According to the American Dental Association (ADA), nearly half of adults admit that they haven’t kept up regular trips to the dentist. Why? Because of the cost.It’s true that dental procedures like root canals, cavities, and even simple cleanings aren’t cheap these days, with out-of-pocket costs easily running into the thousands. This is where dental insurance can help. 

This article looks at the steps you should take before selecting a plan and how to get dental insurance. Still unsure? We have answers to some of the most commonly asked questions that will give you the confidence to get and use your insurance like an expert.

What to do before getting a dental insurance plan

Thanks to today’s easy-to-navigate websites, purchasing insurance only takes a few minutes. But before you grab the easiest (and cheapest) plan available, follow the steps below to make sure what you pick will work for you.

Step 1: Who needs coverage?

Are you looking for coverage just for yourself? Or do you have a spouse or kids whose dental costs you’ll also need help covering? If you’re in the latter group, you need to consider your dependents. Determining just who needs dental coverage is step one. Single and loving it? Skip to pre-existing conditions. 

Did you know dentists who treat kids often require training in pediatric dentistry? With its own special training and skill set, this type of dentistry is covered in some packages and not others. Full coverage plans will be your best option if you think your children will need braces. Overall, when purchasing dental insurance for kids you will need an idea of which pediatric dentists are within your coverage networks and what services are included in the plan.

Step 2: Understand pre-existing conditions

The Affordable Care Act made it illegal for health insurers to deny coverage for pre-existing conditions, however, this only applies to health insurance. Dental insurance is, unfortunately, not clearly included under this act.

Pre-existing dental conditions — conditions experienced before you get dental insurance — can sometimes lead to the denial of insurance claims. Pre-existing conditions can include missing teeth or diagnosed gum-disease but can vary by plan. Figuring out if you have a pre-existing condition will help you find insurance that offers you coverage.

Step 3: Budget for out-of-pocket expenses

Budgeting for dental expenses isn’t impossible as long as you read through the insurance plan details and then compare.

Find out the co-pay amount and how much of a deductible you will need to pay before the insurance kicks in. Deductibles can run upwards of $1,000, so it’s important to try to set this money aside ahead of getting dental work done. That’s part one of your budget done. The type of dental insurance that a person has will typically guide how much they pay for services. Insurance plans often follow a 100-80-50 rule. Many plans also have $1,500 maximums that they’ll payout to claimants annually, though there are exceptions. Compare different plan options to see which out of pocket expenses fit within your budget. 

Step 4: Anticipate waiting periods

Anyone looking to get dental insurance can probably go for cleanings or x-rays immediately. But be prepared for waiting periods from six months up to a year for coverage on root canals or gum disease treatment.

Why? Insurance companies are businesses at the end of the day. Without these waiting periods, nothing would prevent people from signing up for coverage only for a month or two to get some badly-needed dental work and then ditching their coverage. 

Waiting periods don’t necessarily mean more in-depth dental work can’t be done right away, people just might have to pay out of pocket. Again, check your plan options for rules on waiting plans. 

If it seems like we’re telling you to do a lot of reading, you got us. We are. But this will save you huge toothaches down the road. 

Step 5: Decide between group or individual coverage

The National Association of Dental Plans noted that as of late 2016, roughly 250 million Americans had dental coverage, falling into two types of plans:

• Public plans like Medicaid, covering approximately 83.9 million people
• Private and group plans, covering approximately 164.2 million people

How do you decide what to choose? Group plans generally are purchased through employers or groups like the AARP. If you’re purchasing insurance all on your own, you’ll likely select individual coverage.

How to Choose a Dental Insurance Plan

After following the steps above, it’s time to select an insurance plan. Here’s what to do at this point to ensure you get the coverage you need.

Get Clear on Your Coverage

Dental insurance generally breaks down into three types of plans. Knowing which one is right for you can help maximize your dollars and ensure you aren’t paying huge amounts for services.

• Dental Health Maintenance Organizations, or DHMOs, have lower premiums, higher deductibles, and restricted provider networks.

• Dental Preferred Provider Organizations, or DPPOs, have higher premiums, higher deductibles, and broader treatment networks.

• Dental Indemnity Insurance, which is becoming less common, has the highest premiums but allows people to go to any dentist they want.

Whichever you choose, you’ll want to be clear what the plan you’ve selected exactly covers and how much of covered expenses are paid out. More information can typically be found online or the literature they send you. 

Yup, that’s right. More reading. Find a comfy spot and dig into those insurance booklets. 

Know which dentists are in your network

Unless you opt for indemnity insurance, you’ll be restricted on which dentists you can see.

While you aren’t outright restricted from going to out-of-network dentists, this can lead to extra charges. If you’re looking at a PPO or DHMO dental insurance plan, consult their online network list. Dental offices will also generally know which insurance plans they can accept. That said, choosing an in-network dentist shouldn’t prevent people from seeking second opinions. 

Select your coverage level

Now you need to take a critical look at how much insurance you need.

A cheap plan of maybe a few hundred dollars a year with a couple of cleanings included will more or less pay for itself. Cleanings aren’t relatively expensive and are even available at dental schools for cheap, so while it can be tempting to forgo dental insurance entirely, we wouldn’t recommend it. For its relatively low cost and availability in times of emergency, dental insurance is worth the $20 or $30 monthly premium.

From there, you will want to decide if a PPO, DHMO, or indemnity plan is right for you and how much of a deductible you’re comfortable paying.

Narrow down your choices

This is the due-diligence stage of getting dental insurance you’ll actually use. Check out reviews online of potential insurers to make sure there’s a good chance they’ll payout on any claims. Also, check out the reviews for dentists in their networks. It might be worth selecting a slightly more expensive plan if it leads to better coverage and a better dentist.

Get dental insurance

When you’re ready to get dental insurance, the process is pretty easy and generally happens one of three ways:

1. Through a job
2. Through an insurance broker
3. On a dental website

Again, it’s the work leading up to this stage that matters much more than the actual, simple transaction.

Five FAQs to consider when you get dental insurance

Confused? Need more information about the benefits of insurance? Here are some answers to a few common questions.

1. Is there a best dental insurance?

Not exactly.

Finding the best dental insurance depends on a range of factors, including a person’s level of need and their economic situation.

For younger people with relatively strong teeth, a high-deductible plan that’s good for occasional cleanings and emergency fillings or root canals might be the best dental insurance. This same plan, however, might cause serious financial hardship for people expecting to get a lot of use out of their dental insurance.

2. How do I get dental insurance?

Dental insurance can usually be purchased a few different ways. Many people become eligible for group dental insurance after an initial waiting period at a job typically after 60 or 90 days. Others decide to purchase private insurance through an insurance broker or by contacting a dental insurance company directly. You can also get dental insurance online straight through providers.

3. Does dental insurance have open enrolment like the ACA?

This depends in part on if a person is looking to purchase dental insurance alongside their ACA plan. If this is the case, the answer is yes, though a person isn’t limited to purchasing dental insurance strictly during open enrolment periods. They can also purchase ACA dental insurance after a qualifying event, like the loss of a job.

Information on open enrolment periods can be found on Healthcare.gov or websites for state-based exchanges, such as Covered California.

4. How much will dental insurance cost me?

It can be difficult to calculate the true cost of insurance. While premiums can run for under $20 a month, that’s only part of the cost.

