Buying affordable dental insurance may not be a priority for most people. But it probably should be. In 2016, about 74 million Americans did not have dental insurance. Most health insurance plans do not cover daily dental needs, such as exams, fillings, and root canals. And while health insurance covers some extreme oral surgeries (such as jaw restoration after a car accident), routine dental care is usually not covered.
Dental insurance plans are designed to fill the gap. Whether offered by an employer or a private insurer, most plans have monthly premiums, deductibles of $ 25 to $ 100, co-payments, and a maximum annual benefit – the median is $ 1,500.
A good argument for buying dental coverage is that many plans focus on preventative care. If cleanings and exams are free as part of your plan, you may be more likely to make and stick to appointments. This can save you money and your teeth in the long run.
Key points to remember
- Most health insurance plans do not cover preventative or routine dental care.
- Before purchasing dental insurance, think about issues such as your healthcare needs, whether your dentist is part of a network, and whether you want cosmetic services.
- Dental benefit options include employer-provided insurance (sometimes with an FSA), Medicare Advantage plans, Healthcare.gov and Medicaid plans, private dental insurance, and dental savings plans.
- To get the most out of your policy, plan and book a dentist appointment in advance throughout the year to ensure the work is done before your benefits expire.
What are your dental insurance needs?
Here are some things to consider when estimating your family’s dental insurance needs for the next several years and what they might cost.
Do you have a dentist or hygienist you love?
If so, the best place to start looking for a dental insurance plan may be a conversation with your dentist or their staff. Find out which plans, if any, the practice accepts and whether it is part of networks. Also inquire if the dentist participates in discount programs or has an in-office plan.
Are you ready to choose a dentist from a list of networks?
You may be able to save money by choosing a dentist from a dental insurer’s network list. However, the cheapest plans offered by private insurers may have small networks, so check to see that there are dentists in your area who take any plan you are considering.
What kind of care do you need?
If you receive regular care, your dentist can help you plan for what you might need over the next few years. Expensive dental care, such as braces for a child or an adult, can cost anywhere from $ 3,000 to $ 10,000 for complex cases. Dentures can cost thousands of dollars and implants even more.
If you are expecting this kind of expense, it is worth researching which types of dental benefits can help you the most.
Can you wait 6 to 12 months for full coverage to take effect?
Plans often provide for waiting periods of up to 12 months before you qualify for certain expensive benefits, such as braces or dentures.If you can wait, this kind of policy could save you money. If you can’t wait, more expensive plans are available where benefits begin immediately.
Do you want cosmetic procedures?
Cosmetic dentistry includes the whitening of teeth, veneers, gums, and restorative fillings or crowns. Most dental insurance plans don’t cover cosmetic procedures, and plans that do may have a limited network and pay only a small percentage, like 20%, of the cost. Dental discount cards, which provide discounted services from a network of dental providers, can be used for cosmetic procedures. (See more below under “Dental Savings Plans.”)
Dental benefit options
Your location and where you get your health insurance often determine which dental plans are available to you. Monthly premiums for individual coverage range from $ 20 to $ 80, on average. Private and employer-sponsored plans also have annual deductibles and maximum annual benefits of $ 1,000 to $ 2,000.
If the plan’s maximum benefit is not enough to cover your expenses, look for a plan with a higher maximum. Keep in mind that pre-existing conditions are generally not covered by dental plans. If you had a missing tooth before the effective date of your coverage, for example, you may not be entitled to benefits.
Here are the main sources of dental insurance plans.
1. Dental plans offered by the employer
Most Americans (77% in 2016) obtain dental insurance through their employer.
This is often the most economical choice because the employer pays part of the premium. It is important to check the policy before registering, so as not to be surprised by the reimbursable fees. If a flexible expense account is available, consider using it for your portion of expenses.
2. Flexible Expense Accounts (FSA)
Any dental visit or procedure that treats or prevents illness is eligible for FSA coverage (sometimes offered by employers with insurance). Cleanings, x-rays, crowns, tooth extractions, dentures, gum treatments and more are included. However, cosmetic procedures, such as teeth whitening veneers or cosmetic orthodontics, are not. Your dental office should be ready to help make sure services are covered under your FSA plan.
3. Medicare Advantage plans
Most people with traditional health insurance do not have dental coverage. Almost half of them have not been to the dentist in the past year, and almost 20% have spent more than $ 1,000 out of pocket on dental care. Traditional health insurance does not cover dental bills except for those associated with serious conditions requiring hospitalization.
However, most Medicare Advantage plans offer at least some dental coverage. Some plans pay only for preventative care, while others have more extensive coverage. Some Medicare Advantage plans charge an additional premium for dental coverage.Many of AARP’s best Medicare Advantage plans include dental coverage.
The percentage of Americans in 2016 who received dental insurance through their employer.
4. Healthcare.gov and Medicaid
Under the Affordable Care Act, dental coverage for people under the age of 18 is considered an essential benefit and must be available for your child. But dental coverage is not seen as an essential benefit for adults. Some plans in the market for adults include dental benefits. In some cases, the insurer offers separate, stand-alone plans for a separate additional premium.
For children covered by Medicaid or the Children’s Health Insurance Program (CHIP), dental benefits are provided by the states. Some states also offer dental benefits to adults covered by Medicaid.
Private dental policies
Insurance companies sell a variety of individual and family dental insurance policies online. You can choose a plan that covers preventative care only or a more comprehensive plan that also pays a percentage for expensive procedures such as root canals, bridges, and implants. When choosing a plan, check to see if there are dental offices in your area that are part of the network.
5. Dental savings plans
Often referred to as discount, savings, or referral plans, this is a membership club for reducing dental bills. The discount company contracts with dentists who agree to reduce their fees to members. The discount generally applies to all services, including cosmetic procedures.
To join a savings plan, you pay an annual subscription which entitles you to preferential rates with dentists in the network, with no annual ceiling. Some dental offices offer their own internal discount plan with lower prices on services for patients who use that office.
People who need little dental care, such as occasional cleanings and x-rays, can save money by using a discount plan rather than paying for dental insurance. People who have health problems that affect their teeth and gums or who require heavy work can save more with insurance, if they can stay under the plan’s annual limit. The best way to decide is to compare the costs of a reduction plan versus a dental insurance policy for your individual situation.
The bottom line
Make sure you don’t leave any money on the table: If you are purchasing dental insurance or using an FSA, it’s a good idea to keep an eye on key dates for using your benefits. According to the National Association of Dental Plans, only 2% to 6% of people covered by dental plans reach their annual maximum. To get the most out of your policy, plan and book a dentist’s appointment in advance throughout the year to ensure the work is done before benefits expire.