Dental insurance works much like other forms of medical insurance, helping you pay for certain dental treatments and procedures. In return for your premium payments, dental insurance will pay a portion of your covered dental costs.
Common covered services include preventive care, such as cleanings and examinations, emergency treatments, fillings, and X-rays. Depending on the terms of your policy, dental insurance will pay the service provider directly or reimburse you for covered costs.
Key Takeaways
- Dental insurance helps individuals and families cover the cost of dental care and treatments.
- There are different types of dental insurance plans available, including indemnity plans, PPOs, and HMOs.
- Dental insurance offers benefits such as cost savings, access to preventive care, and coverage for major dental procedures.
- It is important to understand the coverage and limitations of dental insurance plans, including waiting periods and annual maximums.
- Alternatives to dental insurance, such as dental discount plans and dental savings accounts, can provide other options for financing dental care.
How Dental Insurance Works
Dental insurance shares the costs of your dental care in exchange for premium payments. Common dental insurance plan terms include:
- Premiums: This is the payment you must make to continue dental insurance coverage. Depending on your policy, you must make premium payments monthly, semiannually, or annually.
- Deductible: The deductible is the annual amount of money you must pay out of pocket before your dental insurance starts sharing costs. For example, if your policy has a $500 deductible, each year you must pay the first $500 of costs before your insurance kicks in.
- Coinsurance: Typically, you must make a coinsurance payment when you receive services. For instance, if your policy covers 80% of the cost of a covered treatment, you must pay the remaining 20%. Usually, you must pay coinsurance directly to the service provider.
- Copayments: A copayment is a fixed amount you must pay when receiving dental treatments. For instance, a policy might require you to pay a $25 copayment for dental cleaning and examination appointments. Depending on the terms of your policy, copayments may or may not count towards your annual deductible.
- Annual coverage maximum: Dental insurance plans set an annual limit on the amount of money they will pay for services. For instance, a policy might have a $2,000 annual coverage limit, meaning it will only pay up to $2,000 in dental costs throughout the policy year.
- Waiting period: Typically, dental insurance plans have a waiting period. This is the amount of time you must wait for the dental insurance to start covering your costs. For example, a plan might have a six-month waiting period, which means coverage would begin six months after enrollment.
What Is Covered and Not Covered
Comprehensive dental insurance plans cover preventive, basic, and major care. You can find cheaper policies that just cover one or two levels of care, though. And even comprehensive dental insurance excludes certain types of services.
| Dental Service | Covered | Not Covered |
|---|---|---|
| Routine cleaning and examination | X | |
| Routine X-rays | X | |
| Toothaches | X | |
| Gum disease treatments | X | |
| Fillings | X | |
| Tooth extractions | X | |
| Root canals | X | |
| Crowns | X | |
| Implants | X (some policies) | |
| Dentures | X | |
| Oral surgery | X | |
| Emergency procedures | X | |
| Bridges | X | |
| Orthodontic treatments such as braces | X (some policies) | |
| Cosmetic procedures such as veneers and teeth whitening | X | |
| Pre-existing conditions such as missing teeth | X |
Benefits of Dental Insurance
“The primary benefit of dental insurance is financial protection against high dental care costs,” said Brandon Plombon, an insurance agent at Plombon Insurance in Eden Prairie, Minnesota. “It helps individuals and families afford routine check-ups, preventive care, and various dental treatments that might otherwise be expensive.”
For instance, if you usually pay $200 twice a year for a dental examination and cleaning, you can forgo that expense if you carry a dental plan. Regular appointments serve a higher purpose than just a nice smile; they also enable a dentist to examine your mouth for serious problems, like throat cancer. Likewise, proper dental care can potentially play a role in avoiding other health problems by identifying harmful bacteria in your bloodstream, which can contribute to serious issues such as diabetes and heart disease.
Some plans also include fluoride treatments in their pediatric preventive care benefits, ensuring children can get a head start on good oral health. By maintaining good dental health, children may avoid trips to the emergency room for ailments such as toothaches and may evade problematic issues such as eating and speech problems.
Types of Dental Insurance Plans
Insurers offer various types of dental insurance plans. Common dental insurance plans include:
- Dental preferred provider organization (DPPO): Like health insurance PPOs, DPPOs feature a network of approved providers. These dentists are under contract to provide services at a set rate for policyholders. You can still see out-of-network dentists, though costs could be higher than if you see those on the approved list. Normally, DPPO plans impose an annual coverage limit, coinsurance or copayments, and a deductible.