Many insurance plans have deductibles that need to be met for the year before starting to cover costs. Other plans require certain work, such as root canals or gum-disease treatments, to be paid for partially (but substantially) out of pocket, often needing you to cover at least 50 percent.

Premium expenses can run about $360 a year for individuals and up to $680 annually for families.

5. Can I use a policy tomorrow that I purchase today?

Yes, but avoid the temptation to pull a fast one. The rules of insurance are clear and typically long for a reason.

As noted earlier, many insurance plans have waiting periods on procedures like root canals, to help prevent people from signing up for insurance right before having a bunch of dental work done and then quickly canceling.

Dental insurance isn’t a video streaming service or gym membership. Attempting to treat it like one is likely to fail — don’t try it. 

Article updated as of June 2021

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Dental insurance can be confusing. We know you’ve got questions. We’ve got answers. Let’s break it down for you.

Insurance basics: Common questions 

How does dental insurance work?

Like any other insurance, you have to pay monthly premiums based on the company, your area of residence and your insurance plan. Public health insurance usually doesn’t cover much (if any) dental work, so the majority is covered by private insurance. 

Dental insurance often depends on the dentists you want and how much you can pay. If you’ve got a dentist already and they’re part of an insurance network, then you can go for one of their plans. When your dentist is not in-network, you’ll still be covered by the insurance, although you’ll pay more out of pocket. If you don’t have a dentist, you can visit any of the dentists in the network and still be covered. 

Most dental insurance providers have a waiting period before any dental work can be done, typically between six months and a year. Most policies do not cover cosmetic care procedures since they aren’t a medical necessity. 

Need more answers? Check out our full guide here.

How much does dental insurance cost?

For many people, dental insurance costs about $50 per month, though it can cost as low as $15 per month. The cost usually depends on the level of coverage you need and the state you live in. 

Most plans have an annual limit of coverage you can get. For most dental insurance plans, the limit is usually between $1000 and $2000. Once you reach your maximum yearly limit, dental insurance cuts all coverage. You’ll have to pay for any other dental work out of pocket. 

Unless you’ve got major procedures scheduled like a root canal or a crown, you’re unlikely to use all your annual coverage. In fact, only about 4% of Americans use up their maximum benefits. 

Why should I buy dental insurance? 

Dental care can be pretty expensive, especially when paid out of pocket. But dental care is absolutely essential to your health, so you can’t skip out on it. 

Most dental insurance plans will cover a big part of your procedures, making dental care affordable for both individuals and families. Your bi-annual visit to the dentist will be paid for in full by your provider – a benefit you can enjoy right away. 

Having insurance is also an excellent incentive to make more preventive-care visits even if you have healthy teeth. Less money is spent on preventive care and saves a lot of money that would be spent on costlier procedures in the future. 

Who needs dental insurance?

Dental insurance is for everyone unless you can afford to pay a hefty bill when you need to get dental care. Even though you may not exhaust your annual limit, you’re better off with insurance. If you’re elderly or you feel like you’re at a greater risk of getting dental problems, then insurance is something for you. 

What is dental indemnity insurance?

Dental indemnity insurance is a type of insurance that pays for your care after you’ve seen the dentist and paid upfront. In this case, you visit the dentist first, pay the cost, and then submit your claim to your provider. Your insurer will then reimburse you for part of the fee. 

This plan is best if you have a preferred dentist or you want a wide variety of providers. The annual coverage limit may be higher, but the monthly premiums also tend to be higher than other plans. 

What is a fee schedule plan?

A fee schedule is a list of prices that every dentist has that shows how much they charge for all procedures they offer. The list also includes how much your dental insurance will pay. The schedule varies depending on what the insurance provider considers allowable and the dentist’s rates. 

The fee schedule plan is often controlled by the “usual, customary and reasonable” (UCR) price that insurance companies wish to set for a procedure. UCR is usually around the average of what other providers charge within the area. 

Types of Coverage

What is covered by Medicaid?

Medicaid covers dental services for all individuals under 21 years enrolled in the program. This is part of a set of benefits referred to as the “early and periodic screening, diagnostic and treatment” (EPSDT) benefit. The dental services covered include preventive care as well as diagnosis and treatment of dental conditions.

The states determine the dental benefits that adults get under Medicaid. Most states only provide minimal emergency dental care, with very few offering comprehensive coverage. 

What is covered by medicare?

Like Medicaid, Medicare does not cover dental procedures. However, it offers limited care required to maintain general health, or is a part of another medical care regimen under Medicare. For example, Medicare may cover the additional dental care after you undergo jaw surgery. 

The insurance does not cover any follow-up dental care after the initial treatment has been done. 

What’s the best dental insurance in the United States? 

There are plenty of dental insurance providers in the country, and what may be good for you doesn’t necessarily work for everyone else. Some of the dental insurance providers include:

• Cigna
• UnitedHealthOne
• Humana
• Delta Dental
• Ameritas

Before choosing a dental insurance provider, it’s best to compare different insurance plans to choose the one best suited for your needs and budget. 

What procedures are usually covered by dental insurance?

Most insurance plans include some preventive care coverage in the form of two checkups and cleaning in a year. Other dental procedures that may be covered under insurance include:

• Fillings
• Crowns, implants and bridges
• Root canals
• Emergency procedures, eg oral surgery
• X-rays
• Tooth extractions

The level to which these services are offered will depend on your plan. Preventive care is often fully covered, while other major procedures like fillings may require additional out-of-pocket funds. 

What does “in-network” mean?

In-network dentists are part of a pool of providers who work with insurance companies to offer dental services at discounted prices. Choosing an in-network dentist ensures that your insurance always covers you and that you’re always paying less for your services.

You’ll also benefit from more coverage and fewer out-of-pocket fees every time you get dental care. 

You’ll have to contend with fewer dentists available for your choosing, though. The dentists in the network may not be perfect for your needs sometimes as well. 

What is PPO? What is DHMO?

A preferred provider organization (PPO) is a type of dental care plan whereby customers choose a dentist from a network of preferred dental providers. 

These providers usually offer their prices at reduced rates within a maximum annual limit. Some PPOs allow you to choose a dentist out-of-network and may even offer you lower rates when you’ve exhausted your yearly coverage. 

Dental HMO is exactly like PPO insurance, only that the dentists offer their services at pre-determined prices. The participating dentists are paid a fixed monthly fee. DHMO is often used by businesses to cover its employees but can be used for individuals as well. An advantage of DHMOs is they often have lower premiums compared to other dental insurance plans. 

How do I get the most out of my benefits?

To get the most out of your insurance, you need to determine which plan is the right one for your needs. Once you have a plan that suits you, you’ll get the best coverage when you remain in-network, whether it’s an HMO or a PPO. If you go out of network, you’ll have to pay more out-of-pocket. You can also work with your dentist to schedule your dental procedures so that your visits do not exceed the annual limit. 

Will all providers accept my insurance? 

Dentists within your insurance network will accept the coverage if the services offered are included in the plan. However, if the dentist is not in-network, they may or may not accept your insurance cover. If they do, they will be listed as out-of-network to your insurer, and you will have to top up the bill in most cases. 

How do I find a dentist who takes my insurance plan? 

Your insurance provider will typically have a list of dentists within their network that you can check out. You can also call the dental office to find out which insurance companies they work with, or you can use Opencare to find a dentist who takes your insurance.

What is covered by dental insurance?

How do I know how much dental treatments will cost me?

