Dental insurance: Your plan options and how much it costs

More than 164 million Americans have dental insurance, and about 90% of them get this coverage through their employer, according to the National Association of Dental Plans (NADP).

Dental care is an important part of overall health. There is a spectrum of dental plans on the market, including a Dental Preferred Provider Organization (DPPO), health maintenance organization (HMO), fee-for-service and discount plans. These plans range in affordability and covered services.

Here’s what you need to know when you’re considering dental insurance.

 

What is dental insurance?

Dental insurance is a form of health care coverage that pays some of the costs for preventive, basic and major dental care.

Dental insurance is typically a separate benefit from medical insurance. Most people get a discount rate on a dental plan through group coverage offered by their employer, but this coverage can be minimal, especially for small businesses.

Jeffrey Weiner, CEO of HKM Associates, an independent insurance agency in New York, says most group dental plans in this category have a 12-month exclusion period, which means coverage doesn’t begin for a year. So, you’ll incur out-of-pocket costs if you need major dental care during this period. Most plans also have coverage limits of $1,000 to $1,500 a year.

If your employer doesn’t offer this coverage, you could buy an individual dental plan on your own through the exchange, an independent broker or directly from an insurance carrier. However, benefits can vary widely. The coverage may not be as cost-effective depending on what the plan offers, which means you’ll need to do your research and understand the key differences between each plan type.

 

Different types of dental insurance plans

Here are four standard types of dental insurance plans:

DPPO

A dental preferred provider organization (DPPO) plan has a large provider network, so you have more options for dentists. 

However, many DPPO plans also offer some form of reimbursement for visiting an out-of-network provider, which helps to curb costs. Other advantages include no copays and no referral requirement for seeing a specialist.

Some of the drawbacks of these plans include higher-out-of-pocket costs, such as an annual deductible for routine care, out-of-network doctor visits and a potential annual maximum limit for covered services that may be well below your needs.

Pros: Large provider network, often provides some coverage for out-of-network care

Cons: Can be more expensive than other plans

DHMO

Unlike DPPO plans, most dental health maintenance organization (DHMO) plans don’t have an annual deductible or annual maximum. However, similar to DPPO plans, DHMO plans include coinsurance, which means you’ll have to pay a share of the costs of covered services. Generally, your coinsurance portion may be equal to 20-30% of the cost for covered services.

The major disadvantage of DHMO plans is that they require you to see in-network dentists to cover your services. Out-of-network visits may only be covered in an emergency. You also need to choose a primary dentist (similar to a primary care provider with medical insurance). You then must get a referral from your primary dentist if you need to see a specialist.

With DHMO plans, you get less flexibility but potentially more affordable dental care since there’s no deductible or annual maximum.

Pros: Usually doesn’t have an annual deductible or maximum coverage limits

Cons: Requires in-network care and referrals to see a specialist

Fee-for-service

A fee-for-service arrangement allows you to choose your own dentist and pay this provider directly based on a quoted fee when he or she performs the service. If you have dental insurance, you can still go to a fee-for-service dental provider, but you’ll have to file a claim to be reimbursed by your insurance company.

This approach allows you to get quality dental care with the provider of your choice. Just keep in mind that this coverage will be out of network. So, it’s best to understand what the dentist will charge for the services you need, how much your insurance will cover for out-of-network visits and what your financial responsibility will be if you choose to go to one of these providers.

Pros: Flexibility to choose your dentist and don’t have to worry about networks

Cons: You pay for services and may need to file claims with the insurer

Discount plans

A dental discount plan is an option if you don’t have insurance.

With these plans, you pay an upfront annual fee instead of a monthly premium. Though you’re responsible for directly paying providers, you receive a dental discount card, which you can use to get a discount on dental services whenever you visit a dentist within the plan’s network.

Dental discount plans are often more affordable than traditional dental insurance, but you may also get fewer services. While there’s no annual coverage limit, you’ll have to pay out-of-pocket each time you receive services — even if these services are at a discount. 

If you have more complex dental needs, it may be more cost-effective to buy insurance.

Pros: Usually affordable and you get discounts on care

Cons: You pay more out-of-pocket than other plans and don’t get help from an insurer

 

How much is dental insurance?

Depending on your dental plan, you may have to pay:

• A monthly premium
• A copay when you visit a dentist
• Coinsurance when you need care
• An annual deductible before the plan begins to pay for covered services

Annual maximum coverage limits also vary by plan and typically range anywhere from $1,000 to $3,000.

NADP’s most recent research estimated the average monthly premiums by plan type for employer-sponsored plans:

• Individual DHMO plan — $11
• Individual DPPO plan — $25
• Discount dental plan — $10 to $12

Monthly premiums for individual dental insurance plans ranged from $20 to $80 per month, according to a Consumer Reports analysis.

 

Full coverage dental insurance

Dental plans typically cover either preventive, basic or major dental services — or some measure of all three.

Full coverage often includes more benefits, including:

• Preventive dental services, such as cleanings and X-rays
• Coverage for basic services, such as fillings, root canals, non-routine X-rays and emergency care
• Coverage for major dental care, such as crowns, bridges, braces

A full-coverage plan also may cover some of the costs for oral surgery and orthodontic treatment.

