Dental insurance is a unique type of coverage for two reasons: It’s more transparent than health insurance, and it focuses on prevention. Since dental disease is often preventable, insurers cover routine checkups and basic care to diagnose and treat issues before they become bigger problems. Compare the different types of dental plans available, what they cover and how much they cost.
When you’re comparing private dental insurance policies, consider the following factors:
Is my current dentist or specialist in-network?
How much does the policy cost, including premiums, copays and deductibles?
What is the annual coverage maximum?
Does the policy have a waiting period?
How long does the coverage last?
Are there any policy exclusions or limitations on pre-existing conditions?
Do I anticipate needing braces or aligners? If so, does the policy cover orthodontic work?
Does the policy offer emergency coverage in case I need dental care while I’m away from home?
How to get dental insurance
You can enroll in dental insurance year-round. Dental insurance plans typically last at least a year, and you have the option to renew your policy or switch insurers when it expires. To apply for a dental policy:
1. Sign up for a policy through your employer.
Many employers offer group dental insurance as part of their workplace benefits. Your premiums are subsidized, making this a cost-effective option — but the coverage isn’t typically customizable.
2. Enroll in a policy through an association.
Similarly, some clubs and associations — like AARP — partner with dental insurance companies to offer policies at discounted rates.
3. Go to an insurer directly.
By shopping around on your own, compare policies and rates to make sure you’re getting the best coverage at the lowest possible price. Enlist an insurance agent or broker to help you narrow down your options.
4. Apply for coverage via the Health Insurance Marketplace.
Thanks to the Affordable Care Act, you can apply for a subsidized policy through HealthCare.gov — it offers standalone dental plans as well as health insurance plans with dental benefits. The site guides you to a state or federal marketplace, where you can look for a policy that suits your budget and dental needs.
Compare dental insurance companies
How much does dental insurance cost?
It depends on the type of plan you have and where you live. But on average, expect to pay between $15 and $50 a month for coverage — or $180 to $600 a year.
If you need dental work beyond preventative care, ask your dentist for a pretreatment estimate. This helps calculate how much you owe after you pay your copay and hit your deductible and annual maximum.
What does dental insurance cover?
The list of included services varies between plans, and read through your policy documents to find out what yours covers. Typically, plans cover two routine checkups annually, but you can expect to pay some out-of-pocket costs if you need more serious dental work, like fillings or braces.
Most dental insurance plans follow the 100/80/50 payment structure, which dictates how much the insurer pays for each type of service. Under this structure, all dental work falls into one of three categories: preventative, basic and major. If you need a dental procedure that isn’t considered preventative care, your dentist’s office sends your insurer a bill. Your insurer then charges you for the percentage of the procedure your plan doesn’t cover.
Type of dental care
What’s covered?
Percentage insurer pays
Preventative and diagnostic care
Routine checkups
Teeth cleanings
Fluoride treatments
Sealants
X-rays
100%
Basic restorative procedure
Fillings
Extractions
Periodontal work
Gum disease treatments
Nonroutine X-rays
80%
Major restorative procedures
Oral surgeries
Crowns
Root canals
Inlays
Outlays
Implants
Periodontal treatments, like soft tissue infection repairs
Orthodontic treatment, like space maintainers, braces and aligners
Prosthodontics, such as dentures and bridges
50%
What’s not covered by dental insurance?
Dental insurance only covers medically necessary services, as well as treatments that help you to maintain tooth and gum health. Check your policy’s exclusions to confirm if that’s the case with your plan.You’ll typically need to pay for these services out-of-pocket:
Composite fillings — ceramic or resin fillings that match the color of your teeth, instead of amalgam or metal fillings. Some plans will cover part of the cost or will only pay for these fillings in non-molar teeth.
Pre-existing conditions — your insurer may not pay for dental care related to a pre-existing condition you had before enrolling in your policy.
Which type of dental plan is right for me?
There are three types of dental plans available: Preferred Provider Organizations (PPO), Dental Health Managed Organizations (DHMO) and Indemnity Plans. They differ in terms of costs and flexibility, so the best one for you comes down to your budget and whether you want to keep seeing your current dentist.
Here’s a breakdown of each plan, according to AHIP.