- Dental health maintenance organization (DHMO): Similar to health insurance HMOs, DHMOs limit you to only seeing dentists on the approved provider list. These dentists have agreed to provide care at no cost or a reduced cost to policyholders, but there tend to be far fewer of them in DHMO networks than in DPPO networks. In exchange for this restriction, DHMOs usually do not impose an annual coverage limit or deductible. Plus, some DHMOs do not require copayments.
- Indemnity/fee-for-service plans: An indemnity plan allows you to choose any dentist you like, and the insurer will reimburse you for a percentage of service costs. Typically, indemnity plans impose maximum allowances for the permitted cost of each type of dental service.
Different dental insurance plans help fit the needs of different types of patients. A DHMO or DPPO might help your family save more on dental costs, provided you are fine with seeing a dentist on the plan network. An indemnity plan, on the other hand, can give you the flexibility to see whichever dentist you like, though the insurance costs could be higher.
“When selecting a dental plan, consider factors like cost, coverage for routine and major procedures, in-network dentists, annual maximums, waiting periods, and exclusions,” Plombon said. “Choose a plan that best aligns with your dental care needs and budget.”
Coverage and Limitations
Many plans include annual coverage limits, exclusions, and waiting periods. To understand these policy terms, read your plan’s fine print and ask lots of questions. Otherwise, you could end up footing the entire bill for your dental services.
Annual Coverage Limits
Many dental insurance plans have annual coverage limits. The limit is the maximum amount of benefit the policy will pay for dental services during the plan year. For instance, if your policy has a $2,000 limit and you file claims for $2,000 in the first eight months of the plan year, you’ll have to pay 100% of all dental costs until the beginning of the next plan year. Plan years typically span a 12-month period.
Often, plans with low annual coverage limits feature lower premiums than those with higher limits. For example, a dental plan with a $1,250 annual limit might cost $111 per month, while a plan with a $750 limit costs $55 per month. Choose a limit that best fits your needs. If you prefer keeping monthly costs low by choosing a lower annual coverage limit, be prepared to pay more out of pocket for dental services.
Costs that impact your annual coverage limit can include those for services such as crowns, extractions, fillings, and root canals. Preventive services, such as cleanings and examinations, may not count toward your annual coverage limit, depending on the terms of your policy.
Waiting Periods
With many dental insurance plans, you must wait for benefits to take effect. So, if your plan has a 12-month waiting period, you can only receive benefits for services such as a filling or root canal 12 months after enrollment. However, some policies do not impose a waiting period on preventive care, such as cleanings and examinations.
Not all dental plans impose waiting periods. Usually, a waiting period affects new enrollees and does not apply when you switch to a new plan with the same provider. Certain providers also offer plans that have no waiting periods for anyone on any covered dental service.
Exclusions
Dental insurance plans usually come with a long list of services they do not cover. Exclusions vary by insurer, so make sure you know what a plan will cover before you enroll. Common exclusions can include:
- Cosmetic procedures with no medical benefits, such as teeth whitening or veneers
- Hospitalization
- Dental services sought outside the United States, unless due to an emergency
- Prescription or non-prescription drugs
- Night guards
- Duplicate dentures
- Reconstructive surgery
Finding Dental Insurance
“You can find dental insurance plans through private insurance companies, employers, or through government health insurance marketplaces in some regions,” Plombon explained. “Research online, compare plans, and consider consulting with insurance agents or brokers for guidance.”
If you purchase a health insurance plan through the government-sponsored Health Insurance Marketplace, you can also sign up for dental insurance. The federal Marketplace enables you to purchase a health plan that includes dental coverage or enroll in a separate dental plan.
Find out if your employer offers a group dental insurance plan. Often, companies pay a portion of their employees’ insurance costs, and group plans may provide higher coverage limits. Some professional organizations also sponsor group dental plans for their members.
You can also purchase an individual dental insurance plan. Many major insurers offer DHMO and DPPO plans. When shopping for a dental plan, get quotes from several insurers before making your decision.
To get the best bang for your buck in a dental plan, always:
- Consider all available options, including employer, individual, and Marketplace plans.
