Buying affordable dental insurance may not be top of mind for most people. But it probably should be. In 2016, about 74 million Americans had no dental insurance. Most health insurance plans do not cover everyday dental needs, such as check-ups, fillings, and root canals. And although health insurance does cover some extreme oral surgery (such as jaw restoration after an auto accident), routine dental work is usually not covered.
Dental benefits plans are designed to fill the gap. Whether offered by an employer or through a private insurer, most plans have monthly premiums, deductibles of $25 to $100, copays, and an annual maximum benefit—the median is $1,500.
One good argument for buying dental coverage is that many plans focus on preventive care. If cleanings and check-ups are free under your plan, you may be more likely to make and keep appointments. This can save you money—and your teeth—over the long term.
- Most health insurance plans do not cover preventive or routine dental care.
- Before buying dental insurance, consider issues such as your care needs, whether your dentist is part of a network, and whether you want cosmetic services.
- Dental benefit options include employer-provided insurance (sometimes with an FSA), Medicare Advantage plans, healthcare.gov and Medicaid plans, private dental insurance, and dental savings plans.
- To get the most out of your policy, plan and schedule dental appointments in advance throughout the year to help ensure the work is done before your benefit runs out.
What Are Your Dental Insurance Needs?
Here are some things to consider when guesstimating your family’s dental insurance needs for the next few years and what they might cost.
Do you have a dentist or a hygienist you like?
If so, the best place to start looking for a dental benefits plan may be a conversation with your dentist or their staff. Find out which plans, if any, the practice accepts and whether it is part of any networks. Also, inquire if the dentist participates in any discount programs or has an in-office plan.
Are you willing to choose a dentist from a network list?
You may be able to save money by choosing a dentist from the network list of a dental insurer. However, the least expensive plans offered by private insurers may have small networks, so check that there are dentists in your area who take any plan you are considering.
What type of care do you need?
Most plans generously cover preventive care, such as cleanings and check-ups. To estimate what the costs for dental care in your zip code will be without insurance, visit Fair Health or Healthcare Bluebook.
If you’ve been getting regular care, your dentist can help you anticipate what you might need in the next few years. Expensive dental care, such as braces for a child or an adult, can cost from $3,000 all the way up to $10,000 for complex cases. Dentures can cost thousands of dollars, and implants even more.
If you expect these kinds of expenses, it’s worthwhile to investigate what kind of dental benefits can help the most.
Can you wait 6 to 12 months for full coverage to kick in?
Plans often have waiting periods of up to 12 months before you are eligible for some expensive benefits, such as braces or dentures. If you can wait, this kind of policy could save you money. If you can’t wait, more expensive plans are available in which benefits start immediately.
Do you want cosmetic procedures?
Cosmetic dentistry includes teeth whitening, veneers, gum lifts, and restorative fillings or crowns. Most dental insurance plans do not cover cosmetic procedures, and plans that do may have a limited network and pay only a small percentage, such as 20%, of the cost. Dental discount cards, which provide discounted services from a network of dental providers, may be used for cosmetic procedures. (See more below under "Dental savings plans.")
Dental Benefit Options
Your location and where you get your health insurance often determine the dental plans available to you. Monthly premiums for individual coverage range from $20 to $80, on average. Both private and employer-sponsored plans also have annual deductibles and annual maximum benefits of $1,000 to $2,000.
If the plan’s maximum benefit is not enough to cover your expenses, look for a plan with a higher maximum. Keep in mind that pre-existing conditions are not generally covered by dental benefit plans. If you had a tooth missing before the effective date of your coverage, for example, you may not be entitled to benefits.
Here are the main sources for dental benefit plans.
1. Employer-Based Dental Plans
Most Americans—77% in 2016—get dental insurance through their employer.
This is often the most economical choice because the employer pays part of the premium. It’s important to check the policy before you enroll, so you’re not surprised by out-of-pocket costs. If a flexible spending account is available, consider using it for your share of the expense.
2. Flexible Spending Accounts (FSAs)
Any dental visit or procedure that treats or prevents a disease is eligible for FSA coverage (sometimes offered by employers along with insurance). Cleanings, x-rays, crowns, tooth extractions, dentures, gum treatments, and more are included. However, cosmetic procedures, such as teeth whitening veneers or cosmetic orthodontia, are not. Your dental office should be willing to help make sure services are covered under your FSA plan.
3. Medicare Advantage Plans
Most people on traditional Medicare do not have dental coverage. Almost half of them have not been to the dentist in the past year, and nearly 20% spent more than $1,000 out of pocket on dental care. Traditional Medicare does not cover dental bills except those associated with severe conditions that require hospitalization.
Most Medicare Advantage plans, however, offer at least some dental coverage. Some plans pay only for preventive care, while others have more extensive coverage. Some Medicare Advantage plans charge an additional premium for dental coverage. Several of AARP's best Medicare Advantage plans include dental coverage.
The percentage of Americans in 2016 who received dental insurance through their employer.
4. Healthcare.gov and Medicaid
Under the Affordable Care Act, dental coverage for people under 18 years of age is considered an essential benefit and must be available for your child. But dental coverage is not considered an essential benefit for adults. Some marketplace plans for adults include dental benefits. In some cases, the insurer offers separate, stand-alone plans for a separate, additional premium.
For children covered by Medicaid or the Children’s Health Insurance Program (CHIP), dental benefits are provided by the states. Some states also provide dental benefits to adults covered by Medicaid.
Privately purchased dental policies
Insurance companies sell a variety of individual and family dental benefit policies online. You can choose a plan that covers only preventive care or a more comprehensive plan that also pays a percentage of costly procedures such as root canals, bridges, and implants. In choosing a plan, check whether there are dental practices in your area that are part of the network.
5. Dental Savings Plans
Often called discount, savings, or referral plans, this is a membership club for reducing dental bills. The discount company contracts with dentists who agree to reduce their fees to members. The discount usually applies to all services, including cosmetic procedures.
To join a savings plan, you pay an annual fee that entitles you to discounted rates from network dentists, with no annual maximum. Some dental offices offer their own in-house discount plan with lower prices on services for patients who use that practice.
People who require little dental work—say, just cleanings and occasional x-rays—may save money using a discount plan rather than paying for dental insurance. People who have medical conditions that affect their teeth and gums or need extensive work may save more with insurance, if they can stay under the plan’s annual limit. The best way to decide is to compare the costs of a discount plan vs. a dental insurance policy for your individual situation.
The Bottom Line
Make sure you don't leave money on the table: If you enroll in dental insurance or use an FSA, it’s a good idea to keep tabs on key dates for using your benefits. Only 2% to 6% of those covered by dental benefit plans reach their annual maximums, according to the National Association of Dental Plans. To get the most out of your policy, plan and schedule dental appointments in advance throughout the year to help ensure the work is done before the benefit runs out.