Background Dental coverage for Iowa’s Medicaid expansion population is provided through the Dental Wellness Plan (DWP), implemented in May 2014. The plan targets healthy behavior incentives via an earned benefits structure, whereby additional services are covered if enrollees return every 6-12 months for routine dental visits. This study examines enrollee satisfaction with the DWP. Methods We surveyed a random sample of DWP enrollees 1 year after program implementation about their experiences. Survey items covered dental plan satisfaction, self-rated measures of health, and knowledge and attitudes toward the earned benefits approach. Results Dental plan satisfaction was rated as low by 38 percent of respondents (n = 416), moderate by 25 percent (n = 276), and high by 37 percent (n = 402). A majority of respondents (66 percent) did not know about the earned benefits structure. Regression analysis indicated that respondents most likely to have low plan satisfaction were those who felt it was difficult to earn benefits (OR 3.66, P < 0.001) and those who were unable to find (OR 3.17, P < 0.001), or did not try to find (OR 3.51, P < 0.001), a regular dentist in the plan. Conclusions Satisfaction with a new model of dental insurance was influenced by whether enrollees had a regular source of care and their perceived ability to return for regular checkups in order to earn covered benefits.