How Does Dental Insurance Work?

Oral health is an essential part of overall health. Seeing a dentist regularly is important for preventing tooth decay and gum disease (periodontitis), which, if left untreated, can lead to more serious health problems. Dental insurance can help you pay for some of the treatments and services you need annually. It may also cover certain types of emergency care. If you're looking into dental insurance, read on to learn about how it works

Don't Assume Health Insurance Includes Dental Coverage

While oral health is an important part of overall wellness, dental care is rarely covered by medical health insurance plans. Instead, coverage comes through special dental policies. Many people get dental policies through their employers or unions, often at the same time they choose their medical insurance plans (upon hiring or during “open enrollment").

Be sure to watch for your dental insurance options if your employer offers it and opt-in if you decide to buy it. If you're not sure whether you have dental insurance or whether your employer offers it, talk to your human resources department, union rep or insurance provider.

How Does Dental Insurance Work?

Like most health insurance, dental insurance has costs associated with it, such as monthly premiums, copays and deductibles. Dental insurance often includes an annual cap on the costs your insurer will pay. Once you reach a certain dollar amount, your insurance plan will no longer cover a percentage of your fees. This cap varies from plan to plan.

Getting Dental Insurance Through a Private Insurer

Like health insurance, dental plans are often segmented into HMO (health maintenance organization plans) and PPO plans (preferred provider organization). Both types are available from private insurers, and plans vary from insurer to insurer.

• Dental HMO plans (DHMOs) have lower monthly premiums and copays. You may have no deductible to meet and no annual maximum ceiling on benefits. DHMOs offer a limited pool of dentists and specialists to choose from.
• PPO plans cost higher monthly premiums and copays. You'll most likely have a deductible you'll have to meet before your plan starts to pay for services. Your plan will also most likely have an annual coverage limit. PPOs offer more choices than DHMOs when it comes to choosing providers.

How Much Does Dental Insurance Cost?

Dental insurance costs vary based on the type of coverage you want and the insurer you choose. Your location and age may also impact your costs.

Plans that only cover basic services, such as preventive care, cleanings and x-rays, may have premiums as low as $20 monthly for individuals and $50 monthly for a family, plus copays and deductibles. Plans containing broader coverage, such as implants and orthodontia for children, may have premiums that cost anywhere from $50 a month to $150 per month.¹

What Does Dental Insurance Cover?

Dental insurance plans vary significantly in terms of the services they cover, and the percentage of costs they pay. Some plans only cover preventive care such as cleanings and x-rays. Other plans cover basic services such as tooth extractions and fillings.

Major procedures may be covered, but it's important to check your plan to determine your out-of-pocket costs. Some plans that cover major dental services, like root canals or extractions, may only pay 50% of the cost.

In general, the higher your monthly premium, the more dental services you're likely to have coverage for.

What Does Dental Insurance NOT Cover?

Most dental insurance plans at least partially cover basic services, such as cleaning, filling cavities and extractions. Coverage varies greatly when it comes to additional services such as tooth extractions, bridges and implants. Be sure to check each plan's coverage details before you buy.

Cosmetic dentistry procedures are not typically covered by dental insurance. These include:

• Tooth whitening
• Orthodontia for adults
• Veneers
• Teeth shaping
• Bonding
• Implants
• Dental crowns

What Is Supplemental Dental Insurance?

Supplemental dental insurance is additional insurance to cover the gaps in your regular dental coverage. For instance, if your regular dental plan covers 50% of the cost of a crown, supplemental insurance may cover some or all of the rest of the cost.

Some people use dental savings plans or dental discount plans as a type of supplemental dental insurance.

Dental discount plans are not the same as dental insurance. Dental savings plans have monthly premiums, but you don't incur copays or deductibles with these plans. Instead, you pay out of pocket for dental services at a discounted member rate. In some cases, dental savings plans may be tax deductible. In some cases, dental savings plans may be tax deductible.

