How does dental insurance work?

Dental insurance is a contract with an insurance company that helps cover the cost of treatments to your teeth and gums. Instead of you paying 100% of the cost out-of-pocket, dental insurance pays a percentage and you pay the rest. Many people get dental insurance through their employer, but you can buy an individual or family dental insurance policy directly from dental insurance companies.

Like health insurance, dental insurance works by sharing the costs of dental care in exchange for a premium you pay. You may also have to pay deductibles, copays and other costs, but the details vary from plan to plan. Here are some common terms of dental insurance plans:

Premiums

A premium is what you pay your insurer in exchange for coverage. Premiums are typically billed monthly, but some policies may collect them semiannually or annually. A typical premium may be $20–$50/month for an individual or $50–$150/month for a family based on the type of coverage.¹

Deductible

A deductible is the amount you pay toward certain dental expenses before your insurance kicks in. For example: if you have a $1,000 deductible, you pay the first $1,000 of covered services and then a fixed amount (ex. $20) for covered services after the deductible is met. Deductibles typically reset after 12 months.

Coinsurance

Coinsurance is a payment you may be responsible for after you meet your deductible. For example: if your dental plan pays 70% of the cost, your coinsurance payment is the remaining 30% of the cost.

Annual coverage maximum

An annual maximum is the limit your dental insurance will pay toward the cost of dental treatment in a plan year. For example: if your annual maximum is $2,000 and your plan has already paid $2,000 in the first 6 months, you’re responsible for 100% of the costs for the remaining 6 months.

In-network vs out-of-network

A network is a group of dentists who have agreed to provide care based on a plan’s terms and conditions. If you choose an in-network dentist, you’ll typically pay less for treatment. If you choose an out-of-network dentists, you could pay higher deductibles, copays and coinsurance.

Reimbursement

An insurance reimbursement is the money your insurer pays to a dentist to cover the expenses of the services provided. Typically, the payment occurs after you receive a medical service, which is why it is called reimbursement.

There are 3 common categories of dental insurance: preventive, basic and major. Many plans take the 100-80-50 approach to coverage, which means preventive care is covered at 100%, basic care is covered at 80% and major care is covered at 50%. Here’s a closer look what dental insurance covers:

Preventive care

Preventive care aims to “prevent” wear and tear, gum disease and tooth loss. Routine visits allow your dentist to examine your mouth, jaw and neck to identify problems and treat them early. Common services covered under preventive care include bi-annual cleanings, oral screenings and routine X-rays.

Basic care

Basic care treats minor-to-medium damage that has already happened, like toothaches and gum issues. Common services covered under basic care include fillings, tooth extractions, root canals and gum disease treatment.

Major care

Complex dental work, including surgical procedures, are typically classified as major dental care. These services can range from crowns and implants to dentures and oral surgery.

Most dental insurance plans don’t cover cosmetic procedures (teeth whitening and veeners) or orthodontic treatments (dental braces). Some policies also don’t cover pre-existing conditions like missing teeth that were lost or damaged before receiving insurance.²

Similar to what each plan covers, the cost for dental insurance will be different for each policy. Factors that can affect how much you pay for dental insurance include:³

• Where you live
• Your age
• Copay
• Coinsurance
• Annual maximum benefit

Yes, you can buy dental insurance without health insurance. When you purchase a health insurance plan, it doesn’t automatically include dental coverage. Dental insurance is separate from health insurance.

You can buy dental insurance anytime of the year and from any insurance provider. Before deciding, be sure to research your options to find the best coverage for you and your family.

A health maintenance organization (HMO) plan and a preferred provider organization (PPO) plan work the same for dental insurance as they do for health insurance. Here’s a quick definition of each:

Dental HMO plans

Dental HMO plans typically cost less than other dental insurance plans, with lower monthly premiums and less out-of-pocket costs. With these types of plans, you’ll only get coverage when you visit dentists and other specialists who are in the HMO network.

Dental PPO plans

Dental PPO plans tend to cost more than HMO plans, with higher monthly premiums and out-of-pocket costs. The higher cost is in exchange for the flexibility to use dentists and providers both in and out of network.

Dental insurance helps manage the costs of preventive care and also helps lower costs of unexpected events like a broken tooth or a cavity. If you’re still undecided, here’s some helpful information to help you decide if dental insurance is worth it.

This information is provided for educational purposes only. It is not to be used for medical advice, diagnosis or treatment. Consult your healthcare provider if you have questions or concerns.