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How to Get Dental Insurance
By Joan Pabón MONEY RESEARCH COLLECTIVE
Dental insurance is a common employer-sponsored benefit generally offered to full-time employees. However, those who cannot get dental insurance through their work or who are retired, unemployed or between jobs may purchase a private dental insurance plan themselves.
The purchase may be directly from an insurance company or through the Health Insurance Marketplace — either at Healthcare.gov or if there is a separate marketplace for your state — as created after the Affordable Care Act.
The following article covers topics related to dental insurance, including what it is and what it covers, along with how to purchase coverage as an individual.
Table of contents
- What is dental insurance?
- Where to get dental insurance
- How does dental insurance work?
- What does dental insurance cover?
- How to choose the best dental insurance
- Summary of How to Get Dental Insurance
What is dental insurance?
Dental insurance can help to cover some of your oral healthcare expenses by paying a portion of the cost of eligible dental procedures. Covered services typically include cleanings, fillings, extractions and even major work like bridges, crowns and implants. However, policies vary in the types and percentage of services they cover.
Research suggests that oral health is intrinsic to overall health, as tooth decay and periodontal (gum) disease have been linked to an increased risk of diabetes, heart disease and stroke. With this in mind, and considering that major dental work can be expensive, dental insurance could be worth the cost — especially if you understand how your policy works and what it covers.
Types of dental insurance
The following are some of the most common types of dental insurance plans and other alternatives that could help you pay oral healthcare costs.
Dental Preferred Provider Organization (DPPO)
Dental PPO plans typically have an annual deductible as well as an annual maximum, which is the most your insurance will pay for covered services during the plan year. These types of plans allow you to see any dentist — whether in or out of network. However, you will pay less for services if you visit an in-network dentist or specialist. Additionally, and unlike DHMOs, DPPO plans do not require you to have a primary dentist or obtain referrals to visit specialists.
According to health insurance company Cigna, DPPO plans will usually cover 100% of preventative care costs and — after you meet your deductible — a percentage of basic restorative services like fillings and extractions, up to the plan’s annual maximum. Coverage for major restorative care varies by plan.
Dental Health Maintenance Organization (DHMO)
Dental HMO plans require you to visit in-network dentists, and will only pay for services you receive out of network in the event of an emergency or when legally necessary. Unlike DPPO plans, DHMOs require you to choose a primary dentist and obtain a referral to visit a specialist.
DHMO plans also cover most preventative care costs, at 100% coverage, and generally charge a flat fee for basic restorative services. Most of these plans don’t have annual maximums and can be more affordable than DPPOs, as you are required to obtain care within a network of providers to be covered.
Alternatives to dental insurance policies
Dental insurance policies aren’t the only way to cover oral healthcare expenses. Alternatives to dental insurance include:
Dental discount plans
Dental discount plans are not dental insurance policies. These plans are membership-based and require you to pay an up-front annual fee in exchange for discounts on dental services. Most plans provide you with a membership card you can present at your dentist’s office to get a discounted rate on certain treatments, and those will depend on the plan you purchase.
Discount plans don’t have waiting periods, but some may require you to choose from a network of participating dentists. Several national health insurers sell these types of plans — and some even offer bundled dental and prescription discount programs.
If your oral health is top-notch and you tend only to visit the dentist for preventative care, a dental discount plan could end up being less expensive than insurance. If, on the other hand, you are likely to require major restorative care during a plan year or have ongoing oral health problems, a dental insurance policy may make the most sense.
Medicaid and Medicare
It’s possible your dental costs will be covered by a federal program. As part of its Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, Medicaid covers dental care costs for children and young adults enrolled in either Medicaid or the Children’s Health Insurance Program (CHIP).
For adults, dental coverage under Medicaid varies by state. According to the U.S. Department of Health and Human Services, while Medicaid programs in most states cover emergency dental services, less than half offer comprehensive dental coverage.
Medicare, on the other hand, doesn’t cover most dental care costs under Part A or Part B. Only some Medicare Advantage (Part C) plans offer benefits that Original Medicare does not, including dental coverage.
