Dental Insurance
Good oral health is important for your overall health – dental insurance can help!
A dental insurance plan can be a good way to avoid paying fully out of pocket for a major dental procedure, such as a root canal.
While costs vary depending on where you live and your specific circumstances, expect to pay anywhere from $575 to $1,500 or more for a major procedure like a root canal.[1]
What Does Dental Insurance Cover?
Dental plans typically cover four categories of services: preventive, diagnostic, basic and major care.
The list below includes examples and is not a complete list of coverages, exclusions and limitations.
Individual plans vary, so you’ll want to read the plan details closely to validate the coverage and benefits you’ve selected and limitations and exclusions that apply.
What Dental Insurance Covers
Cleanings + checkups
Extractions
X-rays
Fillings
Crowns, bridges + root canals
What Dental Insurance Does Not Cover
Anything after the plan’s annual maximum benefit amount has been reached
Elective cosmetic procedures (e.g., tooth-whitening)
Orthodontics (e.g., braces)
Implants
Prosthodontics (dental prostheses)
Oral care related to a medical condition (e.g., TMJ)
Prescription drugs + analgesia pre-medication
Dental Coverage is an ACA-Mandated Essential Health Benefit for Kids
Pediatric services, including oral and vision care, are part of the 10 essential health benefits for children 18 years of age and under.
Adults, however, must obtain dental insurance if they want coverage and don’t have it through an employer.
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Pros and Cons of Dental Insurance
- Guaranteed issue – All applicants aged 18 to 99 are accepted regardless of health history (however, rates are based on age and location).
- Covers pre-existing conditions – With the exception of missing teeth in some cases.
- Apply year-round – There is no official open enrollment period and, in most cases, coverage begins the next day after you enroll online.
- Flexibility – An indemnity plan affords you more provider options. A PPO plan can help lower your out-of-pocket expenses by using an in-network provider. Either way, it’s your choice.
- Options for every budget – Varying amounts of coverage range from 50% to 100%, which means you can find a plan with the level of coverage you need at the right monthly premium rate for your budget.
- Low deductibles – With annual deductibles generally around $50,[2] most people will be able to access their dental plan’s full benefits without paying a significant amount out of pocket first.
- Waiting periods – You may have to put off dental services until you’ve had your plan for 6-12 months to take advantage of your benefits for certain services like fillings and root canals.
- Calendar-year maximums – Unlike ACA plans that don’t have annual maximums for essential health benefits, dental plans have annual caps on how much the plan will pay per year (e.g., $1,000). Even with dental insurance, you will be responsible for the costs of services that exceed the annual limit.
- Not ACA-qualifying major medical coverage – Dental insurance is a form of supplemental health insurance, not ACA-qualifying major medical coverage.
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Who Should Get a Dental Insurance Plan?
A dental insurance plan may be a good option if you:
Can you buy health insurance that isn’t Obamacare? Yes.
It’s important to note that Obamacare alternatives are not comprehensive health plans and have less coverage than Obamacare plans.
Learn moreHow Dental Insurance Works
Dental insurance works much the same way as major medical.
You pay a monthly premium to maintain your dental plan.
When you obtain services from a provider, present your dental insurance card and pay your office copay (if that’s part of your plan).
Your dentist bills your insurance company and the company pays their percentage, then bills you for the remaining balance that you owe (including your deductible if applicable).
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| Service | Typical Payment |
| Preventive - cleanings and check-ups; fluoride treatments for children | 100% |
| Diagnostic* - bitewing x-rays (every 6 months) full-mouth x-rays (every 3 years) | 100%* |
| Basic - fillings, extractions | 80% |
| Major - root canals, crowns and bridges | 50% |
- What services are covered
- What your out-of-pocket costs will be
- Whether benefits vary based on selecting an in-network or out-of-network provider
- Annual maximum – the maximum amount your plan will pay towards covered services in a calendar year
- Co-pay – a fixed amount you pay each time you visit your dental provider
- Co-insurance – the portion of each covered service for which you are responsible to pay
- Deductible – the amount you must pay before the plan provides payment for covered services
- Waiting period – the amount of time you must wait before your plan will pay for diagnostic, basic and/or major dental procedures. Waiting periods vary by state.
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How Much Does Dental Insurance Cost?
Dental insurance is affordable. For example, a 41-year-old woman in Phoenix, Arizona, can get a dental insurance plan for:
- $28.13 - $43.11 monthly premium
- $50 deductible
- $0 - $20 copay
- $1,000 - $1,500 annual limit[5]
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2 Ways to Get Started with a Dental Insurance Plan
Save on Healthcare Costs – Learn More at Our Blog
Footnotes
- [1] Root Canal (anterior). Healthcare Bluebook. Retrieved 31 January 2019, from https://www.healthcarebluebook.com/ui/proceduredetails/D205 Zip Code 81230.
- [2] Is dental insurance worth the cost? (Oct. 2016). Cbsnews.com. Retrieved 4 February 2020, from https://www.cbsnews.com/news/is-dental-insurance-worth-the-cost/
- [3] Is dental insurance worth the cost? (n.d.). Retrieved January 14, 2020, from https://www.cbsnews.com/news/is-dental-insurance-worth-the-cost/
- [4] Cold, F., Health, E., Disease, H., Disease, L., Management, P., & Conditions, S. et al. (2020). Dental Insurance Plans: What’s Covered, What’s Not. Retrieved 16 January 2020, from https://www.webmd.com/health-insurance/dental-insurance-overview#3
- [5] Health eDeals Marketplace Quote, 8/15/2018. Plan options and premiums vary by state.
