Is dental insurance worth it? Learn more about the cost, coverage, and waiting periods

Nichole McKenna

Written by Nichole McKenna DDS, Richard Hattaway DDS

Dental insurance is the first thing that comes to mind when you want to lower the costs of oral care. Nonetheless, there are many downsides like waiting periods, annual caps, and there are always hidden fees. Being aware of the inner workings can help you save money.

Check out the pros and cons of PPOs and HMOs, how much your dental insurance will cost, and the ways you can sign up.

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How does dental insurance work?

Comprehensive dental exam

Picture by Authority Dental under CC 2.0 license

Dental insurance makes sure you have help in financing basic oral care, which is not optional. An insurance policy reduces financial risk in emergency treatment or when you need major dental work.

To start taking advantage of those benefits, you need to choose a plan and determine insurance coverage with your provider. The coverage, also known as an annual cap, is the maximum your insurance will reimburse for your dental procedures per year.

Then, you have to pay activation fees, called deductibles. It is hard to find dental insurance with no waiting period. The policy is usually ready to use after about 1-3 months. Notice, however, that you have to make regular monthly payments to keep your insurance active throughout the year.

If you do, you can visit your dentist. Some procedures will be available for free, while others will require you to cover a percentage out-of-pocket. These are co-payments. Despite having an active insurance policy, you may have to pay the full price for the treatment. Examples of such cases include when your yearly maximum limit is reached, or if the insurance does not cover a specific procedure.

What does dental insurance cover?

Professional dental exam

Picture by Authority Dental under CC 2.0 license

Full coverage dental insurance, one that would pay for all procedures completely, doesn’t exist. You will need to pay a percentage out-of-pocket for some procedures.

Exact coverage depends on your plan and the terms you work out with your provider. The following, however, tend to be more or less accurate for most dental insurance policies.

You will be completely reimbursed for preventative care by almost all dental insurance companies if you are free of severe dental diseases. These procedures include: - dental checkups and cleanings twice a year, - X-rays, - cavity repairs, and - sealants.

In case you are struggling with oral issues, like advanced gum disease or tooth decay, preventive care may no longer be part of the coverage. The same goes if you need to have a dental exam or prophylaxis more than two times per year. You will most probably have to pay out-of-pocket, at least in part.

So-called full coverage dental insurance includes partial reimbursement for restorative and at times even orthodontic treatment. Many plans cover simple procedures in as much as 80% or 50%. Here are a few dental services in this category: - root canal treatment, - extractions, - anesthesia, - restorations like crowns, bridges, dentures.

These types of visits have to be medically necessary, however. The policy is unlikely to reimburse for, for example, crowns if all you are looking for them to fix is aesthetics.

Insurance will not cover any treatment that does not serve to improve the health of your mouth. The following procedures usually have to be paid for by the patient in full: - whitening, - implants, - bonding, and - veneers.

Of course, you may argue that bonding or veneers serve a medical purpose as well as a cosmetic one. Some policy providers may agree to negotiate, but you will need evidence in the form of X-rays and professional evaluations by a licensed dentist.

Types of dental insurance policies

Periapical dental X-rays

Picture by Authority Dental under CC 2.0 license

There are four main categories of insurance plans you can sign up for:

  • individual dental insurance,
  • family dental insurance,
  • private dental insurance, and
  • federal health insurance programs.

An individual plan is meant to cover a single person’s dental costs. A family plan covers dental health of multiple members, even if just one person is officially signed up. It is often taken advantage of when only one parent is employed.

Also known as commercial dental insurance, a private plan is individual dental insurance offered via employers. Federal programs are funded by the state. A popular example is Medicare dental insurance. It has special types of dental insurance for seniors as well.

It’s also important to understand the difference between HMO and PPO. Those are the manner in which the plans of the categories above may be offered.

Health Managed Organizations

HMOs are a type of health or dental insurance plan that assigns patients a primary care provider. Visiting out-of-network dentists is never covered. The benefits include low rates and copayment.

On the other hand, HMO plans are very limited. Some may not even include emergency care. What’s more, many offices are overbooked and understaffed. A lot of patients quote negative experiences with these types of insurance plans.

  • Cheap

  • Copayment is low

  • Designated primary care provider

  • Only in-network dentists

  • Some plans may not include basic procedures

  • Emergencies and orthodontics may not be covered

  • Often overbooked and understaffed

Preferred Provider Organizations

PPO dental insurance policies have networks of providers including both professionals and hospitals with whom they sign contracts. This way coverage is larger for patients who use the plan and choose to go with an in-network specialist.

The pros of PPOs include the freedom of picking your professional, the option of out-of-network visits, and fixed rates.

On the down side, these plans may be more expensive than HMOs, out-of-network coverage is not as substantial (as in-network), and you have to pay out-of-pocket at the time of service.

The last factor means that the insurance provider will reimburse you after your treatment is done. You will have to pay for your dental procedures as if they were non-covered visits.

  • A network of dental providers you can choose from

  • Fixed rates

  • Covered out-of-network visits are possible

  • Usually more expensive than HMOs

  • Out-of-network coverage is lower

  • You are reimbursed after treatment

How much is dental insurance?

Ceramic dental filling

Picture by Authority Dental under CC 2.0 license

The average cost of dental insurance in the US is between $15 and $50 a month. With an average of $30, this comes out to about $360 a year. Annual coverage maximums go up to about $1,000-$1,500.

Bearing in mind that what is covered fully (2 exams, 2 cleanings, fillings, and sealants for children), you are experiencing savings. With the average price for an exam being $60 and $100 for a cleaning, you would spend $320 a year anyway. And this is assuming that you don’t need any fillings.

An important thing to note are charges that may be imposed if you are late with any fees. Those are often quite steep. Make sure to read fine print carefully to become aware of how the policy works.

You may want to search for supplemental dental insurance plans to cover more procedures during upcoming years. Remember though, that this comes with extra costs.

How to get dental insurance?

Finding a great plan is sort of like shopping. You have to compare your choices and consider what is going to pay off most in the long term.

Employer-provided insurance

The easiest way is to sign up through your employer. Visit or contact your HR department and find out what is available for you. You can discuss different options, they often include both individual and family plans. Make sure to concentrate on what is best in your particular situation.

Purchasing private dental insurance

Alternatively, you can ask your friends, family, or dentist. If you want to search for insurance online, visit the Health Insurance Marketplace. This is a government website that makes it easier to find a plan in your state.

FAQ

There is no one best or cheapest plan. It all depends on your individual needs and how much dental work you will require per year. Some more expensive plans may be more cost-efficient in the long term for some risk groups such as smokers.

The more procedures you expect to need, the better off you are with a plan that covers restorative work more widely. Those plans are usually more expensive. Also, remember to start thinking of insurance in advance, as waiting periods can sometimes last up to a few months.

The best way is to reach out to your dentist or the policy provider directly. The office will be able to verify what you qualify for through your online portal. Many insurance plans also give patients identification cards, which include a toll-free number you can call with any queries you may have.

There are other solutions to lower costs of oral care. Authority Dental recommends using dental plans. Discounts are available for all procedures, medically necessary or not. Whether you need dental implants or routine X-rays, there’s no need to worry.

The reductions reach 60%. What’s more there are no yearly caps at all and no paperwork is needed. You can start saving the minute you sign up. There are no waiting periods. The only catch is that you have to find an in-network dentist, but that is true for most insurance policies as well.

References

  1. Dental coverage in the Marketplace - HealthCare.gov
  2. Does Medicare Cover Dental? - Healthline
  3. Health Insurance - HealthCare.gov