Buying health insurance of any kind can be an expensive proposition. Dental insurance typically can be an afterthought, something considered once you’ve got the ‘more important’ issue of choosing general health insurance plans covered.
However, dental care is just as important as health care, and just as expensive. Knowing enough to decipher most dental insurance plans can help keep costs down and keep you healthy.
Insurance for dental services is available through the healthcare marketplace, as well as through individual companies.
Dental insurance uses some specialized terms like deductible, metal level, and waiting periods that are important to understand.
Dental insurance covers different services at different levels and may not cover every service immediately.
It’s important to understand your own needs and resources to choose the right insurance plan.
In addition to monthly premiums, there are out-of-pocket expenses you’ll have to cover.
Individual plans can be more expensive than group plans, though it may depend on how much dental care you’ll need.
While it’s possible to get a dental insurance plan outside the healthcare marketplace, most types of dental insurance still adhere to those standards. If you’re not familiar with those or are looking for a refresher, there are a few key terms to understand:
Dental insurance plans come in four categories indicated by metal:
These are not intended to offer different levels of care. Instead, the metal level indicates how much you pay monthly, compared to how much you pay for medical services. Generally, if you opt for a lower monthly payment, you’ll see a bigger bill at the doctor. The more you pay monthly, the less you’ll have to pay when you need care [1].
| Approx. % Insurance covers | Approx. % Out of Pocket | Monthly Premium | |
| Bronze | 60% | 40% | Lowest |
| Silver | 70% | 30% | Low |
| Gold | 80% | 20% | High |
| Platinum | 90% | 10% | Highest |
The deductible is a fixed amount, determined when you sign up, that you must cover before the insurance starts chipping in. A lower deductible is usually desirable, though it may cost more each month.
Not every plan has a deductible. In that case, the insurance applies immediately. Deductibles can also sometimes apply to only some types of dental care. Preventative care like routine cleanings is often covered from the start.
This is the period you’ll have to wait before some types of care will be covered by insurance. As a result, preventative care is usually covered immediately.
You may have to wait a period before major services are covered, however. Moreover, there might not be one waiting period for every category of care. In other words, you may have to wait longer to get dentures covered than you would for a root canal.
Your premium is the amount the insurance company charges for its services. Depending on your situation, you may have to pay all of your premium. Your employer, union, or others may also contribute.
Most plans will put a cap on the total amount they will pay out for care. As an example, imagine your insurance plan has an annual limit of $2000. That means that the insurance company will pay out $2000 on your behalf total, on all charges within the year. If there are expenses beyond the limit, you’re responsible for it all.
As we’ll discuss further down, insurance companies have a group of dentists they prefer to work with, usually called their ‘network.’ In most cases, seeing a dentist that is part of that network can be much less expensive than an out-of-network dentist.
The dental treatments that dental plans cover are usually divided into three categories:
Preventive dental care usually consists of things like routine cleanings. There are usually no waiting periods, so they’re covered as soon as you sign up. Many dental plans may cover them completely, with low out-of-pocket costs.
Insurance will usually cover a large percentage of basic dental procedures, though not all. Treatments in this category include basic restorative care, such as fillings and crowns.
Everything else qualifies as major restorative care. That includes things like root canals, tooth removal, and dentures. There is usually a waiting period of a year or more before major procedures are covered [2].
Orthodontics, covering things like braces and retainers, are usually considered major services. However, orthodontics coverage may be an optional add-on to a plan that will cover major services.
Summary:
There are a few basic terms to be familiar with when considering which dental insurance plan to choose. Those terms are metal level, deductible, waiting period, monthly premium, coverage limit, and in-network provider.
Additionally, dental care is divided into three payment categories. Preventative care usually has the most coverage, with insurance covering somewhat less of basic procedures. Major procedures are usually only covered after a waiting period.
When choosing a dental insurance plan, you need to:
In many ways, the health insurance marketplace has made choosing among dental insurance companies much easier. While you can seek out individual dental plans, the marketplace gathers them all in one place for easy comparison. However, no website can weigh the various priorities for you.
There are many factors to take into account when deciding between dental plans. However, one key point to keep in mind is that any sort of insurance is a gamble. There may not be a perfect choice, as you may choose comprehensive coverage and then need no more than a cleaning. The additional cost might be considered wasted money.
