Dental and vision insurance aren’t covered by standard individual or family insurance healthcare plans. However, dental care is just as important for a person’s wellbeing. The right dental insurance policy can help you stay healthy and keep your teeth in good shape.

Having dental insurance can also give you much-needed peace of mind—especially considering the high cost of dental work. With a quality dental insurance policy, you can get coverage for anything from routine exams and cleanings to more complex procedures such as root canals and extractions.

Dental plans typically fall into one of three categories: employer-based, self-purchased, or “riders” attached to medical insurance policies. Whether you currently have coverage or are trying to decide whether to add on dental benefits, it’s important to understand the basics of dental insurance, which we’ll be discussing below.

What does dental insurance typically cover?

Like other types of health coverage, dental plan benefits vary by plan and insurance company. For more detail on coverage, always check the plan benefits documents for the plan you’re considering. In general, a dental insurance policy will typically cover:

• Regular checkups and cleanings, usually twice a year (out-of-pocket copay may be required)
• Cavity fillings
• Tooth extractions
• X-rays
• Crowns, bridges, and implants
• Root canals and other necessary repair work
• Dental appliances (e.g.., retainers)
• Emergency dental procedures, such as oral surgery

Please note that certain dental equipment or services may be covered, but at different levels of coverage. Typically, preventive care, such as cleanings, is covered fully, while other procedures, such as fillings or emergency oral surgery, may have higher out-of-pocket costs. You may be responsible for paying a deductible before coverage will kick in for these types of procedures. This is usually waived for preventive care.

While most dental plans cover basic dental work and preventive work, there are some procedures that many do not provide coverage for. A prime example of this is composite (tooth-colored) fillings.  Often, coverage will only be provided for amalgam (silver) fillings, and policyholders will be responsible for paying the difference if they prefer composite fillings.

• orthodontic treatments (braces)
• dental care related to a pre-existing medical condition
• Cosmetic procedures, such as teeth whitening

Of course, all dental insurance policies differ, so policyholders should check their coverage limits to find out exactly what is and what is not covered in their unique cases.

Do health insurance plans cover dental care?

Dental insurance is typically offered in three ways:

• As part of an employer-sponsored health plan
• As part of a health plan you buy yourself, such as through a broker like eHealth
• As a stand-alone dental plan or “rider” (either through your employer or purchased yourself)

Not all health plans cover dental benefits, and availability will vary depending on where you live. Under healthcare law, dental benefits aren’t an essential health benefit for adults. This means that health insurance companies aren’t required to offer dental coverage if you’re over 18 years old. If you’re interested in finding a health plan that includes dental coverage, or if you’d like help finding a stand-alone dental plan, eHealth’s plan finder tool makes it easy to browse and compare prices and benefits across plans.

Please note that while insurance companies aren’t required to offer adult dental insurance, dental benefits are considered an essential health benefit for children. So, if your health plan covers dependents 18 and younger, the plan is required by law to have dental benefits available as part of its health coverage, or to provide these benefits as a separate dental plan. However, health care law only requires that dental benefits be offered to children; you’re not required to buy it.

If your health plan includes dental benefits, your monthly premium should cover the cost for both your health and dental coverage. If you decide to buy dental coverage as a supplemental benefit, you’ll pay a separate premium for your dental plan, in addition to the premium you pay for your health plan.

Dental insurance costs and premiums

There are some factors to consider when finding a policy that’s right for you and fits your budget:

• Dental insurance premiums vary. Typical dental premiums range from around $20 to $60 per month, but this can vary greatly depending on your coverage and even where you live.
• Benefits may be covered at different coverage levels. Preventive care such as routine cleanings are usually covered without out-of-pocket costs. From there, some plans may cover 80% of the costs for certain procedures, such as fillings, leaving the policy holder with 20% of the cost after the annual deductible is met. Other policies may cover major procedures, such as implants, at only 50%, leaving you to cover the remaining half of the bill.
• You’ll pay the full cost for uncovered procedures, such as orthodontics. For more information, see the section above, “What’s usually not covered in dental insurance.”
• Dental plans may have annual coverage maximums. If you reach your plan’s maximum, then you’ll pay for any extra dental costs after that coverage limit. For example, if your plan’s coverage limit is $2,000, you’ll pay for remaining costs for the year once your plan has paid $2,000 in dental benefits. 
• Time limit restrictions may apply. Some dental plans only cover certain services, such as fillings or X-rays, a certain number of times a year or every few years. So, if you need a lot of dental work done up front, not all of the benefits may be covered immediately. If it’s urgent that you get the procedures and you can’t wait, you may have to pay out of pocket.

Types of dental insurance plans

When selecting a dental insurance plan, understanding the different types available is key to making an informed decision. Dental insurance plans are typically categorized into two main types: indemnity plans and managed-care plans. Indemnity plans, often referred to as “fee-for-service” plans, offer a broad choice of dental care providers and typically involve the policyholder paying upfront and being reimbursed a portion of the cost. Managed-care plans, which include Dental Health Maintenance Organizations (DHMOs) and Preferred Provider Organizations (PPOs), usually limit provider choices to a network of dentists who agree to offer services at lower costs. The major differences between these types of plans lie in the choice of dental care providers, out-of-pocket costs, and the manner in which bills are paid. These differences can significantly affect your dental care experience, from the flexibility in choosing a dentist to the financial aspect of managing dental expenses.