When setting up your dental appointment, you can ask your dentist for an estimate of how much the procedures will cost. Some insurers will encourage you to send a treatment proposal before beginning the dental treatments. This proposal will help your insurer determine whether the services are covered, the maximum coverage you can get and whether you’ll need to top up out of pocket. 

How do I know what my dental insurance covers? 

Your office can send your insurance a pre-estimate/predetermination request to find out what the insurance will cover and what it will not. The pre-estimate will also let you know how much they’ll cover so you can plan the dental visit. If you have anything other than major, always recommend getting a pre-estimate. To do that, call the office or send the insurance company a pre-estimate or predetermination after you book your dentist appointment. However, a pre-estimate is not a guarantee that the insurance will pay for everything in the pre-estimate.

The office took my insurance; why do I still have an amount to pay?

A number of reasons may be responsible for this. First, you may have exhausted your annual limit. You may have also selected a dentist that’s out of network, or the services may have been denied(insurance determines the service not necessary).If your treatment has been denied, you can follow up with the insurance company yourself and dispute the treatment that was not covered. 

Why didn’t I get my free cleaning? 

When we say insurance covers two cleanings a year, it’s not totally free. You have an annual maximum (average $1000-1500 USD per year), but once you’ve used that maximum, your insurance will not pay for any other services even if you’re eligible for them. However, some plans will specifically say diagnostic and preventive care aren’t calculated as part of the maximum. In these cases, you would still have those two free cleanings. 

How do I check the balance of my annual dental insurance maximum?

Do you know how much your maximum annual insurance is? If you do, you can calculate the difference between what you’ve already spent and that annual limit. To get accurate figures though, you can always reach out to your insurance provider to check how much you’ve used up and how much you’re left with for the year. 

What if my dentist referred me to a specialist; is that covered?

Some specialist services may be included in your plan. Whether you’ll be covered or not depends on your insurer, your dental care plan and the circumstances of referral. If you’ve exceeded your annual limits, however, you may not be covered by your insurance. You might also have to pay more if the specialist is not in-network. You can use Opencare to find plenty of dentists and specialists near you that are covered by insurance.

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In America and Canada, dental insurance coverage is quite pervasive. In fact, about 80% of Americans have either private insurance (172 million) or enjoy publicly funded dental benefits (87.6 million). 

But how many people actually understand how insurance works? Have you ever asked yourself “what is covered by my dental insurance?” Are you taking full advantage of your benefits to keep your pearly whites healthy? Read on to learn about how dental benefits work and what dental procedures are covered by insurance. 

How does dental insurance usually work?

When you sign up for dental insurance, you’ll pay a monthly premium, just like health insurance. Many plans also use a co-insurance structure. This means the insurance company will pay part of the cost of the procedure and you’ll be responsible for the remaining amount. 

For example, PPO plans (we’ll explain more about this common type of dental plan later), use a 100/80/50 co-insurance structure. This means they’ll pay 100% of preventative care costs, 80% of the cost of basic procedures (such as a dental filling), and 50% of major procedures. 

Many plans will have a deductible, which means you’ll have to pay for a certain amount before your insurance kicks in. Annual maximums are also common, which means they will only pay up to a certain amount within a one-year period. 

You can buy stand-alone dental insurance. However, many people have dental benefits attached to their medical insurance. A stand-alone plan tends to be more flexible and offers more benefits overall. They also are not likely to have a waiting period which means you can get the care you need faster. 

Dental benefits as part of your medical plan are more convenient. However, there are typically more limitations on the benefits such as when and how they can be used. 

Basic dental plans vs full coverage plans

Before deciding on a plan, it’s important to be aware of what it covers. Dental insurance plans can be divided into two groups – basic and full coverage. 

Basic dental plans cover preventative care costs. This includes coverage for routine dental visits, professional cleanings, and dental x-rays. Some plans will also offer partial coverage for basic procedures like fillings. However, your insurance co-pay will generally be higher.

Full-coverage plans generally cover the same things as basic plans. You can expect preventative care coverage and basic procedures. However, they offer coverage for a wider range of procedures, as well as the percentage that is covered is higher. 

With a full-coverage plan, procedures like crowns, root canals, and extractions may be covered. Plus, more advanced procedures like dentures, dental implants, braces, Invisalign, and other orthodontic procedures may also be included. 

The name full-coverage is slightly misleading because they still won’t cover 100% of your dental costs. Plus, each plan has its own list of covered treatments. Be sure to read the fine print carefully before undergoing dental treatment. 

Types of coverage: 

Now let’s talk about the various places you can get your insurance coverage. 

Employer coverage

Most people with private insurance get it through their employer or some other kind of a group insurance plan. This is typically a less expensive way to get coverage, but not always so do your homework. It depends on the type of plan your employer offers. 

Large employers are more likely to offer dental benefits, but some smaller companies also offer coverage. 

Individual plans

If you don’t have access to dental coverage through your employer, you can get an individual or family plan. Most preventative care costs will be 100% covered, however always read carefully to understand your whole coverage package.

Medicare

The government program for patients 65 and over doesn’t cover most dental care. There is one exception, however. Medicare Part A, which is hospital insurance, will cover certain dental services if the patient receives them while they are in the hospital. 

VA benefits

Eligible individuals can buy discounted dental insurance through the VA. Coverage is offered through Delta Dental and MetLife. The patient is responsible for paying premiums as well as the full cost of copays. 

Medicaid

Medicaid is another publicly-funded source of dental benefits used for people who can’t afford dental care. Eligibility is based on income and coverage tends to be very limited. 

All states are required to offer dental benefits to children, but each state can decide what they want to offer for adults. Most states offer at least emergency dental care coverage but fewer than half of the states offer comprehensive dental coverage for adults. 

What procedures are typically covered?

Are dental cleanings covered by insurance? Preventative care is typically cheaper than dealing with the ravages of periodontal disease or other dental issues. To that end, most dental plans offer coverage for the following:

• Twice-yearly dental exams (may require a co-pay)
• Dental x-rays, commonly offered once every two years
• Dental fillings
• Root canals
• Tooth extractions
• Bridges, crowns, implants
• Emergency dental care
• Dental appliances

Keep in mind not all of these procedures are covered fully. Dental procedures are divided into four categories, preventative, diagnostic, major, and basic. 

Preventative and diagnostic procedures are often covered at 100%. This includes regular dental exams, professional cleanings, and dental x-rays. 

Basic procedures are covered at 80% and major procedures at 50%. Major procedures include crowns, bridges, dentures, and other similar procedures. 

Basic procedures include fillings, root canals, oral surgery, and periodontal care. All of these except fillings can be considered major procedures as well. It depends on the severity of your situation. 

Dental bonding is also typically covered. However, if the tooth needs bonding as a result of an accident, you’ll be encouraged to use your medical insurance first. 

What procedures typically aren’t covered?

There is also a list of dental procedures that insurance typically doesn’t cover. Much of the determination is based on medical necessity. 

For example, you may need a crown to hold together a broken tooth and help to prevent further damage and that would be covered. However, a veneer over a chipped tooth serves a primarily cosmetic purpose. For this reason, veneers are almost never covered.

Another good example is that dental plans will cover silver-colored amalgam fillings based on medical need. However, if you want more expensive tooth-colored composite fillings, you’re going to have to pay the extra cost for those. 

Nitrous oxide (laughing gas) is used sometimes to help nervous patients relax. Unfortunately, dental insurance doesn’t cover it. If you really can’t handle visiting the dentist, you can opt for sedation which is usually covered.