Type of plan
How it works
Features
In-network dentists only
Referrals required
Best for
PPO
Covers visits to any dentist with cheaper out-of-pocket costs in network
Average premiums
Usually no copays
Discouns for in-network provider
Annual maximum usually $1,000
No, but you’ll pay more out of network
No
Flexible and affordable
DHMO
Only covers visits from your designated in-network primary care provider (PCP) dentist
Low premiums
Copays
Usually no deductibles
No annual maximums
Usually no waiting period
Yes
Yes, your PCP must refer you to specialists
Most budget-friendly plan
Indemnity
Covers visits to any licensed dentist without negotiated discounts on dental services
High premiums
No copays
Low deductibles
No annual maximums
No
No
Flexibility but with a higher premium
Dental insurance glossary
These are some of the key terms you might come across when researching dental insurance:
Benefits. The services covered under your dental insurance policy.
Benefit period. The length of time your dental insurance policy is in effect.
Coinsurance. The percentage of your dental bill you’ll pay after you reach your deductible and your insurer has paid their portion.
Copay. A set rate you’re charged for specific visits or dental services.
Deductible. The amount you’ll pay for dental care in a given year before your insurance company steps in.
Dual coverage. The benefits you have under more than one dental plan. If you have two policies, the total amount paid can’t exceed 100% of your dental expenses.
Exclusions. Treatments and services that aren’t covered under your dental insurance plan, such as dental prosthetics.
In-network provider. A dentist that’s partnered with your dental insurance company to offer services to policyholders at prenegotiated rates.
Limitations. Your plan’s restrictions, like the maximum number of cleanings you can get annually.
Out-of-network provider. A dentist that doesn’t have any ties to your dental insurance company. You’ll pay more if you visit an out-of-network provider.
Out-of-pocket costs. Dental expenses that aren’t reimbursed by your insurer, including copays and deductibles.
Pretreatment estimate. An overview of dental services and costs to help you predict your out-of-pocket expenses.
Preventive care. Dental procedures, treatments and services that help to maintain oral health and prevent problems down the line.
Primary care provider. Your go-to dentist. This person is also known as a general dentist for adults, or a pediatric dentist for children.
Reimbursement levels. The percentage of costs your insurer covers for specific treatments or services. There are three reimbursement levels:
Class I — preventative and diagnostic care, like checkups
Class II — basic procedures, such as fillings
Class III — major restorative procedures, like dentures
Waiting period. The time you’ll need to wait before you can get certain dental work done.
Yearly coverage maximum. The maximum dollar amount your insurer pays for dental expenses in a given year.
How does dental insurance work?
Dental insurance works in a similar way to health insurance, though it’s significantly cheaper. A dental insurance policy is designed to help you manage the cost of dental work. Plans vary, but yours may cover routine care like regular checkups and cleanings, as well as fillings and extractions.
Every month, you pay a premium to maintain your coverage, and that dollar amount doesn’t change. Depending on your plan, you might pay a copay whenever you visit a dentist, which is a fixed cost for certain services, like X-rays.
Other plans may require you to pay out-of-pocket for services covered by your plan until you reach your deductible. When that happens, your coinsurance kicks in, and your insurance company starts covering 20% to 80% of your dental bills. So, if your coinsurance for a cavity is 30% and the cost for that service is $100, you’d pay $30 and your insurer takes care of the rest.
Some dental insurance plans cap annual coverage at $1,000 to $2,000 a year and generally, the higher your premium, the higher that amount will be. If you hit your yearly coverage maximum, you’ll be responsible for any dental costs for the remainder of your policy.
But if you don’t, many insurance companies roll over a portion of unused coverage to the next year.
Do dental plans have waiting periods?
Not typically. For preventive and routine care, you should be able to see a dentist right away.
Most dental insurance policies have a waiting period of six to 12 months for standard work like fillings and extractions, and longer for major work like crowns. But Dental Health Managed Organizations (DHMO) plans don’t, so you won’t need to wait to get treatment.
Is dental insurance worth it?
This comes down to your financial situation, oral health and how much you’d pay for dental care costs otherwise.
If your employer offers dental insurance, also known as group dental coverage, it’s worth taking them up on that perk. You’ll pay low premiums for coverage, typically between $5 to $20 a month, and get the peace of mind in knowing you won’t pay as much out-of-pocket for dental care.
If you’re in the market for a private policy and your teeth are in good shape, a basic dental plan might be sufficient. Most dental policies cover routine and preventative care at 100%, so that covers your annual checkups and teeth cleanings — and gives you an incentive to schedule regular appointments.
And if you anticipate needing major dental work, like crowns and dentures, it’s worth getting dental insurance. While you’ll pay a larger portion of the bill than your insurer, you’ll still pay a lot less than you would if you were uninsured.
How much does dental work cost if I’m uninsured?