HMO dental insurance plans

HMO (Health Maintenance Organization) dental insurance plans represent a managed-care approach focused on preventive care and network-based dental services. In an HMO dental plan, policyholders are required to choose a primary care dentist (PCD) from within the plan’s network of dental professionals. This primary dentist manages all of their dental care needs, including referrals to specialists if necessary. One of the key features of HMO plans is the emphasis on preventive care, often including regular check-ups, cleanings, and X-rays at low or no additional cost to the insured.

The cost structure of HMO plans typically involves lower premiums and minimal or no deductibles. However, these plans usually do not cover services rendered by out-of-network providers, meaning all non-emergency dental care must be performed by dentists within the HMO network to be covered. The focus on network services helps keep costs down, both for the insurance provider and the policyholder, but it also means less flexibility in choosing dentists compared to other types of dental insurance plans. This type of plan is ideal for individuals who prioritize lower costs and are comfortable receiving care from a specified network of dental providers.

PPO dental insurance plans

PPO (Preferred Provider Organization) dental insurance plans offer a blend of flexibility and cost management, making them a popular choice for dental coverage. In a PPO plan, policyholders have the freedom to choose any dentist, but they receive greater benefits and lower out-of-pocket costs when they use dentists within the plan’s preferred provider network. These networks consist of dental professionals who agree to provide services to plan members at negotiated, reduced rates.

One of the distinguishing features of PPO dental plans is the balance between choice and cost. While premiums for PPO plans are generally higher than those for HMO plans, they offer more flexibility in choosing dentists, including the option to see out-of-network providers, albeit at a higher cost. The cost structure of PPO plans typically involves deductibles, co-pays, and co-insurance, where the policyholder shares a portion of the service costs. Additionally, these plans often have an annual maximum benefit limit.

PPO dental insurance is well-suited for individuals who value the ability to choose their dentist and are willing to pay a bit more for that flexibility. It’s also beneficial for those who might need or want dental care from specialists outside of a predefined network.

Indemnity dental insurance plans

Indemnity dental insurance plans, often referred to as traditional or fee-for-service dental plans, are known for their flexibility and straightforward reimbursement model. These plans allow policyholders to visit any dentist they choose, without the need to select from a network. After receiving dental services, the policyholder pays the dentist directly and then submits a claim to the insurance company for reimbursement.

A key characteristic of indemnity plans is the absence of a network restriction, offering the widest choice of dentists. The insurance company typically reimburses a percentage of the cost for dental services based on a UCR (Usual, Customary, and Reasonable) fee schedule, which determines the amount they consider appropriate for specific dental procedures in a given region.

The cost structure of indemnity plans often includes deductibles, which is the amount the insured must pay out-of-pocket before the insurance begins to cover expenses. There are also usually co-insurance obligations, where the insured pays a certain percentage of the service cost, and the plan covers the rest. Premiums for indemnity plans can be higher compared to managed-care plans, reflecting the increased flexibility and choice they offer.

Indemnity dental insurance is particularly suitable for those who want the freedom to visit any dentist and are comfortable with the process of paying upfront and submitting claims for reimbursement. It is ideal for individuals who prioritize choice and control over their dental care providers and are willing to manage the potentially higher costs associated with this type of plan.

Discount dental plans

Discount dental plans are an alternative to traditional dental insurance, offering a way to save money on dental care without the structure of a standard insurance plan. These plans are not insurance; rather, they operate as a membership program where individuals pay an annual or monthly fee in exchange for access to a network of dentists who have agreed to offer services at discounted rates.

Members of a discount dental plan receive a membership card that they present to participating dentists to receive dental services at reduced rates. The discounts typically apply to a wide range of services, including routine cleanings, X-rays, fillings, crowns, and even more complex procedures like root canals and orthodontics. The specific discounts and services covered vary by plan and provider.

The key appeal of discount dental plans is their simplicity and affordability. There are no deductibles, no annual limits, and no paperwork to file for reimbursements. These plans often become active within a few days of joining, eliminating waiting periods. However, it’s important to note that all expenses are paid out-of-pocket at the time of service, albeit at a lower cost.

Discount dental plans are ideal for individuals who want to save on dental care but either don’t have dental insurance or find traditional dental insurance to be outside their budget. They are also a good option for those who need immediate dental care and cannot wait for an insurance plan’s waiting period. However, it’s crucial for potential members to ensure that there are participating dentists in their area before joining a plan.

How to choose the right dental insurance plan for you

As you’re shopping for a dental insurance policy, make sure that your current dentist accepts the plan you’re considering (unless you’re willing to switch dentists). Licensed insurance brokers like eHealth make it easy to search for plans that have your current dentist in network. You can start browsing dental insurance plans using eHealth’s plan finder tool or find individual and family plans that include dental coverage.

