It may be a smart move. Research suggests good dental health supports good general health.[0] And unexpected dental bills can add up.
We’ll cover some important information about dental insurance for you and your family in the remainder of this blog post, including:
- How dental care can help your overall health and your whole family.
- How dental insurance works (it’s different from medical insurance) and the costs.
- The different places you can get dental insurance, including family coverage.
Compare dental plans, coverage options and costs.
How Dental Insurance Can Help Your Family
While regular cleanings are an important part of good oral health, the benefits associated with access to dental care go beyond just clean teeth.
More oral healthcare. A 2017 report from the National Association of Dental Plans (NADP) found that Americans with dental benefits were more likely to go to the dentist, take their children to the dentist, receive restorative care and experience greater overall health.[1]
People without dental benefits visit the dentist less frequently and are more likely to have extractions and dentures and less likely to have restorative care or receive treatment for gum disease, according to the NADP data.
They are also:[2]
- 67% more likely to have heart disease
- 50% more likely to have osteoporosis
- 29% more likely to have diabetes
Cancer screening + early detection. A dental check-up often also includes oral cancer screening. In addition, some heart diseases, pancreatic cancer, and strokes can be connected to gum disease, so the potential health benefits go beyond healthy teeth.[3]
Gives children a leg up. Children in the U.S. miss 51 million school hours a year due to dental issues. A child with good dental health has an easier time eating, speaking, sleeping, playing, going to school and paying attention in class.[4]
So you know that dental care for the whole family, and especially kids, is important. How does dental insurance work and what kind of costs can you expect?
How Much Does Dental Insurance Cost?
Dental insurance premiums are lower than the premiums we’re accustomed to seeing for unsubsidized major medical insurance. Individual dental premiums can range from $150 to $600 annually, averaging around $300, or $25 per month (2016).[5]
The more people on your policy, the higher your premium amount.
Dental insurance deductibles are also typically low. Most PPO and indemnity dental plans have an average annual deductible of $50 (2016).[6]
You may be thinking, “Wow, dental premiums and deductibles are so low. This is a no-brainer!”
But it’s important to understand how dental policies actually work since their cost-sharing structure and coverage limits are very different from what we’re accustomed to with health and even auto or homeowner’s insurance.
Find out how much family dental insurance plans cost in your area.
How Dental Insurance Works
While medical insurance policies are primarily meant to protect you financially in the event of a serious or catastrophic illness or accident that could cost many thousands of dollars, dental insurance is structured to emphasize preventive care.
As a result, it covers a higher percentage of preventive care costs and fewer of the costs associated with major dental care (more on that below).[7]
How major medical health insurance works: You pay your monthly premium to maintain your policy. If you use covered medical services, you usually pay in full up to the amount of your annual deductible (though some preventive care services are covered prior to meeting your deductible).
After that, your insurance begins to share the costs of covered services with you (coinsurance) up to the annual out-of-pocket limit or maximum. At that point your policy will pay 100% of your covered costs until the next policy year begins. There is no cap on benefits for ACA-qualifying major medical policies.
How dental insurance works: You select a maximum coverage (or benefit) amount for your plan and pay your monthly premium to maintain your coverage (higher premium = higher maximum coverage limit). When you obtain covered dental services, you pay in full up to your deductible amount (which is typically relatively low).
Once you’ve paid your dental deductible your insurance policy pays a specified percentage of covered costs up to the maximum benefit amount associated with your policy. At that point, if your dental services exceed the maximum benefit amount, you’re again responsible for paying 100% of those costs for the remainder of the policy term as you’ve maxed out your dental benefit.[8]
Most dental plans’ annual maximum coverage limit does not exceed $2,000 per person (per calendar year).[9]
Where to Get Family Dental Insurance
About 77% of the U.S. population has dental benefits according to the NADP Dental Benefits Report (2017).[10]
When it comes to dental insurance, you have several coverage options for you and your family:
- Part of an Affordable Care Act (ACA)-qualifying major medical policy
- Other Federal programs: Medicaid and CHIP
- Through an employer’s group plan
- Individual private dental insurance
We’ll discuss each option in more detail below.
Dental Coverage with Obamacare
Dental care is not considered an essential health benefit for adults, but it is for kids 18 and younger.[11]
That means ACA Marketplace health plans have to offer dental coverage for children on your policy, but you don’t have to buy it. There are a few state exceptions: parents in Kentucky, Nevada, and Washington are required to purchase dental insurance for their children.[12]
And your “child” can continue to access dental benefits as a dependent on your ACA plan until they age off of your plan at age 26 (depending on your state).[13]
There are three styles of dental coverage with ACA plans, each having a different cost-sharing structure, so it’s important to understand the details of any specific policy you’re considering:
Embedded coverage includes both medical and dental benefits in the same policy.
Bundled coverage include separate medical and dental plans that are purchased and administered through the same insurance carrier (which may result in a discount).
Stand-alone coverage is purchased in addition to your medical coverage either through a health insurance carrier that has a dental option or through a dental carrier. All costs and benefits are separate.
Learn more about dental coverage in the ACA Marketplace.
Is your ACA plan missing dental coverage? Supplement with dental insurance.
Medicare, Medicaid and CHIP
Traditional Medicare does not cover dental procedures, but Medicare Part A (Hospital Insurance) will pay for certain dental services you may receive when you’re hospitalized.[14] If you’re a Medicare recipient, you may want to consider supplementing with an individual dental insurance policy.