Dental schools and community health centers
You may be able to receive low- or no-cost dental care at a dental school or dental hygiene school near you. Most dental schools have clinics that provide dentistry students with real-life experience — under the supervision of licensed professionals. And these services are usually available to all, even the uninsured.
Alternatively, the U.S. Department of Health and Human Services has a tool that can help you find community health centers near you, some of which may provide affordable dental healthcare services.
Where to get dental insurance
You can get dental insurance through several means, including:
Employer-sponsored group dental coverage
The most common way of getting dental insurance is by enrolling in an employer-sponsored group dental plan, which tends to be more affordable than individual policies.
Some companies extend dental coverage as part of their benefits package, most commonly to full-time employees, yet that will depend on the organization. If your spouse or parent has coverage through their employer, you may also be eligible to enroll for benefits under their policy.
The individual health insurance market
If you can’t get dental coverage through your workplace, you can purchase a private policy directly with an insurance carrier.
Premiums vary by state and the level of coverage you select. Shop around and compare coverage options before committing to a company, and always verify whether the insurer you’re doing business with is a reputable company that’s been around for a while.
The Health Insurance Marketplace
Dental insurance through the private market may be unaffordable for many. In that case, the Health Insurance Marketplace offers options for various needs and budgets. Plans also vary by state, yet there are generally two types of policies available: stand-alone dental plans and those that bundle medical and dental insurance.
To get a policy through the federally-run Health Insurance Marketplace, you must enroll during the annual Open Enrolment Period, yet there are exceptions to that rule. Also note that several states have their own health insurance exchange or marketplace, and you may choose whether you want to enroll through the federal marketplace or the one run by your state.
Some individuals may also be able to obtain dental coverage through Medicare or Medicaid, but that will depend on their situation and their state’s eligibility criteria. Jump to the previous section for more details.
How can I get dental insurance?
You can get dental insurance by qualifying for employer-sponsored benefits at your workplace (or having a spouse that qualifies for benefits), purchasing an individual policy through the private market, enrolling in the Health Insurance Marketplace or by qualifying for Medicaid or Medicare — even if this last option has some caveats, as mentioned in the previous section above.
How does dental insurance work?
Besides covered care and network specifications, dental plans share some general characteristics. The following concepts are important in understanding how dental insurance works:
- Premium – Generally charged monthly, premiums are you pay for dental coverage during a plan year. Even if your coverage doesn’t kick in immediately, you still have to pay your monthly premium.
- Waiting period – Depending on the plan you choose, there may be a waiting period during which your insurance policy will not cover dental services, which means you must pay for them out of pocket. Moreover, some plans may have different waiting periods for different services.
- Deductible – The deductible is the amount you must pay out of pocket for dental services before your policy begins to cover a percentage of those services. Your deductible resets every year, and — generally — the higher the deductible amount you choose, the lower your monthly premium. Depending on your plan, preventative services may be covered right off the bat, even if you haven’t met the deductible.
- Coinsurance – After you meet your annual deductible, your dental policy will cover a percentage of the cost of eligible services. For example, if your plan covers 80% of basic services like fillings, you will be responsible for the remaining 20% of all bills for basic services. This is what’s known as coinsurance.
- Copayments – A copayment is a fixed amount you pay for certain covered services to which your deductible does not apply. For example, your plan may have a $15 copayment for cleanings, and that amount won’t change regardless of whether you’ve met your deductible. Note, however, that not all plans have copayments, and some may use a combination of copayments and coinsurance (a fixed rate for preventive services and an 80/20 coinsurance for others, for example).
- Annual maximums – Your annual maximum refers to how much your policy will pay toward dental expenses during a plan year. Not all plans have annual maximums, and coverage limits vary by plan. There may even be different maximums for different services. For example, most plans cap how much they will pay toward non-medical services like orthodontia.
As previously mentioned, depending on the type of policy you choose, you may also have to visit providers within your plan’s network to be covered for services and select a primary dentist that will refer you to in-network specialists when necessary.
What does dental insurance cover?