However, this won’t usually apply to regular checkups. Most insurances will add the caveat that you need to be having two extractions or some other type of major work for sedation to be covered. Alternatively, your dentist can write a prescription for something to calm your anxiety and insurance will typically cover that. 

Dental appliances such as mouthguards for bruxism (teeth grinding) are usually not covered. In some situations, such as for gum surgery, some insurances may cover mouthguards.

How much does dental insurance cost?

Dental insurance is relatively affordable, on average costing Americans between $15 and $50 a month. To determine if dental insurance is worth it for you, you’ll need to pay attention to your dental habits as well as the type of plan you purchase. 

Don’t forget to factor in other dental costs like co-pays, co-insurance, deductibles, and annual maximums. 

You also need to carefully weigh your likelihood of needing major dental work done as the cost can quickly add up. For people with healthy teeth, it can be cheaper to pay for the cost of routine dental care out of pocket.

Types of dental insurance networks

Insurance providers typically work with a network of dental professionals. To get the most benefit from your plan, you’ll want to choose in-network providers. Let’s look at the most common types of dental networks you might encounter.

PPO

A preferred provider organization (PPO) has a list of preferred dentists in their network. You’re not completely restricted to using a dentist from their list, so if you find a dentist outside their network that you like, you can go to them, but you’ll pay more to do so.

DHMO

A dental health maintenance organization (DHMO) is similar to PPOs in that they provide a list of preferred dentists. This arrangement takes all the guesswork out of knowing how much your dentist appointment will cost. All the dentists in the network have agreed to a set price for their services. 

There is no annual maximum or deductible, but you are required to use in-network providers.

Fee-for-service dental plans

These types of dental plans offer the most flexibility with a very large network of providers. However, the price you pay for services can vary significantly. You are required to pay a percentage (which varies according to procedure) and your insurance covers the rest.

Choosing your dental insurance plan

We hope this article has given you some guidance when it comes to dental insurance and dental procedures covered by medical insurance. The most important thing is to stay up-to-date with your dental checkups. Regular exams and cleanings are the best way to avoid expensive dental problems in the first place.

Find a dentist near you and level up your oral wellness today!

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Dental work can be expensive. And what makes it more expensive, is when you put off seeing your dentist, or even performing good, basic dental hygiene. But when you don’t even do the basics, dental procedures can get expensive real quick. For example, a simple amalgam filling can cost around $300 and one dental implant can cost up to $4,500!

Prices like those will leave you wondering how on Earth you’re going to pay for the procedures you need. Thankfully, we’ve got some suggestions. Let’s discuss!

Can dental work be covered by medical insurance?

What’s our big trick for saving money on dental costs? It isn’t anything that crazy. We simply recommend your dentist bill your medical insurance instead of your dental plan because some dental procedures can be covered by medical.

You might assume the only insurance covering you when you visit the dentist is your dental plan. However, medical insurance will cover some procedures, even though a dentist performs them and they are mostly dental in nature. After all, dentists are doctors too that have spent years refining medical experience in their chosen specialty.

There are specific rules about what is covered and what will be denied. If your dental work is needed because of a medical reason, it’s more likely your medical insurance will cover it.

For example, if you need to fix some teeth because you were banged in the face, your medical insurance may cover it since the work is needed as a result of an injury. Another common reason is when you need dental appliances or services to treat medical conditions, such as sleep apnea.

What’s the difference between dental insurance plans and medical insurance plans?

Understanding the difference between dental and medical insurance can be difficult. Knowing where one begins and the other end is confusing, to say the least. It might be simpler to say that any work that happens in a dental office should be covered by your dental benefits, but it doesn’t work that way. However, that’s a good thing for you.

Dental benefits and medical insurance are not the same thing and don’t quite work the same way. Dental benefits primarily cover preventative care, often up to 100%. They often come with a rather high deductible and there is usually a limit on annual spending. 

Thus, if you want any work done that isn’t included in the preventative care package, you’ll need to fulfill your deductible first. If your deductible is $1,000, you’ll have to pay the first $1,000 for a procedure out-of-pocket. After that, your insurance will kick in. Keep in mind that basic dentist appointment costs such as copays usually help to fulfill this deductible as well.

Learn more about what procedures dental insurance covers with our Ultimate Guide to Dental Insurance

On the other end of things, dental insurance will often only pay up to a certain amount. For example, you might have a $3,000 yearly limit. 

Medical insurance, on the other hand, is more useful as a safety net. There isn’t as much emphasis on preventive care, but rather it’s there to cover unexpected expenses from injuries and emergencies. You’re probably already aware that without insurance, most people wouldn’t be able to cover the high cost of medical help on the spot. 

Though your specific plan may have a deductible (and sometimes a high one) the spending limits are usually much higher than a dental plan. In most cases, there is plenty of room to cover the cost of your dental procedure. 

Can I be reimbursed from medical insurance on dental work?

The short answer? Yes, your medical insurance may reimburse you for dental work. The hard part is knowing if they will in your specific situation or not. Even if the procedure you’re applying for might be covered for someone else, there’s no guarantee your medical insurance will pay your claim.

For example, if you lose or break a tooth because of an injury, it’s possible your medical insurance will cover it because it is a medical cause. However, if your troubles are purely dental in nature (such as losing a tooth because you didn’t care for your teeth well), the claim may be denied. 

It also depends on the insurance plan you have. Insurance with better coverage will be more likely to pay your claim. Plus, remember that if your medical insurance has a high deductible, you’ll be responsible for that first. 

In other words, while you can hope your medical insurance will cover a procedure, there is no guarantee and you may want to have a backup plan for those bills.

12 procedures medical insurance might cover:

By now you should have a basic understanding of the difference between dental benefits and medical insurance. Let’s look at some common dental procedures that can be billed to medical insurance companies. 

1. Sleep apnea appliances

Sleep apnea is a medical condition characterized by the patient not being able to breathe properly at night, usually because the airway is being blocked off. This medical condition can often be treated by using an oral appliance to bring the jaw forward and maintain the airway open. 

2. Surgical extractions

In some cases, tooth extractions will be covered. This is more likely if you are having multiple teeth removed at once and almost assured if the extractions are necessary because of an injury.

3. Wisdom teeth removal

Leaving wisdom teeth in your mouth that should be removed can cause health problems in some cases. On a limited case-by-case basis, medical insurance may cover this procedure.

4. TMJ night guards and appliances

The temporomandibular joint (TMJ) connects the jaw to the temporal bones in the skull. Problems with this joint can cause pain in the surrounding area as well as severe headaches that may be alleviated by TMJ dental devices. 

5. Laser surgery when you have severe periodontal disease

Though not yet well understood, periodontal disease can have a systemic effect on your body and affect issues such as cardiovascular disease. As such, treatments for periodontal diseases, such as laser surgery, can be considered a medical issue.

6. CT scans

CT scans are used as a diagnostic tool for procedures such as implants or cavities. Sometimes, dental x-rays don’t offer the complete picture, and a CT scan can allow your dentist to get a closer look.

7. Dental implants

Missing teeth are more than just a cosmetic issue. Your jaw needs all your teeth to help properly support the structure of your face. There are also other health issues that may arise when you have missing teeth, prompting medical insurance to cover the cost. 

8. Bone grafting

Was your bone loss caused by a medical reason such as trauma or cancer? Bone grafts to correct this are often eligible for coverage. 