You’ll likely have to see an in-network dentist to take advantage of full coverage benefits. Otherwise, you risk paying more out-of-pocket for dental care. Also, full coverage doesn’t mean the plan will cover 100% of your dental services every time.

Preventive care is usually covered at 100%. Some plans may require you to pay a copay for preventive or basic care, while others may not. Restorative dental work may be covered at around 50%, depending on your plan, so it’s important to carefully review each plan’s Explanation of Benefits and compare things like copays, coinsurance, deductibles and annual maximums before signing up for full coverage.

 

Affordable dental insurance 

Going with a dental discount plan is one way to get cheap dental insurance.

As mentioned earlier, these plans usually have low premiums. So, you spend less upfront, but you also pay higher out-of-pocket costs later when you need dental care. 

These plans are not enough if you need anything more than cleanings and an occasional dental procedure. However, if you need more, you may wind up paying less in the long run by going with a DHMO or DPPO. 

 

Dental coverage in health plans

Dental insurance is usually a separate policy from a traditional health plan. This is often the case if you have dental coverage through your employer.

However, some plans on the market and on the health insurance exchange include dental coverage. With these plans, your monthly premium will cover both dental and medical care.

If you go with an ACA exchange plan with higher coverage levels, be prepared to pay a higher monthly premium but a lower copay and deductible. With lower coverage levels, you can expect the opposite.

Though the Affordable Care Act doesn’t consider dental coverage an “essential health benefit” for adults, it is for children 18 and younger, so you’ll need to get dental coverage for your children or any minors in your household. 

Keep this in mind as you search for family coverage and compare health plans and their costs.

 

What is the best dental insurance?

Several insurers, including Humana, Cigna and Spirit Dental, offer competitive dental insurance plans. Which one is best depends on what you want from a dental plan.

Here’s how those three dental insurance companies compare:

Humana

Humana has a large provider network, with more than 260,000 dentists across the U.S. 

It offers:

• DPPO
• DHMO
• Discount and value plans

One of the biggest benefits is that most Humana dental plans — except for Bright Plus for Veterans and Bright Plus plans — don’t have a waiting period for covered services. For the two previously mentioned plans, the waiting period is 90 days for basic services.

Many of Humana’s plans come with low deductibles and cover 100% of the cost for preventive services. However, most Humana dental plans have low annual benefit maximums, ranging from $1,000 to $1,500, depending on where you live and how long you’ve held a policy. 

Humana’s plans appear to be a good value for basic preventive services but may not provide enough coverage if you need major restorative dental care or orthodontic care.

Cigna

Cigna offers plans that start at about $20 a month per person. For that, you get access to more than 93,000 dentists and no out-of-pocket costs, copays or deductibles for preventive services like cleanings and oral exams.

Cigna offers three plans: 

• Cigna Dental Preventive
• Cigna Dental 1000 
• Cigna Dental 1500

The 1000 and 1500 plans offer up to $1,000 and $1,500 worth of annual coverage, respectively, for restorative care, such as fillings. The deductible for both plans is $50 for an individual and $150 for families. 

However, the major difference is that the 1500 plan offers a lifetime limit of up to $1,000 for orthodontia coverage. The 1000 plan doesn’t provide an orthodontic benefit (plan members may access in-network discounts for these services). 

Another drawback is that Cigna dental plans have a six-month waiting period for basic services and a 12-month waiting period for restorative and orthodontia services, so if you need to see a dentist before this time, you’ll have to pay out-of-pocket.

Spirit Dental

Spirit Dental has no waiting period for preventive, basic or major services, allows you to choose your own dentist and covers three cleanings a year, as well as implants and major services.

With no waiting period, you can access dental care almost immediately. Your plan will become active on either the 1st or 15th of the month, depending on when you signed up. You’ll have to pay a monthly premium and all plans come with a $100 lifetime deductible, which you only have to pay once.

Two Spirit Dental plans are:

• Spirit Network Dental
• Spirit Choice Dental

Spirit Network Dental has a provider network, while Spirit Choice Dental is a fee-for-service plan.

Some of Spirit’s plans come with up to a $5,000 annual maximum after you’ve had the plan for three years, but this maximum isn’t available in all states. Some plans can have maximums as low as $750, which means you’ll have to trade affordability for fewer services and higher out-of-pocket costs, depending on where you live.

 

Is dental insurance worth it?

Dental insurance may be worth it if you get regular preventive care but don’t need major dental work.

Weiner says even if you can get a dental plan through your employer, the coverage will be limited. If you’re considering buying individual coverage, it may be better to just self-insure, he adds.

“On an individual level, there’s not really anything in the marketplace that’s worth the price of admission,” Weiner says.

That’s because most plans have a low annual maximum. Weiner says if you decide to self-insure, you can probably work out a payment plan with your provider to pay for services over time, especially for major restorative care.

Either way, be prepared to pay for some dental services out of pocket since even the best plans only provide 100% coverage for preventive services and partial coverage for everything else. Depending on your needs, Weiner suggests buying a discount dental plan to supplement your regular dental insurance.

“Make sure you know what you’re getting,” he says. “People will say ‘I want a dental plan,’ but then they don’t realize what the actual coverage is. Dental plans aren’t designed to fully cover you. If you have a lot of dental work done, it’s a limited benefit.”

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