dental insurance coverage typically find strong in-network preventive benefits for their children. Routine cleanings, exams, fluoride treatments, and X-rays are generally covered at a high rate in-network, with little to no cost-sharing for your family on those visits.
Out-of-network care under Aetna typically receives substantially lower reimbursement, so keeping your child’s care with an in-network provider makes a meaningful difference in cost. Some newer Aetna plans subject to ACA requirements also include medically necessary orthodontic coverage for children under a pediatric oral health benefit. This applies in specific clinical situations rather than as a general orthodontic benefit, so confirm your plan’s provisions with Aetna if your child may need orthodontic treatment.
9. Cigna: Extended Pediatric Coverage Through PPO and DHMO Plans
We also offer dedicated information on insurance benefits for families with Cigna dental plans.
Cigna’s DHMO plans carry no deductibles before coverage begins, no annual dollar maximums on covered services, no claim forms, and no waiting periods. Referrals are not required for network pediatric dentists for children aged 13 and under. If you want straightforward dental health coverage without tracking annual caps or deductibles, a Cigna DHMO plan is worth comparing against PPO alternatives when you next have an open enrollment opportunity.
Pediatric coverage through Cigna may continue through the end of the calendar year in which your child turns 19. That extended age range matters for teenagers undergoing orthodontic treatment, undergoing wisdom tooth evaluations, or who are active in contact sports, where dental injuries are more likely. Most Cigna plans limit cleanings and bitewing X-rays to two per calendar year and full-mouth or panoramic X-rays to once every three calendar years.
What “Full Coverage Dental Plans” Actually Mean for Your Child
The term “full coverage dental plans” is widely used in insurance marketing but lacks a standardized definition. In practice, it refers to a plan that covers all three service tiers: preventive, basic restorative, and major services. It does not mean every service is paid at 100%.
Even the broadest full coverage dental insurance plan still applies coinsurance, annual maximums, deductibles, and frequency limits. A plan that covers a crown does not necessarily cover it at 100%. Most major service coverage falls in the 50% to 80% range depending on the plan tier. Annual maximums cap the total benefit available per child per year.
When you are evaluating full coverage dental insurance for your family, focus on these four things before enrolling:
- What is the annual maximum per child?
- What coinsurance percentage applies to restorative and major services?
- Are there waiting periods on basic or major services for new enrollees?
- Is your preferred pediatric dentist in-network?
If your child’s treatment costs exceed the plan’s annual maximum, ask Dr. Ken about phasing non-urgent work across benefit years. For families without insurance, our membership plans offer a straightforward self-pay alternative with predictable costs.
What Happens When Your Child Needs Care Beyond Routine Visits
Preventive visits are the foundation of your child’s dental health, but dental needs do not always stay routine. A fall, a deep cavity, or a developmental concern can mean your child needs restorative or specialized treatment, sometimes in the same benefit year as their regular cleanings.
When that happens, knowing your plan’s cost structure in advance puts you in a much better position. We recommend calling your insurer and requesting a pre-treatment estimate before any major procedure. This is a formal process in which the insurer reviews a proposed treatment plan and informs you in writing of what it expects to pay and your cost share. It is not a guarantee of payment, but it gives you a realistic picture before treatment begins.
We can also help with this process from our end. Our team submits pre-authorization requests on your behalf when required, follows up with your insurer, and explains what the response means for your out-of-pocket costs before you make any treatment decisions.
A Note on Medicare Dental Coverage and Children
Medicare dental coverage is one of the most searched dental insurance terms, so it is worth addressing directly here. Traditional Medicare (Parts A and B) does not cover routine dental care for children. Medicare is designed for adults aged 65 and older and for qualifying individuals with certain disabilities. Children are not typically Medicare enrollees.
If you are searching for Medicare dental coverage for a child in Colorado Springs, the programs to research are Medicaid (Health First Colorado) and CHP+, both covered in detail above. Adults enrolled in Medicare who are looking for their own dental coverage can compare plan options on the official website.
No Insurance? Here’s What We Offer For You
Not every family has dental insurance coverage, and we do not think that should stand between a child and good dental care. Our membership plans are designed for families who are self-pay or whose insurance does not cover everything their child needs.
Membership plan benefits include routine preventive visits, discounts on restorative services, and predictable annual pricing with no claims to file and no annual maximums to track. It is a straightforward option for families who want quality pediatric dental care without the complexity of navigating insurance benefits.
Book Your Child’s Appointment at Otter Kids
We accept Delta Dental, Anthem Blue Cross Blue Shield, United Concordia/TRICARE, Medicaid, MetLife, Humana, UnitedHealthcare, Aetna, and Cigna at our Colorado Springs locations. Our team will verify your child’s dental insurance coverage before the visit and walk you through any expected costs.
Whether your child is due for a routine cleaning, a first visit, or needs restorative treatment, scheduling is straightforward. Dr. Ken Otterstedt and the Otter Kids team are here to make every appointment a positive experience for your child and a clear, stress-free process for you.
Frequently Asked Questions
We accept Delta Dental, Anthem Blue Cross Blue Shield, United Concordia/TRICARE, Medicaid (Health First Colorado and CHP+), MetLife, Humana, UnitedHealthcare, Aetna, and Cigna. For families without dental insurance coverage, we also offer membership plans. Contact our office to confirm your specific plan before scheduling.
Yes. The TRICARE Dental Program, administered by United Concordia, covers eligible active-duty family members as well as National Guard and Reserve members and their families. TDP enrollment is separate from your TRICARE medical coverage and must be completed before dental benefits activate. We welcome TRICARE families at our Colorado Springs locations.
Medicaid dental services for children in Colorado include routine cleanings, check-ups, fluoride applications, dental sealants, fillings, crowns, and extractions, with two preventive visits covered per year and additional care as needed. Children who do not qualify for Medicaid may be eligible for CHP+, which provides up to $1,000 in dental benefits per benefit year.
No. Traditional Medicare does not cover routine dental care for children. For children in Colorado, the relevant programs are Medicaid (Health First Colorado) and CHP+. Adults enrolled in Medicare who are seeking their own dental coverage can visit Medicare’s official website to use plan comparison tools.
Full coverage dental plans typically cover all three service tiers: preventive, basic restorative, and major. However, coinsurance, annual maximums, deductibles, and frequency limits still apply. Full coverage dental insurance does not mean every service is paid at 100%. Always review your actual benefits summary before scheduling restorative or major treatment.
Yes. In Colorado, Anthem Blue Cross and Blue Shield is the operating trade name of Rocky Mountain Hospital and Medical Service, Inc. Anthem is the local BCBS affiliate. If your insurance card shows either name, your dental health coverage is through the same Colorado-based carrier.
Once the annual maximum is reached, additional covered services become out-of-pocket expenses until the next benefit year resets. We can help you phase non-urgent treatment across benefit years to keep costs manageable. Our membership plans are also available as a self-pay alternative.
Some restorative and major procedures require prior authorization from your insurer before treatment can begin. Our team handles the pre-authorization process on your behalf, submits the necessary documentation, and explains what your insurer’s response means for your costs before any decision is made.