On the other hand, if you need major dental care without the corresponding dental benefits, the costs can add up to a big problem quickly. Only you can decide where you want to lay your bet.
Learn more about the types of dental insurance options available.
As part of the Affordable Care Act, the healthcare marketplace has made a lot of information available to help people understand their insurance. The dental insurance plan levels already mentioned, the metal levels, are helpful. However, it may be more so to understand how the different types of dental insurance are organized.
Basic dental insurance plans, in addition to determining covered services, may also determine who you can see. It can also determine how the insurance pays providers. Types of dental insurance include:
There are also some differences on the dentists’ side of things. DPPO and DHMO plans differ in regards to how they pay providers, as do fee-for-service plans and point-of-sale plans.
Your dental care needs may vary depending on your situation. A working adult may only need preventative care, fillings, fluoride treatments, or a few other basic services, though cosmetic options like teeth-whitening might appeal.
On the other hand, if you have kids, your insurance coverage is probably going to get more of a workout. Take your dental history into account, as well as any waiting periods if treatment is time-sensitive. The best dental plans meet your specific needs.
Frequently, insurance plans are offered through your employer. However, some of the cost of dental policies is spread out among the group, so if all you need is preventive care, you may be able to find a better deal elsewhere.
The specifics of a dental plan can vary depending on local laws. Unfortunately, even if you find the best dental plan ever, you can’t sign up if it’s not available to you. Companies also may only operate in some areas, having negotiated with participating dentists.
While a dental insurance company may have a nationwide network of contracted dentists, they usually don’t work with every dentist.
As mentioned, insurance plans are often set up so that seeing an in-network dentist is less expensive. Out-of-network providers can mean higher out-of-pocket costs. If you have a favorite dentist, make sure they work with the insurance company you choose.
Medical bills can quickly weigh you down, so tracking those expenses can be vital. However, when it comes to insurance plans, that can be difficult [4]. Not only is there a monthly premium, but also an out-of-pocket cost that can be difficult to estimate.
It may be better to plan for more than you need. You don’t want to plan for only preventative care, then find yourself somewhere with no in-network dentist needing major services.
Summary:
There are a range of factors that are important to keep in mind when selecting your dental insurance plan. However, for the most part, it boils down to balancing your expected needs against the costs of different treatments. If you think you’ll need major services, a higher monthly premium can be worth it. However, it can be expensive if your estimates are off.
The average cost for dental insurance is around $600 a year, but that includes both individual and group plans [5]. The two categories are different enough that it makes more sense to look at them separately.
Group plans are frequently offered through employers. In general, group plans are less expensive, having lower monthly premiums and better terms for basic treatments and major services. A dental health maintenance organization generally has the lowest cost, around $17 to $18 a month. A DPPO or indemnity plan averages about $15 or $20 more.
Note that many employers require you to be with the company for a length of time before insurance is available. Any insurance waiting periods may delay treatments even further.
Individual plans may have longer waiting periods or other coverage limitations. They usually cost from $4 to $15 more than group rates for a single person, or about $20 to $35 more for a family.
If it’s just you and all you get is the two cleanings per year recommended by dental professionals, it might actually be cheaper to skip the insurance and pay out of pocket.
You can sign up for dental coverage through a specific company, which often offers quick quotes through its website. Keep in mind, however, that those don’t necessarily have all your information or reveal waiting periods.
The healthcare marketplace offers a chance to compare many different options when you sign up for health insurance. In that case, the prices aren’t quotes, but the exact amount you’ll pay.
Summary:
Dental insurance can either be bought individually or as part of a group. In general, group plans are less expensive, though individual plans are cheaper under some circumstances. You can get a quote from an insurance company’s website, or the healthcare marketplace.
Choosing insurance and avoiding big healthcare bills can be difficult and confusing. To offer some direction, here are a few simple questions you can ask yourself to get headed in the right direction.
Summary:
Ask yourself a few simple questions to clarify your needs. Winnowing down your options can help make your choice clearer.
Here are some simple answers to common questions on dental insurance.
The American Dental Association estimates that the total costs for dental expenditures in 2016 were around $124 billion, and the number has only been going up. Dental health is often more important than people realize. However, a good insurance plan is the only way to make sure you don’t pay more than your share of that $100 billion bill.