9. Frenectomy surgery

Some infants and children need tongue surgery to correct issues in the mouth. This is considered a medical procedure.

10. Congenital defects

If the root cause of your oral health issues is a congenital defect, health insurance may cover treatment.

11. Botox injections

You might be wondering if you read that right, but yes, sometimes Botox injections can be covered. However, they need to be for non-cosmetic reasons such as to treat bruxism and jaw pain.

12. Mucosititis and stomatititis 

The effects of chemotherapy and similar treatments can ravage your entire body. Oral health problems related to these treatments may be covered.

Getting a little help with all this

Wondering how to know if your dental procedure might be covered by medical insurance? Your dentist’s office is an excellent resource. In fact, they’ll be the ones coding the procedure and billing your insurance company and the codes they use can have an impact on whether the claim is approved. Find a dentist who is willing to work with you on billing your medical insurance. It can make all the difference.

However, don’t be upset with the dentist’s office if the claim is denied. After all, they’re doing their best to help you out and ensure your best dental health. They’ll make an educated guess about what your medical insurance is likely to cover, but they won’t always be right. 

If coverage is denied, it’s possible your dental office will offer a payment plan to help you cover the cost of your dental work. They are 100% on your side and will do what they can to help ease the burden.

Save money on dental procedures the easy way

The good news is that you don’t have to learn all the ins and outs of medical billing to ensure you can save money on your dental visit. Your dentist’s office will give you their best guess as to if your procedure will be covered. They’ll also handle all the coding and filing of the paperwork. All you have to do is cross your fingers and hope for the best. 

Again, your dentist’s office can’t assure you that your claim will be paid. However, they’ve already seen many people who needed the same procedures and have an idea of what your insurance will pay. 

Looking for an awesome dentist near you? If you don’t already have one in your area, this is the time to hire one. Don’t shy away too quickly, there’s a great new way to find a perfect fit. Find a dentist through our platform here at Opencare today and level up your oral wellness!

The post How to make your dental work cheaper: 12 dental procedures that might be covered by medical insurance appeared first on The Floss By Opencare.

Dental health is vital to your overall well-being. However, few people know much about the various types of dental insurance, how they work, or how to leverage them to keep their dental and overall health in good shape.

In fact, about 28 percent of Americans don’t have any dental insurance at all. Among those who do have it, many make costly mistakes with how they use it.

So let us guide you through how dental insurance works, understanding dental insurance billing and plans, and the questions you need to ask yourself to make sure you choose the best option for yourself and/or your loved ones.

How Does Dental Insurance Work: What’s Covered, What’s Not

In America, the Affordable Care Act (ACA) doesn’t provide dental coverage for adults and there are no penalties for not having it. This is because health insurance and dental insurance are entirely separate from each other. In some ways these types of insurance are similar, but there are also distinct differences in how coverage works.

Dental insurance policies can vary widely depending on the provider. You pay a premium based on the type of plan you choose and where you’re located. Many people pay around $50 per month. You may also have a deductible to pay before your insurance pays for any procedures.

In general, dental insurance breaks procedures into three categories: Preventative, basic, and major.

Usually, preventative care—such as twice annual cleanings, checkups, and x-rays—are completely covered with insurance. Sometimes the wording may be explicit about paying for a preventative visit every six months (but not closer together), while other policies may be more lenient within a 12-month period.

Basic procedures like silver fillings, root canals, or dentures are often 80 percent covered. You’re only covered 50 percent for major procedures, which may include crowns (which you typically get after a root canal), implants, and more. You cover the remaining costs out of pocket. The balance you pay is called coinsurance. At the time of the procedure, you may also have a copay. A copay is a set dollar amount you contribute.

However, there’s a bit more to dental insurance than just the 100-80-50 structure and your premiums.

First of all, most dental insurances have a waiting period of six to twelve months (or more) before they will cover anything besides preventative care. Periodontics and prosthodontics might not be available in your first year. If you need a major procedure just a few months after signing up for dental insurance, they likely won’t help with any of the costs. Also note that dental plans may not cover any pre-existing conditions.

A significant way in which dental insurance is different than health insurance is how annual maximums work. Whereas your health insurance might cover all costs after your deductible, dental insurance doesn’t work this way. Dental insurance has an annual maximum of what it will pay, which is typically around $1000-$1500 per year. After that, you pay out of pocket for all costs until the next calendar year. All of the costs mentioned are for during regular business hours. Prices may vary for after-hours visits or urgent care.

Dental insurance will not cover any cosmetic procedures. Cosmetic procedures may include teeth whitening, veneers, tooth shaping, and gum contouring. Some policies cover braces, but others require a rider. A rider doesn’t come with a basic insurance policy, but is instead a provision that adds benefits or amends the terms of the policy.

Different Types of Dental Insurance

Dental insurance prices vary depending on where you live as well as which type of dental insurance you choose. The plan you choose will affect your premiums, which dentists are covered, and the percentage of procedure costs you’ll pay.

Dental Health Maintenance Organization (DHMO)

DHMOs, also referred to as Dental HMOs, work similarly to a health insurance HMO.

This type of plan provides a network of dentists who accept the plan for a set copay or no fee. Members receive discounted rates for services and this type of plan typically has the lowest premiums, no deductibles, and no annual fee. Depending on the plan, your waiting period for major dental work may be short or nonexistent. The most significant downside to a DHMO is you’re unlikely to be allowed to see an out-of-network dentist.

Preferred Provider Organization (PPO)

PPO insurance usually has a broader network of approved dentists than a DHMO plan. You can choose to see a dentist outside the network, but it costs more. In exchange for more dental options, members pay higher premiums and deductibles. PPOs often have a maximum amount they’ll reimburse each year and some have a waiting period before coverage starts.

Point of Service Plans (POS)

A POS plan combines elements of an HMO plan and a PPO plan. The plan allows the use of out-of-network services, but the benefits are much less than if you use an in-network provider. Your benefits are determined at the time of service, depending on whether the dentist is in the network or not.

Dental Indemnity Insurance

Indemnity dental insurance, also referred to as “fee-for-service,” is usually only available to groups of people through workplaces. Your chosen plan reimburses a percentage of the dental provider’s fee. This type of insurance typically covers the broadest range of procedures, but they still have a few exceptions. The good news is that they usually have lower deductibles and higher maximum coverage limits than other plans. However, you have to pay a deductible upfront and your premiums tend to be higher.

Table or Schedule of Allowances Plans

These are indemnity plans that pay a predetermined dollar amount for each of your procedures—no matter what the actual charges are. On your end, you pay the difference between the charged fee and the carrier’s payment. Sometimes your plan is paired with a PPO to limit how much the dentists are allowed to charge.

Direct Reimbursement

Unlike how other plans focus on the type of treatments you receive, this insurance bases your benefits on dollars spent. This self-funded (or employer-funded) plan allows you to choose what dentist you want to see. Depending on the terms of the policy you choose, you either pay the dentist directly or your benefit is assigned to the dental office. You then sometimes submit a paid receipt or other proof of treatment. Finally, you’re reimbursed a percentage of the dental costs.

Dental Discount Plans

Technically, dental discount plans aren’t a type of insurance, but they do save you money on dental care. You pay a fixed annual fee and in return receive a predetermined discount off the standard price of the dental treatment. In most cases, your annual fee covers your preventative cleanings and checkups as well. Dental discount plans have a much simpler structure than insurance plans, so you don’t have a lot of paperwork to complete and instead receive your discount right away. These plans used to be sold only to individuals, but it’s becoming more popular for employers to purchase these plans for company employees as well.