These are the average costs for common dental procedures in the US, according to the latest data from the American Dental Association (ADA). This gives you an idea of how much you might pay for dental care if you don’t have insurance.
Procedure
Cost
Routine exam
$44.10
Teeth cleaning
$82.08
Sealant application (per tooth)
$44.12
Amalgam (silver) filling
$146.61
Root canal on a molar
$918.88
Porcelain crown
$1,026.20
Extraction of an erupted tooth
$147.32
How to make a dental insurance claim
In most cases, your dentist will submit claims for you, and insurers typically process them within 30 days.
Once the claim is processed, your insurer sends you and your dentist an Explanation of Benefits (EOB), which outlines your benefits, copays and deductibles and how much they paid.
A few insurers require preapproval for all dental work other than checkups. To avoid an unexpected bill, ask your dentist to submit a claim for you in advance.
Alternatives to dental insurance
If you don’t want or need dental insurance, explore these alternatives:
Dental discount plans. Also known as dental savings programs, these plans operate like a membership. You’ll pay an annual fee that’s typically lower than dental insurance premiums. In return, you’ll get a discount between 10% to 60% if you visit an in-network dentist — but you’ll likely pay more for treatment than you would with dental insurance. However, there are no annual coverage caps or waiting periods.
Pay cash for dental care. If you have the savings to self-insure and expect to only need a checkup and cleaning twice a year, you can opt to pay for all of your dental costs out-of-pocket. Just know that you won’t have access to the prenegotiated rates and discounts that come with dental insurance and dental discount plans.
Visit a dental school. The ADA lists dental schools across the country where you pay a low rate to see a dental student for treatment.
Go to a dental clinic. Some clinics offer a sliding scale of fees based on income, and some do diagnostic exams free of charge. To find a clinic near you, search the ADA’s database.
Bottom line
Dental insurance can help you cover the costs of most dental treatments, and work as a financial safety net in case you end up needing more extensive procedures. While it’s more straightforward than health insurance policies, there are a few things to consider before committing to a policy — including your deductible, and how your insurer classifies basic and major dental work.
To get the coverage you need at an affordable price, take the time to compare dental insurance policies.
Frequently asked questions
General dental care isn’t covered by Medicare, which means you’ll pay for cleanings, fillings, extractions and dental services out-of-pocket. But Medicare Part A (Hospital Insurance) may pay for certain dental services you need while in hospital, like inpatient care or emergency procedures.
Medicaid covers dental services for all child enrollees nationwide. Most states provide emergency dental services for adults, but less than half pay for comprehensive dental care. The Center for Health Care Strategies (CHCS) has a handy state-by-state guide that helps you figure out if you’re covered for dental work.
Most insurers allow you to nominate your dentist for in-network membership, which is helpful if you want to use your insurance to continue seeing the same dentist.
The process varies, but typically, you’ll need to request and complete a nomination form from your insurer. They’ll then send an application to your dentist, who has 60 to 90 days to return it. If your dentist chooses to join the network, you’ll be able to visit them and earn in-network discounts on dental treatments.
Use HSAs with high-deductible plans. These are policies with a deductible of at least $1,350 for an individual or $2,700 for a family, according to Healthcare.gov.
When you enroll in dental insurance, ask your insurer if the policy is HSA eligible. If it is, set up a HSA through your bank, or when you pay your taxes.
You can pay for basic routine and restorative procedures using your Health Savings Account (HSA). These include:
Cleanings and checkups
Fillings
Extractions
Root canals
Crowns
Bonding
Dentures
Cosmetic procedures — like teeth whitening — don’t qualify as eligible HSA expenses. You also can’t use your HSA to cover items like toothpaste, dental floss and mouthwash.
No. Also known as Obamacare, the Affordable Care Act (ACA) doesn’t require anyone to have dental coverage — so you won’t pay tax penalties if you don’t own a policy.
Yes. Dental insurance is a standalone coverage, so you don’t need to have health insurance in place to purchase it.
You don’t have to buy dental and health insurance from the same insurer, either.
You can only use your health insurance to pay for dental care in limited situations, according to America’s Health Insurance Plans (AHIP).
For example, if you get into an accident and require a complicated oral surgery to repair your teeth and jaw, your health insurance policy may cover some of the costs.
Katia Iervasi is a staff writer who hails from Australia and now calls New York home. Her writing and analysis has been featured on sites like Forbes, Best Company and Financial Advisor around the world. Armed with a BA in Communication and a journalistic eye for detail, she navigates insurance and finance topics for Finder, so you can splash your cash smartly (and be a pro when the subject pops up at dinner parties).
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