You can use dental savings plans or supplemental plans to cover some services that dental insurance does not pay for. You can also use them to cover dental services you may need after you reach your regular policy's annual cap. The cap on costs that dental insurance will pay can be as little as $1,000 or less annually.² If you need significant care, you will reach that cap quickly.

Across the board, about 50% of companies offer dental coverage.³

Medical Dental Coverage

Original Medicare (Parts A and B) does not include dental coverage for preventive care or emergencies. However, Part A may cover some dental services that are required during hospitalizations. Some Medicare Advantage (Part C) plans include dental insurance, but you'll have to shop around and compare plans to get the type of coverage you want.

Dental Insurance Waiting Periods

Often, dental plans enforce a waiting period for coverage of major services, such as fillings, extractions, dentures, crowns and oral surgery, to take effect. For instance, you may need to wait six months after you buy a plan for it to pay for these services. Insurers use waiting periods to discourage people from opting into dental plans only when they need major services.

You can usually take advantage of coverage for preventive care and cleanings immediately. If in doubt, check with your dental insurer.

How to Apply for Dental Insurance

You can purchase dental insurance through your job or union, provided they offer it, or individually.

You may also be able to buy it through a state-run or federal agency, such as the Healthcare.gov Marketplace. To buy insurance on the marketplace, you must be a U.S. citizen, national or eligible immigrant; you must live in the U.S., and you cannot currently be incarcerated.

If you're eligible for Medicare, you are eligible to buy a Medicare Advantage (Part C) plan that includes dental coverage. You can look for plans by zip code by using the Find a Plan tool at Medicare.gov.

If you are eligible for Medicaid, you may or may not be able to obtain dental insurance for yourself. Every state is required to provide dental coverage to children who get Medicaid, but state laws about dental coverage for adults vary. Check Medicaid.org for your state's Medicaid rules around dental insurance.

Getting Dental Insurance Through Healthcare.gov

If you're buying dental insurance on your own through the Healthcare.gov Marketplace, you have the option of buying a separate, stand-alone dental plan in addition to a healthcare plan, or buying a healthcare plan that includes dental coverage. Either way, you'll incur costs, such as monthly premiums, deductibles and copays. Marketplace dental plans are categorized as either high coverage or low coverage:

• High coverage plans cost higher monthly premiums but have lower copayments and deductibles.
• Low coverage plans have lower monthly premiums but higher copayments and deductibles.

Dental plans are available for individuals and for families. Your zip code will determine the plans you can consider, and their costs.

Is Dental Insurance Expensive?

Dental insurance can be expensive. Comparing and reviewing dental policies is important when you are shopping for a plan.

Deductibles and copays vary significantly, based on the plan you choose and your geographic area.

Is Dental Insurance Worth It?

Dental insurance may be very useful for you and your dependents, especially if your child requires orthodontia. For many people, dental insurance is good to have. For others, it may be an unnecessary expense. When you're trying to figure out if dental insurance is worth it for you, contrast the costs of the plan vs. the costs of the services you anticipate needing. This may help you decide if it has value for you and your family.

CareCredit Financing for Dental Exams and Treatments

Regular dental checkups are important to help prevent, identify and treat dental problems before they become more advanced. The CareCredit credit card can help you pay for dental exams, cosmetic dental procedures, and other costs that insurance doesn't cover — to help you keep your pearly whites bright and healthy.* Apply today and use our Acceptance Locator to find a dentist near you that accepts CareCredit. Make the most of your wellness journey by downloading the CareCredit Mobile App. You can find a provider on the go, manage your CareCredit account, and easily access the Well U blog for more great articles, podcasts, and videos.

Author Bio

Corey Whelan is a freelance writer with 15 years of experience focusing on medical issues and health and wellness content. Her work has been featured in outlets such as Newsweek and Time, Inc.

Our Expert Reviewer

Patty Caballero and her team of consultants together have more than 35 years of health insurance knowledge working for some of the biggest health insurance companies in the U.S. She has knowledge in building brands and strategic initiatives to help consumers better understand their health benefits.