Why You Should Always Try to Choose an In-Network Dentist

Several types of insurance plans will charge you more money if you use an out-of-network dentist rather than an in-network one. An in-network dentist is one who has an agreement about the terms and provisions with your dental insurance provider.

This agreement means the procedural fees are set and you have a better idea of what you’ll end up paying—which is usually less with an in-network dentist.

The majority of dental offices will accept your insurance even if they aren’t in network. This can result in you paying far more than anticipated. They don’t have any agreements with your insurance on what appropriate prices are for procedures. If they decide to charge more than your insurance expects, you’re the one who has to make up the difference out of pocket.

Questions to Consider When Choosing Dental Insurance

Several factors affect which type of dental insurance is best fitted to your situation.

In most cases, dental benefits from an employer are an affordable, easy choice. However, this isn’t an option for all people. Ask yourself these questions when you need to choose a dental insurance plan on your own:

• Is there a specific dentist or specialist I want to see?

• What is the annual maximum?

• What is the deductible (if any)?

• Is there a waiting period for coverage?

• What is the copay percentage?

• Are there limitations for pre-existing conditions?

• Is there emergency treatment coverage?

If you’re considering investing in dental insurance, it’s essential to understand how it works. Knowing the key differences between types of dental insurance plans, and choosing the best option for you, could end up saving you a significant amount of money.

In some situations, dental insurance may end up not saving you money at all. It’s always worth the time to research which plan would likely benefit you most. No matter which type of dental insurance you choose (if any at all), the best way to save money on dental care is to keep your mouth healthy. Make sure to brush, floss, and visit a dentist regularly.

The post How does dental insurance work? An overview of coverage appeared first on The Floss By Opencare.

Few patients really understand dental insurance. And helping any patient understand more is no easy feat. Dental benefits are complicated. Every plan type varies from one insurance company to the other and many of them change annually. That’s why explaining dental insurance to patients is a top priority. Let’s discuss patient insurance literacy. 

Make sure patients under stand their insurance before coming in

Before you start explaining dental insurance to patients, you need to know what that coverage has to offer, including how it works. The bigger the coverage, the easier it is for patients to book a dentist appointment. 

The majority of American dental plans provide 80% coverage for basic dental care. That includes sealants, fillings, extractions, periodontal treatment, and non-routine X-rays. A plan often covers the complete cost of preventative treatments like routine cleaning and oral exams. 

Although dental plans can ensure 50% coverage for other treatments — like bridges, dentures, and crowns — patients are still saving a hefty sum in the long run. And if they know the ins and outs of their dental plan, they can save plenty of money and protect themselves from financial risk. 

They’ll also pay specific rates, which means reducing their out-of-pocket costs. With dental insurance, procedures like routine cleaning become an easy choice. They ensure optimal dental health. 

What patients typically know about their dental insurance

Just 9% of American adults understand the four basic terms of health insurance, one survey shows, such as co-insurance, out-of-pocket maximum, deductibles, and health plan premium. Although that’s 2% more than in 2016, it seems they are still a long way off from making the most of their healthcare services. 

Around 77% of the US population has dental benefits. However, 40% are not even using it. Data indicates the reason dental patients don’t rely on their dental plans is that they think treatments would still be expensive. Simply put, they don’t have an understanding of the merits of having dental insurance. 

Millennials are the least informed about dental benefits of all adults. Various age groups understand insurance policies differently. While those between 22 and 37 claim they’re confident about how much they know about insurance, they actually display the lowest comprehension. Luckily, this group is among the  easiest to reach. With an active presence on social media, their level of comprehension can increase dramatically in a short period of time.

Why does it matter?

Studies show insurance illiteracy is often linked to a lack of care. When a patient doesn’t understand insurance, they’re usually unable or unwilling to seek the care they need. And in most cases, the dental insurance for patients will cover a huge portion of treatment costs. 

Experts analyzed 506 adults with basic health coverage. Reports indicated people who were aware of their insurance benefits had a lower chance of delaying their necessary level of care. 

But, 16% of interviewees who didn’t fully understand insurance plans avoided simple dental procedures like cleanings and checkups. Although insurance covers the costs, they were still less inclined to find a dentist than the rest of the group. 

The right way to explain insurance to patients

Choose talking points and simplify the terms

Focus on simple, short messages. Once you pick a subject to talk about, be consistent. With proper talking points, it becomes easier to help patients get the message. The key to success is simple communication.

Instead of providing patients with tons of information at once, build the topic slowly to make it easier to understand. Begin with simple ideas and practical examples that would come in handy in their day-to-day lives. 

And don’t go too deep into dental insurance jargon or use complex dental or insurance terms. The goal is to inform patients about what they have to gain from having (and using) insurance, including how dental insurance for patients can help them sustain optimal dental health. 

Don’t you think you can handle it? Join Opencare and change the way you communicate with patients. You’ll learn how to improve your practice, grow your business, and attract new clients. We offer full service insurance verification and claims processing to take away the headache of insurance plans for patients.

Get creative

To boost engagement and help more patients, you may need a new strategy. This will help you change your own communication style and perspective, while helping patients boost their insurance literacy. You might try one of all of the following:

• A social media presence. Being active on social media is a valuable tactic, especially platforms like Instagram and Facebook. You get to share dental information, reviews, or videos. With practical content, you can also boost their insurance literacy level and explain some of the misunderstood terms. 
• E-mail and Social Campaigns are one of the most effective digital marketing techniques. When used on social media, campaigns can generate 67% more leads and 86% exposure. For instance, send clients an insurance reminder at the end of the year to inspire them to get a treatment before it gets too late to use the benefits.
• Newsletters can become a key factor in helping patients with their insurance literacy. For example, you can cover some FAQ, define the basic terms they are least acquainted with, and talk about out-of-pocket costs. You can do this on a blog, through e-mail, or direct mail.

Perfect your website

A website is still part of a vital communication strategy. It establishes authority, presence, broadens your market share, and solidifies your brand. With SEO-optimized content, you can enhance organic traffic. Plus, you can aid patients in maximizing their insurance plans.

Although investing in a website to boost literacy may not be the most profitable solution, it is still worth it. By focusing your efforts on improving a patient’s education, you help them build a basic understanding. This knowledge will help them use all the benefits of maximizing their financial plans. 

After all, dental insurance can be very complicated to understand. So, instead of trying to teach a client in a single meeting, you can use your website to simplify the content. That makes it more approachable and easier to learn. 

Final thoughts

Creating a better healthcare environment for patients starts with maximizing their healthcare costs. But, before a patient can use their dental plan, they need to understand all the key insurance points. 

It’s true a huge portion of the American population doesn’t fully grasp the benefits of dental insurance. However, you can help change that, by teaching your patients how to access their healthcare services. This can help provide better access to dental services and promote the benefits of using insurance in a dental office.  

The post How much do dental patients really know about their insurance coverage? appeared first on The Floss By Opencare.

It’s always better to be proactive than reactive when it comes to dental care. While this applies to flossing and brushing, this mindset is also relevant to use your dental benefits. According to the National Association of Dental Plans, around 77% of Americans have dental benefits. However, most people don’t optimize dental benefits for the most savings each year.

What are Dental Benefit Plans? 