Before enrolling in any dental coverage, be sure to read the fine print to make sure you understand what you’ll be responsible for paying out of pocket, what’s covered versus what’s not, and what your deductible will be. You can save money by only buying what you need; stand-alone policies these days are very customizable to suit your needs and budget. If you like, eHealth’s team of knowledgeable licensed insurance agents can walk you through your options. Just give us a call during business hours to get personalized help.

Don’t put off shopping for a dental insurance plan. As mentioned, most plans have a “waiting period” of up to a few months before coverage officially kicks in, so the sooner you purchase a policy, the sooner you can start using your dental benefits.

Choosing the right dental insurance plan for your needs involves careful consideration of several key factors, beyond just ensuring your current dentist is within the plan’s network. Here are some tips to help you find the right plan:

1. Assess Your Dental Health Needs: Evaluate your dental health and consider any anticipated procedures. If you foresee needing major dental work, look for a plan with comprehensive coverage, while if you only need preventive care, a basic plan may suffice.
2. Compare Plan Types: Understand the differences between PPOs, HMOs, Indemnity, and Discount Dental Plans. Each has its pros and cons regarding provider flexibility, cost, and coverage limitations.
3. Check the Provider Network: If you have a preferred dentist, make sure they are included in the plan’s network. Tools like eHealth’s plan finder can help identify plans that include your current dentist.
4. Review Coverage Details: Examine what each plan covers, including preventive care, basic procedures, and major dental work. Pay special attention to coverage limits, exclusions, and whether the plan covers orthodontics or cosmetic dentistry if these are important to you.
5. Understand Out-of-Pocket Costs: Look at deductibles, co-pays, co-insurance, and annual maximums. A lower premium plan might end up costing more overall if it has high out-of-pocket expenses.
6. Consider Waiting Periods: Be aware that many plans have waiting periods for certain types of coverage, especially for major dental work, so plan accordingly.
7. Customization Options: Explore if the plan allows customization to align with your specific needs and budget. Stand-alone policies often offer various levels of customization.
8. Seek Professional Advice: If you’re unsure, consider consulting with licensed insurance agents like those at eHealth. They can provide personalized assistance and clarify any doubts you might have.
9. Act Timely: Don’t delay in purchasing a plan, especially since most have waiting periods before the coverage becomes effective. The sooner you enroll, the sooner you can utilize the benefits.

By taking these steps, you can choose a dental insurance plan that not only fits your current needs but also offers flexibility and affordability to adjust to your future dental care requirements.

Frequently asked questions about dental insurance

Should I buy dental coverage? 

If you’re currently without dental coverage, you might be wondering whether or not it’s worth buying your own policy. There’s no universal answer here, as everyone’s financial situation and oral health needs are different.

Generally, you’ll want to start by considering the costs of a dental plan versus your typical annual dental care costs. Break down what your dentist charges for twice-a-year cleanings, X-rays, fillings, and other routine care. Then, compare these costs with the dental plan premiums under different plans. Keep in mind that you may be able to deduct your insurance expenses come tax time.

You’ll also want to consider your overall dental health when deciding whether to buy a policy of your own. If you have a history of dental problems, it will probably be worth spending the money on coverage to have the additional peace of mind. If you’re on Medicare, remember that Medicare will not cover dental work unless medically necessary.

Do I need to pay upfront if I have dental insurance?

If you can’t find affordable dental insurance, you will likely be required to pay your dentist upfront before treatment. For treatments that span months, such as braces, the dentist may allow partial payments with each visit.

Even if you have dental coverage, you may still be required to pay a smaller up-front copayment. Emergency dental work, such as on broken teeth after an accident, may be covered by standard medical insurance. In that case, you may be asked to pay a small copay per that policy.

How are dental copays calculated?

The cost of a dental copay varies depending on whether you have partial or full coverage dental insurance. You’ll also have to consider what procedure you’re having and whether you’re seeking treatment in-network or out of network.

However, many procedures, such as bridges and fillings, have a $50 deductible. A percentage of the remaining costs is covered by the dental insurance plan.

What does this look like? Let’s say that you’re getting a filling and the procedure will cost $100 total. The simplest form of a deductible is the patient paying the first $50 of treatment. Your insurance will pay 80% of the remaining $50, or $40. So your copay is: $100 – $40 = $60.

How much does dental insurance cost?

The cost of dental insurance varies depending on several factors, including the level of coverage, the insurance provider, and the location. On average, individual dental insurance plans can range from $20 to $50 per month, while family plans may cost between $50 and $150 per month. Plan costs vary based on a number of factors including location and age. Additionally, the type of plan, such as a preferred provider organization (PPO) or health maintenance organization (HMO), can impact costs. It’s essential to compare plans carefully and consider factors such as deductibles, copayments, and coverage limits to find a dental insurance plan that fits your needs and budget.

Can I buy dental insurance without health insurance?

Yes, it is possible to purchase dental insurance without having health insurance. Dental insurance plans are often available as standalone policies, allowing individuals to access coverage specifically for dental care. While dental and health insurance are separate types of coverage, having dental insurance can help individuals manage the costs of routine dental care, such as cleanings, exams, and fillings. It’s important to research different dental insurance options and consider your dental care needs when selecting a plan.