Children covered by Medicaid or who receive Children’s Health Insurance Program (CHIP) coverage via a Medicaid expansion, must be provided benefits for dental care as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Minimally, dental services for children must include:
- Relief of pain and infections
- Restoration of teeth
- Maintenance of dental health[15]
Children covered by a separate CHIP may either provide dental coverage as a package of dental benefits that meets the CHIP requirements or as a benchmark dental benefit package which is substantially equal to 1) the most popular federal employee dental plan for dependents; 2) the most popular plan selected for dependents in the state’s employee dental plan; or 3) dental coverage offered through the most popular insurer in the state.[16]
Adults covered by Medicaid – States may choose whether or not to provide dental benefits for adults that are Medicaid recipients. Most states provide at least emergency dental services, however, less than half of states currently provide comprehensive adult dental coverage.[17]
Learn more about dental benefits under Medicaid or CHIP.
Individual Private Dental Insurance Policies
If you don’t have coverage through your workplace or a public option, consider enrolling in private, individual dental coverage for yourself or your family.
There are three main types of stand-alone private dental insurance policies that you can obtain: HMOs, PPOs and indemnity plans.[18]
- An HMO, or health maintenance organization, covers treatment within a limited and specified network.
- A PPO, or preferred provider organization, allows patients to see dentists outside the preferred network, but that generally means a higher out-of-pocket cost.
- An indemnity plan allows patients to see any dentist and typically picks up a percentage of the costs. This plan may be helpful when you want to stay with your dentist and they do not participate in a dental network.
You can also opt for dental discount plans or dental savings plans. They are not insurance plans, but rather programs in which a group of dentists performs services at a discount. With these plans, you generally pay the dentist directly.[19]
Do you need individual dental insurance for yourself or family coverage? Get a quote to compare policies.
Dental Insurance for Kids – More Common Questions
Having dental insurance for your kids is generally a good idea. Visiting the dentist regularly can help get them into the habit of good oral healthcare early; prevent issues like tooth decay; ensure that your child’s teeth, jaw and gums are developing correctly as they age and provide early detection and help for issues like misalignment.
What is “pediatric” dental?
Pediatric dental services are performed by a pediatric dentist that is specially trained and licensed for treating children from babies through teens and individuals with special needs.[20]
Do you need infant dental insurance?
While you probably don’t want to wait on medical and prescription coverage for a newborn, babies typically don’t need dental coverage until they have teeth, which is typically between 6 months and one year.[21]
When should you add your baby to your dental insurance?
The American Dental Association recommends that your child’s first visit to the dentist happen around age one. By age two or three, the pediatric dentist may recommend a check-up and cleaning every six months.[22]
Does health insurance cover dental for kids?
ACA-qualifying major medical insurance plans include dental as an essential health benefit for kids 18 and younger. That means that you must be offered dental coverage for your child when you enroll in an ACA health plan, however in most states you’re not required to enroll in the dental benefits.[23]
Outside of the ACA, the only type of insurance that covers dentists visits and oral healthcare is dental insurance.
Can you get child-only dental insurance?
Yes. Some insurers offer child-only private dental insurance and discount plans.
Does dental insurance cover braces?
Not as a standard coverage. Orthodontics coverage for children may be able to be added to your dental policy with a rider (an amendment to your coverage). The orthodontic lifetime maximum benefit is usually different from the yearly maximum benefit and insurance usually covers about 50% of related charges.[24]
How long can you stay on your parents’ dental insurance?
ACA health plans that include dental coverage (embedded plans) offer the option to cover children’s dental care up to age 26, although age limitations vary from state to state.[25]
Ready to Get Dental Insurance for Your Family?
Here are a few things to keep in mind about dental insurance:
- Dental plans typically cover services like cleanings and exams, extractions, x-rays, fillings, crowns, bridges, and root canals.
- They typically do not cover elective cosmetic procedures like teeth whitening, braces, implants, dental prostheses, prescription drugs, or anything after your policy’s annual maximum benefit has been reached.
- The costs of preventive care like cleanings, x-rays, sealants, and oral exams are often 100% covered, though you may pay a small office visit copay.
- Policies are usually guaranteed-issue, meaning you won’t be denied coverage.
- However, there are waiting periods for certain major dental services like root canals.
- Premium amounts are relatively affordable and are based on age and geographic location.
- You can apply year-round, there is no annual open enrollment period like there is for major medical insurance.
- Dental policies have annual maximum benefit amounts – once you’ve reached your policy’s annual maximum you will pay for your dental care 100% out of pocket for the remainder of the year.
Compare policy costs and coverage by requesting a quote, it just takes a minute to see multiple plan options.
Summary + Next Steps
We’ve covered a lot of information about family dental insurance. Here are the key takeaways:
Having dental coverage has been shown to encourage preventive oral healthcare and increased visits to the dentist, which in turn supports good overall health.
Cost-sharing in dental insurance plans is different from health insurance plans. They cover a larger portion of preventive care but include an annual maximum benefit limit, typically under $2,000 per person per year. It’s important to understand this in order to determine if dental insurance is a good fit for you.
There are three main types of private dental insurance plans: HMOs, PPOs and indemnity plans.
Dental coverage can be purchased as part of an ACA-qualifying major medical plan during open enrollment or as stand-alone coverage any time of year. Dental coverage is an ACA essential health benefit for kids ages 18 and younger.
You can get a dental insurance quote today and be on your way to better oral health tomorrow!
Call (888) 855-6837 to speak with an insurance agent to discuss your options.
