Dental insurance policies work by helping you effectively budget for the cost of maintaining healthy teeth and gums. Dental insurance is available as part of medical insurance plans or as a standalone policy purchased from the Marketplace or a dental insurer.
Key Takeaways
- Dental insurance covers costs related to issues with the teeth and gums, as well as preventive care such as annual cleanings.
- Not all procedures are covered; for example, cosmetic procedures, such as teeth whitening, are not typically covered.
- Deductibles, co-pays, and coinsurance will apply, and many policies have annual coverage maximums that are relatively low, ranging from $750 to $2,000 in many cases.
- Look at the best dental insurance companies to see which offers the best coverage for you.
Overview of the System
Like health insurance, you can select a dental plan based on the providers (dentists) you want to be able to choose from and what you can afford to pay.
- If you already have a dentist you like, and they are in the insurance company’s network, you can opt for one of the less expensive plans.
- If you don’t have a dentist at all, you can choose from the dentists in the network and again have the option of a less expensive plan.
- If your existing dentist is not in the network, you’ll pay significantly more to see your dentist than an in-network one—so much more that you may not have any chance at coming out ahead by being insured.
The monthly premiums depend on the insurance company, location, and plan. For many people, the monthly premium will be around $50. This means you’re spending $600 on dental costs each year even if you don’t get any work done.
You also can get dental insurance through a group plan, a Medicare Advantage plan, and other ways.
Deductibles, Copays, Coinsurance, and Maximums
Here are some terms you might encounter when comparing dental insurance plans.
Deductible
An insurance deductible is the minimum amount to be paid before the insurance policy pays for anything. For example, if the deductible is $200, and the covered individual’s procedure is $179, the insurance does not kick in,and the individual pays the entire amount. Many plans exempt preventative care from the deductible.
Copays and Coinsurance
Copays are a set dollar amount and also may be required during a procedure. When a dental deductible is met, most policies only cover a percentage of the remaining costs. The remaining balance of the bill paid by the patient is called coinsurance, which typically ranges from 20% to 80% of the total bill. Plans will not have both copays and coinsurance. HMOs usually have copays and PPO plans usually have coinsurance.
Annual Maximums
Most dental policies cap how much they'll spend on your dental procedures. Coverage maximums typically range from $1,000 to $2,000 per year. Generally speaking, the higher the monthly premium, the higher the yearly maximum.
When patients reach the yearly maximum, they mustpay for 100% of any remaining dental procedures. Insurance companies may offer policies that roll over a portion of the unused annual maximum to the following year.
Most dental insurance plans follow the 100/80/50 payment structure: They pay 100% for preventive care, 80% for basic procedures, and 50% for major procedures.
How Dental Insurance Pays for Procedures
Dental procedures covered by insurance policies are typically grouped into three categories of coverage: preventive, basic, and major. Every policy differs in terms of which procedures are categorized as preventative, basic, and major and whether each is covered. So, it is essential to understand what is covered when comparing policies.
Preventive Dental Services
Most dental plans cover 100% of preventive care, such as annual or semiannual office visits for cleaning, X-rays, and sealants. These are the most common procedures covered, often without any waiting period. You are typically limited to 2-3 cleaning and routine exam visits per year.
Basic Dental Services
Basic procedures are treatments for gum disease, extractions, fillings, and root canals, with deductibles, copays, and coinsurance determining the patient’s out-of-pocket expenses. Most policies cover 80% of these procedures, with patients paying the remainder. Most dental insurance policies have waiting periods ranging from six to 12 months before any work can be done.
Major Dental Services
Major procedures such as crowns, bridges, inlays, and dentures are typically only covered at 50%, with the patient paying more out-of-pocket expenses than other procedures. Some policies classify root canals as major procedures, while others treat them as basic procedures and cover much more cost. Waiting periods for major work (such as crowns, dentures, and bridges) are 12 months, but can be longer or shorter, depending on your insurance plan. This means you must stay with the same insurer for the stated time.
Patients needing costlier procedures should pay particular attention to the details of dental insurance policies. For instance, a single dental implant can cost $3,000 to $6,000. Many basic dental insurance plans don't cover implants, and those that come with limits and exclusions. With that in mind, many consumers choose dental insurancecovering implants.
Insurance companies set waiting periods to guarantee that they profit from a new account and discourage people from applying for a new policy to cover upcoming, expensive procedures.
Applying Tax Credits for Dental Insurance
Any leftover tax credit you don't use to pay for your family’s health insurance as purchased through Healthcare.gov may be applied to pediatric dental insurance premiums if your medical insurance policy does not include children's dental coverage. If your health insurance policy includes children’s dental coverage, you cannot use tax credits to buy an additional plan.
Can Tax Credits Be Applied to Dental Insurance?
Yes and no. You may use tax credits for dental insurance if your plan doesn't include children's dental coverage. If the plan does include children's dental coverage, you may not use it to purchase an additional plan.
Does Dental Coverage Cover Cosmetic Treatments?
No. Most dental insurance policies do not cover any costs for cosmetic procedures, such as teeth whitening, tooth shaping, veneers, and gum contouring. Because these procedures are meant to simply improve the look of your teeth, they are not considered medically necessary and must be paid for entirely by the patient. Some policies cover braces and orthodontia, and some don't. Usually you'll have to delay braces fora lengthy waiting period.
Is There a Limit to Your Dental Benefit Each Year?
Yes, most plans cap out at $1,000 to $2,000 annually for benefits. Most dental PPOs plans have a maximum annual benefit of $1,500 or more.When the annual limit is met, patients pay 100% of their dental costs. However, according to research from the National Association of Dental Plans, few enrollees with higher limits hit their maximum.
Is My Annual Exam Covered by Dental Insurance?
Most plans cover routine procedures such as exams, tooth cleaning, fluoride application, and X-rays at 100%.
Can I Use My Dental Insurance Immediately?
Most dental policies require a six- to 12-month waiting period for any restorative work such as fillings. Routine exams and cleanings should be covered immediately.
The Bottom Line
Choosing a dental plan can be challenging once you review the paperwork's fine print. Much depends on your oral health, age, necessary procedures—and even which dentist you want to see. Seniors on Medicare, for instance, will have a different definition of what constitutes the best dental insurance possible than other age groups. Carefully review your options with the insurance company or a trusted insurance agent who can advise you on the finer points.