- Compare annual coverage limits, coinsurance terms, deductibles, premiums, and waiting periods.
- Make sure the insurer you choose holds a license to sell dental insurance in your state.
- Choose an affordable plan that fits the dental needs of you and your family.
Alternatives to Dental Insurance
“For those without dental insurance, alternatives like dental savings plans, discount dental plans, or paying out-of-pocket might be considered,” Plombon said. “Some dental offices also offer in-house membership plans for reduced costs on services.”
Discount Dental Plans
Discount dental plans are like membership programs. You pay plan fees and in return receive discounted dental services from participating dental providers. When you visit the dentist, you pay the entire bill, but at a lower rate than non-members. For example, a family plan might charge a membership fee of $16 per month and offer discounts of 20% to 50% for cleaning, examination, extraction, filling, root canal, and X-ray services.
Dental Savings Plans
Dental savings plans also offer discounts to their members. You pay an annual membership fee and receive discounted dental services through a network of participating dentists. For instance, a dental savings plan might offer its members a complete set of dentures for $950, compared to the non-member price of $1,600.
Dental savings plans and discount dental plans have advantages and disadvantages. If you’re relatively young and only need basic dental care, these alternatives might provide the services you need, while offering savings. Unlike most dental insurance plans, discount dental and dental savings plans do not require a waiting period, giving you access to services upon enrollment. However, these alternatives might not give you access to a broad network of dentists and may not provide the type of comprehensive care you and your family might need.
Is Dental Insurance Necessary?
“While not mandatory, dental insurance can be highly beneficial in offsetting the costs of dental care,” Plombon said. “Regular dental check-ups and preventive care can help avoid more expensive treatments in the future.”
Whether it's a good investment for you depends on the kind of care you need and the plan you choose. The average premium for the top six dental insurance companies we reviewed is $35 a month, or about $420 a year. Without the coverage, you'll pay an average of about $250 to $285 for two cleanings and one examination, plus another $200 to $400 for X-rays. If you need a filling, you can expect to pay about $150 out of pocket; if a tooth requires a crown, you’ll pay more than $1,000.
The best dental plans might cover 80% of the filling cost and half the cost of the crown, so you'll still have out-of-pocket expenses, but you'll come out ahead nevertheless. Just be sure to read the plan carefully because lower coverage amounts or exclusions can make a big difference in your total costs.
How Much Does Dental Insurance Cost?
We surveyed 13 insurance companies in El Paso, Texas, and Los Angeles, comparing the cost of their lowest-premium PPO plans that include coverage for preventive, basic, and major services. Premiums ranged from around $16 to $61 per month, with an average cost of $35.
Dental insurance premiums can vary based on their annual coverage limits, coinsurance and copayment requirements, and deductibles. For the most accurate premium estimate, request insurance quotes from several insurers.
Does Dental Insurance Cover Orthodontic Treatment?
“Orthodontic treatment, such as braces, may be covered by some dental insurance plans but often with limitations, waiting periods, or specific conditions,” Plombon explained.
When shopping for dental insurance, carefully read the fine print to understand what’s covered and what isn’t. Some plans cover traditional metal braces, clear braces, clear aligners, and retainers. Often, plans only extend orthodontic coverage to children, but not adults. Policies that cover orthodontic care may impose waiting periods between treatments, along with lifetime coverage limits. A plan might also exclude procedures necessary for orthodontic treatments, such as jaw surgery.
Can I Use Dental Insurance for Cosmetic Dentistry Procedures?
Typically, dental insurance does not cover cosmetic dentistry. However, some policies might cover cosmetic treatments in situations where the treatment is considered medically necessary. For example, you might need restorative dental work following an accident.
The Bottom Line
Dental insurance can help offset the high cost of dental care. More importantly, it can help you maintain good oral health. Insurers offer a variety of traditional and alternative dental plans to fit the needs and budgets of most individuals and families. Some employers offer employee dental plans, or you can purchase a policy independently or through a government-sponsored marketplace. Having dental insurance tends to make people more likely to get proper care, which can prevent serious dental and health problems later in life.
Article Sources
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American Dental Association. "Types of Dental Plans."
New York State of Health. “2024 Dental Plan Comparison Tool.”
Healthcare.gov. "Dental Coverage in the Marketplace."
Aetna. "The Difference Between Dental Insurance and Dental Savings Plans."
