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Dental insurance guide

dental_insurance_guide

dental_insurance_guide

What is dental insurance?

Dental insurance is insurance that covers a portion of basic dental expenses that you may encounter during a typical year, paying for procedures and treatments that generally improve and maintain your oral health.

How much is dental insurance?

When you’re shopping for adult dental coverage, you’ll see a wide range of plans available – and it’s hard to point to an “average” premium because plans and their benefits vary dramatically.

In general, higher premiums may result in lower out-of-pocket costs, shorter waiting periods or a higher benefit cap. This ‘cost to benefit’ relationship is most easy to see when making comparisons of different plans from the same carrier.

It’s common to see dental plans that fully cover the cost of preventive care, including routine exams, cleanings, X-rays, and sealants from in-network providers. But some plans – especially those with very low premiums – will have out-of-pocket costs for these services. You’ll want to look at the details of each plan to make sure you understand how much you’ll pay for various services.

Even if you don’t anticipate needing anything other than preventive care, you may find that you at least break even with the preventive care benefits that the dental plan provides. You can check with dentists in your area to see how much they charge for services such as routine check-ups, x-rays, and semi-annual cleanings. Then total up the amount you’ll pay for the dental insurance, plus the amount that the plan requires you to pay for those services (if any).

How does dental insurance work?

Many dental insurance plans are similar to health insurance in that:

  • You pay a monthly premium for dental coverage.
  • Your dental plan will typically have a deductible.
  • Your dental plan may have preferred providers. This means you may have to visit dentists in the plan’s provider network in order to have coverage or maximize your benefits.


How to get dental insurance

You can buy individual dental coverage year-round (without a qualifying life event) directly from insurers, from local insurance brokers, or from licensed online vendors that offer multiple insurers’ plans. (Note that the ACA’s pediatric dental benefit rules do not apply to plans purchased outside the exchange/Marketplace.)

You can also buy dental insurance through the public health insurance exchange/Marketplace in your state, but this is generally limited to the same open enrollment and special enrollment periods that apply to health insurance.

And in most states (including all of the states that use HealthCare.gov as their exchange), you can only buy a Marketplace dental plan if you’re also buying a health insurance plan at the same time.

If your employer offers dental insurance, you can enroll in it when you first become eligible, or during the employer’s annual open enrollment period.

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Is dental insurance worth it?

Depending on the premium for the plan you’re considering, you may find that you come out ahead by paying for the dental insurance. But perhaps that’s assuming you’ll make full use of the benefits and get yourself to the dentist for all of your routine care.

If you’re currently spending $0 on dental care because you just don’t go to the dentist, you’ll obviously start spending more now with a dental plan, since you have to pay the premiums. But routine dental care can help to avoid major dental care down the road. Your future self — and your wallet — will thank you.

What does dental insurance cover?

The benefits and cost of your dental coverage will depend on whether your plan is offered by an employer, obtained through a public health insurance Marketplace, provided as part of your state’s Medicaid program, obtained through a Medicare Advantage plan, or purchased directly from a dental insurance company.

Your policy may give you access to cleanings and routine exams with low – even $0 – out-of-pocket costs. And it may cover a portion of the cost of fillings and extractions after your deductible is met.

Some plans may also pay some of the cost of more extensive dental work, such as root canals, crowns, endodontics, and periodontics. But plans may have a waiting period for these services, or may cover a larger percentage of their cost after your plan has been in effect for a certain amount of time.

Some dental plans include benefits for cosmetic orthodontia services. Under pediatric dental coverage obtained via a health insurance Marketplace, orthodontia services will generally only be covered when considered medically necessary. It’s important to carefully review a dental insurance policy before and after purchasing.


Frequently asked questions about dental insurance

Frequently asked questions about dental insurance

What insurance covers dental implants?

The specifics of what’s covered by dental insurance varies considerably from one dental plan to another. While many dental plans stick to the “basics” by covering preventive / routine care, some plans are more comprehensive – covering at least part of the cost of some expensive dental procedures.

Oral surgery, impacted extractions, and crowns are often covered, at least in part, by dental insurance plans. And depending on the plan and the circumstances, you may find that it may pay part of the cost of a dental bridge.

But some expensive dental procedures tend to be considered cosmetic rather than restorative, and are thus less likely to be covered. Veneers, for example, are generally considered cosmetic and typically are not covered by dental insurance. Some dental plans may cover some of the cost of implants, but a plan may consider implants to be cosmetic and thus will not cover the cost.

Employer-sponsored dental plans can be more generous, particularly if the employer is focused on creating a competitive benefits package. Some employers focus on keeping premiums as low as possible, so their dental benefits might be fairly basic. But other employers focus on providing a competitive benefits package, including robust dental coverage, as part of their recruiting and retention strategy.

So dental benefits vary considerably from one employer to another. But you may find that your employer offers a dental plan that does cover at least some of the cost of services like braces, implants, and bridges.

However, even when a dental plan does cover expensive services, it’s important to keep in mind that nearly all dental plans have annual benefit caps that can seem fairly low in comparison to the cost of major dental work. For example, if your plan has a $1,500 benefit cap and you’re getting a $5,000 dental implant that’s covered by your plan, you’ll still have a considerable out-of-pocket expense after the plan pays its maximum allowable benefit.

How much does a dental bridge cost without insurance?

Dental bridges can range in price from around $1,000 to $5,000 per tooth, assuming implants are not needed to support the bridge. Some dental plans may cover at least a portion of the cost of a bridge.

But depending on the total cost and the specifics of your dental plan, you may find that dental bridges exhaust the plan’s annual benefit cap and have to pay the rest of the charges yourself.

How much is a dental cleaning without insurance?

According to an analysis by CareCredit, a dental cleaning can range from $75 to $200, depending on the dentist you use. Another study found that, including x-rays, which are often done in conjunction with a cleaning, the cost for a teeth cleaning visit can be $300 or more.

Many dental plans will cover all or most of the cost of routine check-ups, cleanings, and x-rays, as long as you use a provider who is in the dental plan’s network. You might find that a basic dental plan nearly pays for itself when you factor in your reduced out-of-pocket costs for semi-annual dental cleanings.

Can you get dental insurance without a waiting period?

If you’re shopping for a dental plan because you’re in need of dental work other than preventive care, be aware that there may be waiting periods for dental plans before they’ll pay for services. The waiting period can potentially be waived if you’re transitioning from a comparable dental plan, but it will be applicable if you haven’t had recent dental coverage.

Which companies offer dental insurance?

There are hundreds of carriers that sell dental insurance in the US. The National Association of Dental Plans lists more than 240 member insurers, although many of them are affiliate entities of a variety of well-known parent organizations. For example, among the top 25 dental carriers in the large employer market, nearly half are Delta Dental member companies that operate in specific states.

Some dental insurers provide group coverage that employers can offer as part of an employee benefits package, others sell individual/family dental plans, and some offer both types of coverage. Dental insurers can also partner with state Medicaid agencies or Medicare Advantage plans, and provide dental benefits to enrolled members.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.