Dental benefit plans are commonly provided by employers to help pay for dental care. Dental benefits are technically different from dental insurance, which are meant to absorb more risk than a benefits plan. Keep in mind “dental benefits” and “dental insurance” are not the same despite the terms often getting mixed up.

A 2019 survey reported that around 47% of adults are part of employer-sponsored dental insurance plans, but many don’t use the benefit. Under half of these people use their dental insurance and only 4.2% reach the annual maximum.

If you’ve got it, use it! Learn your plan inside and out to help. Know your premium, deductible, annual maximum, and if your plan follows a calendar year. These details are critical if you want to optimize your dental benefits.

Learn the Terms

Let’s have a quick review of what you spend money on with your dental benefits and what each of the common terms mean. This information will help you understand how much money you spend on dental care and how much money potentially goes to waste if you don’t use your benefits.

Premiums

The price you pay for dental insurance (or dental benefits) each month. You pay this amount whether you get any dental treatments done or not. Your premium almost always includes free preventative care, such as two dental cleanings per year.

Deductible

The deductible is the amount of money you pay out of pocket to the dentist before your insurance covers any of your services. On average, deductibles are around $50 per year to $100 per year but can vary substantially by plan. Deductibles start over every year.

Annual Maximum

A yearly maximum is the highest amount of money your plan will cover over the course of one full year. The average annual maximum is around $1,000 to $1,500, but varies by plan. The maximum typically renews at the first of the year and unused benefits don’t roll over from the previous year.

Coinsurance

Some plans may include coinsurance. This is the percentage of your charges you are responsible to pay. For example, some plans may pay 60% of a procedure while you’ll need to pay the remaining 40%.

Flexible Spending Accounts (FSA)

Your flexible spending account is set up through your employer. You decide how much money you want to put in your account and a portion of it is deducted from every paycheck pre-tax. They work similarly to debit cards with how you use your FSA card to pay for various dental expenses.

Generally, FSAs can be used to cover services such as cleanings, benefit plan copays, dentures, and more. An FSA may also cover certain dental products available at local drug stores. Products like toothache relievers, denture cleaners, and denture adhesives are more likely to be covered than basic items, such as toothpaste or floss. This is a crucial tip to optimize your dental benefits.

In-network & Out-of-network

In-network dentists have specific pre-negotiated rate agreements with dental insurance companies. Although out-of-network dentists will often still accept your insurance, they don’t have set rate agreements. It’s almost always cheaper to see an in-network dentist. If you don’t, you risk paying more and it can take a bigger chunk out of your annual maximum or the money in a flexible spending account.

Use Your Dental Benefits Before the End of the Year

In almost all situations, dental benefits are “use it or lose it.” If you don’t reach your annual maximum, or use all of the money in your flexible spending account within a year, you typically forfeit all of that money. These are some of the top reasons to use your dental benefits before the year’s end. Optimize your dental benefits by using them before the year ends.

Flexible Spending Accounts Have Deadlines

Most people have an FSA with a December 31 deadline to use funds, though occasionally, some will end at a different time of the year. Some employers allow a grace period of up to two and a half months to use your FSA money, but not all provide this option. An employer may also allow you to carry over a maximum of $500 to use the following year, but again, this isn’t the norm. Check with your FSA administrator or your employer to learn your account details.

When you set up these accounts, it’s ideal to carefully calculate what you expect to spend within a year and only add that amount. Learn exactly what services and products are covered. It’s unlikely you are able to use these funds for any cosmetic procedures, such as getting your teeth whitened or veneers.

Discuss with your doctor in the summer or fall, during a regular appointment, if there are any procedures your teeth need. No matter what time of the year your dentist informs you that you need a dental service, if you have remaining money in your FSA, try to get it done before the end of the year (when your deadline typically runs out).

Dental Benefits Run Out

Standard dental benefits have a deadline at the end of each year as well. When you have a dental plan, you pay a premium for it. That premium is wasted if you never visit the dentist within a calendar year. 

Don’t forget, your premium usually completely covers preventative care visits twice a year. Some people avoid getting dental work done towards the end of the year because they are close to the annual maximum and don’t want to exceed it (at which point you pay entirely out of your own pocket).

This can be a valid concern, but most dentists will work with you to see if it’s possible to split your work up in two phases. In this case, one phase is before the end of the year and the other step is at the beginning of the next year when your annual maximum renews. Not all dental work is possible to be split into two phases, but it’s worth checking with your dentist. 

The closer you get to your annual maximum, the more money you’ve saved that year. If you have a spouse on your dental plan, make sure they make use of the funds as well. Get the most out of your dental benefits.

Fees May Increase at the Start of the Year

That root canal or those crowns you need may become more expensive in the future. It’s common for dentists to increase their rates at the beginning of the year to account for an increased cost of living and new equipment needs. Your dental plan may also change to have a higher copay. Prices are significantly more likely to increase than they are to decrease. Get necessary dental work done now before rates and copays have the opportunity to change.

Catch Dental Problems Before They Worsen

Preventative visits, such as cleanings, are essential to keep your teeth healthy. Additionally, these visits provide insights into any issues with your oral health. X-rays and a thorough check of your mouth can reveal any dental work you need done.

If a relatively small problem is discovered during a visit, such as needing a cavity filled, it can be tempting to wait until the following year to remedy the issue. But when you delay dental treatment, you risk requiring more extensive and expensive treatment later on. Cavities can turn into painful and pricey root canals. 

Catch dental problems while they’re small and easy to fix. Dentists sometimes also notice the first signs of health issues that may necessitate a visit to the doctor.

Appointments Fill Up

Remember, most people have similar dental plans to you. Many people who haven’t reached their annual maximum will be trying to get appointments at the end of the year. Dentists often take time off during the holidays, so there may be fewer time slots available.

Those who have already reached their maximum, are strategically breaking their procedures up into two phases, or just signed onto new dental plans will be setting appointments for January. You want to make your appointment before all of the spots are filled up, especially if you know you have work that needs to be done. Letting a dental problem fester until February isn’t good for your oral health or your wallet.

Optimize your dental benefits to not only are you saving the most money, but to also give yourself an incentive to stay on top of your oral health. You want to get as close as possible to your annual maximum and the same goes for any flexible spending account you may have. Dental benefits aren’t meant to be used only for emergencies, but to be used mainly for prevention. Keep your mouth and wallet happy by always using up your dental benefits before the end of the year.

The post How to optimize dental benefits before year-end appeared first on The Floss By Opencare.

Dental insurance is a way to avoid the high costs of unexpected dental emergencies and to cover routine dental visits. According to the National Association of Dental Plans, about 77 percent of Americans in 2016 had dental insurance.

If that many people are insured, then dental insurance must be a good investment, right? The answer is: maybe.

Let’s take a realistic look at dental insurance by examining the costs and coverage to determine if it’s right for you.

What Does The Insurance Cover

First, let’s clarify that dental insurance and health insurance are not one and the same. Health insurance covers your bills after you reach your deductible while dental insurance covers your expenses until you reach an annual limit—after which you pay out of pocket.

Americans pay about $360 a year on average for dental insurance, which can range between $15 – $50 per month. How much a person pays depends on the plan they have, what state they live in, and how much they pay in premiums. High premiums mean more coverage and low premiums mean less is covered, and the majority of plans come with a coverage limit that most people don’t exhaust.

Your dental insurance is split into three categories: preventative, basic, and major.

