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Dental Insurance Benefits, Costs and Alternatives

Finding Health Insurance, Health
Dental Insurance Benefits, Costs and Alternatives

Dental insurance can help you pay for most types of dental care and be a financial safety net if you have large dentist bills.

One-third of Americans have not seen a dentist in the past year, according to the Centers for Disease Control and Prevention’s National Health Interview Survey. Most often, the reason is money. About 40% of adults who haven’t seen a dentist in the past year say they don’t go due to cost, according to the American Dental Association.

No matter the reason, before it comes time to get care, there are several options to choose from to help pay. Which one is right for you depends on how the numbers crunch out.

In this article

How dental insurance works

Group dental insurance

Individual dental insurance

Dental discount plans

Paying in cash

The right dental coverage for you

How dental insurance works

Most dental plans have networks of providers, or preferred dentists and oral specialists. If you choose a HMO or preferred provider organization plan, using an in-network dentist will save you the most money.

Types of dental insurance networks include:

  • A more restrictive HMO network, where you must use a network dentist or the plan won’t pay.
  • A less restrictive PPO network, where you can use a non-network dentist, but you will pay more out of pocket.
  • An indemnity plan, where you can go to any dentist you choose, but you’ll have to pay upfront, submit a claim and wait for reimbursement.

Dental PPO plans are the most common and may have an annual deductible such as $50 or $100, which is the amount you must pay the dentist before the plan pays for more care. After that, the plan will pay for a percentage of your dental care. The most common is the “100-80-50 plan” that covers:

  • 100% of preventive cleanings and care.
  • 80% of common procedures such as cavity fillings.
  • 50% of major work such as bridges and extractions.

Indemnity and PPO dental plans cap the amount they pay toward your care in a year. This is called the annual maximum benefit.

HMOs typically do not have maximum benefits or make you pay a percentage of charges. You’d likely have copays in an HMO, which is the set amount you pay for each visit. And dental HMO deductibles are lower — 84% are $25 or less, according to the National Association of Dental Plans, or NADP. The trade-off is that you have to choose one dentist or facility and allow it to coordinate all of your dental care, and dentists may be hard to find in your area.

Group dental insurance

Among Americans with private dental insurance, 92% get it through work or another group, according to the NADP. Because employers get a group rate and often pay a portion of workers’ dental insurance premiums, group dental insurance is also the lowest cost dental coverage.

If your employer offers dental insurance, taking it is probably your cheapest coverage option: $19 to $32 per month on average for an individual, according to the NADP. That’s about $228 to $384 per year, not including your employer’s contribution.

There are other, nonemployer group plans. For example, AARP members can sign up for group dental insurance through the association (and Medicare doesn’t provide dental benefits).

Individual dental insurance

For the millions whose employers don’t offer dental plans, private individual dental insurance plans are an option. You can purchase them on dental plan websites or through some insurance brokers. They can cost around $20 to $60 per month per family member.

Individual plans will pay your dental bills very much like group dental plans, but they have some additional rules. Individual dental insurance plans may have:

  • 12-month minimum contracts.
  • Six- to 18-month waiting periods before they will pay for serious or expensive procedures.

These rules are meant to discourage people from buying dental insurance only when they need treatment or canceling the plan once a large bill has been paid.

Most individual health insurance plans don’t include dental benefits for adults. However, the Affordable Care Act requires plans sold in state and federal marketplaces to include dental benefits for children. If you have an ACA plan or intend to buy one during open enrollment, you can use that for your children’s dental coverage.

Dental discount plans

Dental discount plans are not dental insurance and cannot be combined with dental insurance to lower bills for any procedure. Also called dental savings programs, these plans are an alternative to dental insurance and operate more like a membership club than an insurance plan.

Here’s how it works: You pay an annual fee and sometimes an enrollment fee, usually much lower than dental insurance premiums. In return, you get a discount at the dentist’s office, but pay more than you would with dental insurance.

You can buy a dental discount plan for yourself or your family, and since there is just one annual fee, you have the discount for a year. Plans can range from about $70 to $200 for an individual and about $120 to $300 for a family for a year’s worth of discounts.

Just like dental insurance, discount plans use networks, so you’ll have to find a dentist or oral specialist who takes your plan in order to get any discount at all. Some discount networks include thousands of dentists, while others include fewer than 200, so be sure to use the plan’s website to find a provider in the network.

Paying in cash

Planning to pay cash for dental treatment may work out in your favor if you have a clean bill of oral health and need nothing more than a cleaning every six to nine months.

If you go this route, have money in savings in case you wind up needing extensive dental treatment. In such cases, you may be able to work out a payment plan with your dentist, especially if you have a good cash payment history.

The right dental coverage for you

Even if you think your mouth is healthy and you don’t need to see a dentist anytime soon, you could be mistaken: 27% of adults ages 20 to 64 have untreated tooth decay, according to the CDC.

If you have no dental benefits now and need serious treatment soon, look for a dental discount plan that will help lower the cost of your upcoming procedures.

Otherwise, find a dental insurance plan with no waiting periods for major procedures. Plans with no wait times are more expensive than most individual plans, but that higher cost could be justifiable if you need a $1,300 root canal.

If you’ve been to the dentist recently and know your mouth is healthy, a dental discount plan could save you a lot of money. A lower cost dental insurance plan could also work for you if you’d rather not worry about the “what if” costs of major treatment.

Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: lacie@nerdwallet.com. Twitter: @LacieWrites.