Dental Insurance: How Does It Work And Provided Coverage

Dental care can be expensive, and preventive care can cost hundreds of dollars per visit. Other procedures like fillings and root canals can cost a few thousand dollars. Despite the high cost of procedures, millions of Americans go without dental insurance each year.

Key takeaways:

The lack of dental coverage can make you think twice about having necessary dental procedures. Delaying dental care can cause worsening problems and increasing pain. Dental insurance protects your pocketbook when you need dental work, so you don’t have to make that decision.

What is dental insurance?

Dental insurance covers care and procedures typically not covered by medical insurance. Dental insurance can be purchased through the Healthcare Marketplace or directly from an insurance company. Employers offering health insurance may also offer dental and vision coverage at an additional cost.

Dental insurance differs from medical insurance but works similarly. As with health insurance, you pay a monthly premium and may have a deductible and share costs through co-pays or coinsurance. The monthly premium for individual dental insurance averages $29 – $50.

Dental plans can be PPO, HMO, or EPO. If you purchase one of these plans, you will have a specified network of dentists to choose from. It is essential to ensure an available in-network dentist in your area before purchasing a plan. Other types of plans include indemnity, direct reimbursement, and point-of-service.

How does dental insurance work?

Dental insurance works similarly to health insurance. You may have in-network and out-of-network providers. Much like health insurance, you may have to meet a deductible before cost-sharing takes effect. However, there are differences between health and dental insurance.

If you have health insurance or a Medicare Plan, supplemental dental insurance is a great way to fill gaps not covered by health insurance or the dental insurance plan offered through your employer or Medicare plan.

With dental insurance, you can have primary and secondary plans. Primary dental insurance typically covers the enrollee. Secondary dental insurance covers a dependent. For example, you may have a primary plan through your employer. You can also be listed as a dependent on your spouse’s dental plan. Depending on the plans, the secondary plan may pay the primary plan's uninsured costs. You may also be covered under your spouse's plan when you’ve reached the maximum annual limit with your primary plan.

What does dental insurance cover?

Dental plans vary, so check your plan guidelines. However, most dental plans cover standard preventive and repair services. Dental insurance often covers preventive care like twice-yearly cleanings at the full cost. Simple procedures like fillings for cavities are often covered as well.

Dental procedures covered by insurance

Common procedures and services covered by dental insurance include:

  • Dental cleanings
  • X-rays
  • Fluoride
  • Fillings
  • Crowns
  • Extractions

Dental services not covered by insurance

Procedures and services not commonly covered by dental insurance include:

  • Teeth whitening
  • Veneers
  • Braces and retainers

While it is not widely included in dental insurance, braces and retainers are covered under some comprehensive plans. Check your plan guidelines to determine what expenses are covered.

Costs associated with dental insurance

Dental care is much more affordable for those with dental insurance. The average monthly cost of an individual dental insurance plan is $15 – $50. Depending on your plan, you may have additional costs, including a deductible, coinsurance, or co-pays.

Deductible

The dental insurance deductible is the amount you pay out-of-pocket before insurance cost-sharing begins. Most dental plans have a low deductible. Typical deductibles are $50 – $100 annually. The deductible is usually paid before you have a procedure.

Coinsurance

Coinsurance is the amount you pay after the insurance plan has paid its share. The amount of coinsurance you are responsible for varies, depending on your plan and the procedure. Basic restorative care like root canals, fillings, and extractions are usually covered at 80%, making your share 20% of the total cost. Major restorative care like crowns and bridges are typically covered at 50%. Be sure to check your plan details for your coinsurance amount.

Co-pay

Some dental plans have a co-pay for certain procedures. You are responsible for a fixed amount for each procedure or service. There may be a specific co-pay for routine visits or things like x-rays or fillings.

Will I have to pay upfront for dental services?

Some dental offices may require an upfront payment for procedures even if you have a dental plan. The paid bill is submitted to your insurance company, and you receive reimbursement. Some dentists require payment for the uninsured portion of the cost, and they may request payment the day of the procedure. Some dentists offer in-house payment options and third-party financing many be offered for major procedures, such as implants and crowns.

With or without dental insurance, it's beneficial to speak to your dentist's billing department to learn what payment options are available.

Does dental insurance have waiting periods?

Many dental insurance plans include a waiting period for major procedures. Typical waiting periods are three months to one year after your plan becomes active. The waiting period is often waived for preventive care. Some plans deny coverage for pre-existing conditions, such as tooth loss or periodontal disease, even if it occurs within the waiting period, so know the plan coverage and exceptions before purchasing.

Does health insurance cover dental care?

Often, health insurance plans don't cover dental care. However, there are some exceptions. CHIP plans typically cover preventive dental care for children. Adults are more likely to be covered under Medicaid in Medicaid expansion states.

Private health insurance, Medicare, and Medicaid often cover emergency dental procedures performed in a hospital. Common services covered by medical insurance include:

  • Dental infections
  • Biopsies
  • Wisdom tooth extractions
  • Treatment for TMJ and related headaches

Check your health insurance plan to determine if the needed services are covered.

A good dental health insurance plan is more affordable than you may think. Healthy teeth are important to your overall health. Having dental coverage can be a great way to ensure that you are able to get the preventive and curative dental treatment that you need.

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