The divide is usually in a 100/80/50 structure. Most dental plans cover 100 percent of your preventative care; such as semiannual teeth cleanings, x-rays, oral evaluations, and sealants for some age groups. Insurers typically cover about 80 percent of basic procedures such as cavity fillings, periodontal work, tooth extractions, and fillings. For major procedures, you can expect your dental insurance to pay for about 50 percent. This category includes implants, crowns, bridgework, major oral surgery, dentures, and more.

Cosmetic work like teeth whitening, veneers, tooth shaping, and gum contouring is unlikely to be covered by dental insurance and you will have to pay out of pocket. 

It’s also important to note that there are variations in plans. For instance, one insurance plan might consider a root canal to be a basic procedure, while another may rule it to be a major one. For individual policies, it’s standard to have a one-year waiting period before your plan kicks in  to cover orthodontics (braces), prosthodontics (dentures or bridges), and periodontics (scaling or root planning).

Types of Dental Insurance

There are several types of dental insurance you can choose from like the ones listed below.

Preferred Provider Organization (PPO)

When you use a PPO, you pay reduced fees to visit “preferred” in-network providers. You aren’t required to use in-network providers, but  it will save you money.

The good news is that the insurance network will pay more than an HMO (Health Maintenance Organization) plan or indemnity plan. However, you’ll end up paying more if you use a provider who’s not within the network. Additionally, dental PPOs often have a maximum amount they’ll reimburse you each calendar year.

Just half of PPOs cover over $1,500 each year and the other half only offer benefits below $1,500. Premiums tend to be between $168.72 to $366.84 per year, and family plans are roughly double. Some procedures might have a waiting period before coverage begins.

This type of plan might be useful if you don’t need immediate dental care and want low premiums.

Health Maintenance Organization (HMO)

Unlike a PPO where seeing in-network providers is just “preferred,” when you use an HMO, you’re required to use only the dental providers in the insurance network.

While that means you get a minimal choice in providers, with an HMO preventative work is typically completely covered and you might not even have a deductible or maximum annual limit. Premium payments are also on the lower end. You may, however, have a co-pay for basic procedures. An HMO might cover under 50 percent of the costs of major or restorative procedures or leave payment totally up to you.

This type of plan is ideal for people who don’t need a lot of options when it comes to dental providers, have good dental health, and want to focus on preventative care.

Indemnity or Fee-for-Service Plans

With indemnity dental insurance, you choose your dental provider and your plan will pay a percentage of the provider’s fee.

Your deductible might be lower than with other plans and your annual maximum coverage limit might be higher. The downside is that your premiums tend to be higher than other plans and you pay your share of costs upfront.

If you anticipate needing significant procedures and want to have the ability to pick from a large selection of providers, this is the type of plan that will allow you to do so.

Out of Pocket (No Dental Insurance)

Instead of using any dental insurance, you can choose to pay all of your dental care out of pocket.

Prices vary depending on where you live. If your area has a high cost of living, you’ll pay more. The American Dental Association (ADA) conducts surveys every few years to find the average American costs for various dental procedures. According to their 2013 survey (the most recent publicly released data), you can expect to pay around these prices for the following procedures:

• Series of x-rays = $124
• Teeth cleaning = $85
• Silver dental filling = $125
• White dental filling = $149
• Porcelain crown = $1,000

2016 data provided to NerdWallet by FAIR Health shows the average national prices for three types of root canal procedures:

• Front tooth = $762
• Bicuspid = $879
• Molar = $1,111

If you don’t foresee needing dental care often and don’t like the concept of paying a yearly fee for something you may not use, you’re better off paying out of pocket. 

When Dental Insurance Might be Worth It

For some people, dental insurance is a good investment. 

For instance, dental issues aren’t entirely a result of lifestyle choices—they also have strong hereditary influences. If your family has a history of root canals, a high number of cavities, or other dental problems, there is a good chance you’ll also end up needing a lot of dental work. This means you would have frequent dental bills from more regular treatments. In this scenario, you could make the most of your dental insurance.

Another situation where dental insurance makes sense is if you have little to no money set aside for emergencies. When you have no wiggle room in your finances, a major dental procedure can set you back financially. . Rather than choosing between long-term debt and severe dental issues, it’s better to have dental insurance at the ready. Dental insurance can also be motivational. If you need an incentive to stay on top of your dental cleanings and other preventive care, dental insurance might be beneficial to you. It’s standard for dental insurance to cover two annual cleanings. If you don’t use them, you’re missing out on services you already paid for. 

When Dental Insurance Might Not be Worth It

Many people find they end up losing money with dental insurance rather than saving any.

For instance, if you have healthy teeth and no unusual dental needs, annual dental insurance may not be useful for you. Except in the case of an emergency, you’ll be paying money into a plan that you almost never use.

Additionally, extra dental insurance outside of what’s offered by your employer is typically unnecessary. Employer dental benefits typically cover between 25 to 80 percent of normal treatment costs like cleanings, crowns, and fillings. In fact, those with great dental health may be better off skipping dental insurance offered by their employer altogether. To determine if your job’s dental insurance is worth it, look over the monthly payments, annual maximum, and coinsurance.

Signing up for dental insurance when you already need an urgent dental procedure is also often useless. There is typically a delay before dental insurance benefits kick in. For major procedures, you may have to wait a full year before your insurance would help with costs. This delay means you either have to pay completely out of pocket for your procedure (while paying for dental insurance that isn’t helping with the procedure) or wait a significant amount of time to get your work done. If you wait too long on a crucial dental issue, you can cause more oral health problems that will be pricey later.

Finally, dental insurance isn’t worth it if there is a specific dentist you want to visit who doesn’t accept dental insurance. Unlike health insurance, dental insurance is not accepted at all practices. Call your dental provider and ask  if they accept dental insurance. You don’t want to enroll just to find out you can’t use your new insurance with your preferred provider.

How to Save Money on Dental Work

Even without insurance, there are ways you can save money on the dental work you get done.

One option is to visit a dental school where students conduct procedures while supervised by trained dentists. You pay a lower cost for appointments. The American Student Dental Association (ASDA) has 66 dental schools across the United States and Puerto Rico. Appointments at a dental school are often in high demand, so make sure to book your appointment in advance.

Try visiting a dental clinic. Clinics often offer a fee that’s based on your income and circumstances. . Check for low-cost care options in your state. Even if a clinic says they allow walk-in appointments, call ahead as you may need to put your name on a waiting list. Some people use dental discount plans. These are different from insurance and you can’t use a dental discount plan if you have insurance. A dental discount plan is similar to being a member of a club. You pay an annual fee and sometimes an enrollment fee and in exchange you get a discount on average dental care prices. These fees are usually lower than the costs of premiums on dental insurance policies, but you’ll pay more at the dentist’s office than you would with insurance. There are no waiting periods or annual caps. If you’re an AARP member or part of a similar organization, check to see if you’re eligible for group dental insurance plans offered by your membership.

Is Dental Insurance Worth It?

Whether dental insurance is worth it for you all comes down to personal preference and a combination of factors.

If you have a family history of dental issues, are living on a tight budget, or need motivation to get your preventative dental work done; you may want to look into your options for dental insurance. There are several types of dental insurance available including PPOs, HMOs, and fee-for-service plans. For people with very healthy teeth, employer-offered dental benefits, specific dentists they want to see who don’t accept insurance, or who already need urgent dental procedures done; dental insurance might be a waste of money. Without insurance, you can save money on dental work by using a dental school, dental clinic, or signing up for dental discount plans.

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