Most dental insurance plans — regardless of type — cover certain expenses, although the percentage of coverage may vary by type of care. Here’s what’s typically covered.
| Type of care | Preventative Care | Basic Restorative Care | Major Restorative Care | Orthodontic Treatment |
| Services generally covered | Routine cleanings | Tooth extractions | Bridges and dentures | Braces |
| Exams | Dental Fillings | Crowns | Retainers | |
| X-rays | Root canals (depending on the situation) | Dental implants | Recommended tooth extractions and oral surgery |
Most dental insurance plans will cover 100% of preventative care costs but differ in the percentages they will cover for basic and major restorative care. Another care category encompasses cosmetic dentistry and orthodontic procedures. While some plans will cover some orthodontic treatment, most won’t cover services that aren’t medically necessary.
Full-coverage dental insurance
Full-coverage dental insurance refers to plans that cover a variety of dental services: preventative, basic, major restorative and perhaps even orthodontic treatment. Since these plans are more comprehensive, they also tend to be more expensive. Additionally, full-coverage policies may not cover 100% of all services. Read your policy details to understand which treatments are covered and whether there are limits on particular services.
Supplemental dental insurance
Supplemental dental insurance can help you cover treatment and services your medical or dental policies do not. For example, if your dental insurance doesn’t cover orthodontia or cosmetic dentistry — or if you exceed the annual limit for these services — a supplemental dental policy could fill the gap.
No-waiting-period dental insurance
As mentioned above, the waiting period is the timeframe during which you must pay for dental care out of pocket. After the waiting period, your policy will kick in and cover a percentage of eligible services.
Not all dental insurance policies have waiting periods, and many plans cover preventive services like routine cleanings as soon as you enroll in coverage. Check your plan details to see whether you have one or several waiting periods for covered services.
Many providers on our list of best dental insurance companies offer plans with no waiting periods for preventive care, and at least one of those options offers same-day coverage for major services.
How much is dental insurance?
An individual dental plan with coverage for preventative care (100%), basic services (80%) and major services (50%) can cost a Kansas City resident around $46 per month.
However, the actual cost of dental insurance will depend on your location and the type of policy you purchase. A full-coverage plan will cost more than a basic dental plan, for example, and a policy with a higher annual deductible will generally have a lower monthly premium.
Group dental policies such as those provided by employers are generally cheaper than policies available in the private insurance market. You may also find more affordable options in the Health Insurance Marketplace, whether through your state or through HealthCare.gov.
How to choose the best dental insurance
When purchasing any kind of insurance, make sure to compare policy details and overall costs to get the best possible deal. Also consider the types of services you might require, and opt for a policy that provides the best value for you, even if it doesn’t offer the highest level of coverage. For example, some individuals could be better served by a dental discount plan if they generally don’t require services beyond preventative care.
Also, take your time to understand how policies work. While the terminology may be confusing at first, knowing the basics of dental insurance can help you determine the type of plan and level of coverage that may be best for your needs and budget — or to figure out whether you need dental insurance at all.
Lastly, if you’re purchasing a policy in the private market, look into the insurer you’re doing business with to make sure it’s a reputable and financially stable company.
Summary of How to Get Dental Insurance
- Many employers offer dental insurance as part of their benefits package.
- If you are unemployed or don’t qualify for employer-sponsored benefits, you may purchase a dental insurance policy on your own directly from an insurance company.
- Those looking for more affordable options may consider purchasing dental insurance from the Health Insurance Marketplace.
- Whether you buy a policy on your own or through the marketplace, understanding how dental insurance works (including waiting periods, deductibles and annual maximums) can help you pick the right level of coverage at the best cost.
- Medicaid also covers dental health services for children and young adults enrolled in either Medicare or CHIP, yet dental coverage for adults under Medicaid varies by state.
- Original Medicare (Part A and Part B) doesn’t cover most dental health care costs, but some Medicare Advantage (Part C) plans do.
- Dental insurance may not make financial sense for everyone. Some people may benefit from dental discount plans, which charge an annual fee for discounts on certain dental services.
- Those who cannot afford dental insurance or don’t qualify for a policy through the Health Insurance Marketplace may be able to receive dental care at a local dental school, hygiene school or community healthcare center.
Joan is a professional translator, writer and editor with a special interest in personal finance and insurance topics. She has been a contributing author and independent researcher at ConsumersAdvocate.org since 2017 and an editor at Money since 2019. Her work has been featured in MSN Money and Apple News.