Affordable Dental Insurance

Photo: Irina Patrascu

Do your teeth need some TLC? If you don’t already have coverage through your employer, you may be on the lookout for affordable dental insurance to help defray the cost of your next session in the exam chair.

Fortunately, dental insurance is inherently inexpensive, so unless you’re going for the priciest plan you can find, it probably won’t break the bank. On the downside, the majority of dental plans are frustratingly limited, with low annual maximums, long waiting periods, and small provider networks. It’s crucial to read all of your plan’s paperwork so you don’t get any nasty surprises.

Below, I’ll detail three good bets for dental insurance. I’ll also go over basics such as the major plan types, their pros and cons, typical coverage levels and limits, and what impact the Affordable Care Act has had on dental insurance.

If you’re ready to start your search for dental insurance now, getting several quotes online at a site such as eHealthInsurance can be a good first step.

The Best Affordable Dental Insurance

To get a sense of dental-plan pricing, I obtained a quote for a 35-year-old female in Tennessee who wants basic individual coverage, as well as quote for a family of four in the same location. I focused on providers who offer individual plans in the majority of the U.S., which excluded some big providers (for instance, MetLife, Aetna, and Guardian only offer individual coverage in a handful of states, while Principal and Concordia provide mainly employer-sponsored coverage).

I looked at the plan deductibles, maximums, and any applicable co-pays or coinsurance for preventive, basic, and major dental work. I considered plan variety, clarity of benefits and costs. If applicable, I also considered the insurer’s customer satisfaction ranking from the 2014 J.D. Power Dental Plan Satisfaction Report.

United Healthcare

United Healthcare stood out for a couple reasons. First, it has earned top marks in the J.D. Power survey for customer satisfaction. Second, with six plans to choose from, both individuals and families have a better shot at getting coverage that works for them.

My individual United quotes ranged from a low of $17.29 per month to a high of $48.48. Family coverage was a bit pricier compared to some competitors at $73.71 to $183.45 per month. There’s a $1,000 cap on annual benefits paid out on all but the most expensive plan, which begins at a $1,200 maximum and goes up to $1,500 if you keep your coverage for four or more years. There is a $50 deductible per individual, or $150 per family.

Preventive care has a $25 copay with the two cheapest plans, but no copays at other levels. Basic services have 30% coinsurance unless you step up to the two most expensive plans, which have 20% coinsurance. There is a four- to six-month waiting period before United will pay for these services (meaning you can’t let your required dental work pile up, buy insurance for a month and get it all taken care of at a discount, and then promptly drop your coverage).

For major services, such as crowns or dental surgery, some plans offer no coverage, and some have 50% coinsurance; these services have a 12-month waiting period. Unfortunately, United does not offer any orthodontic coverage.

Humana

Humana offered a bit more flexibility at the lower end of the price scale, and it gets solid customer satisfaction marks from J.D. Power. There were also no waiting periods for care.

My individual Humana quotes ranged from a low of $11.29 to a high of $32.74 per month for three plans. Family coverage ranged from $28.78 to $94.72.

In both cases, the cheapest plan was a managed care option that requires you to coordinate all care through a primary dentist — while this reduces flexibility, it also keeps costs down. Two more benefits for this managed plan: There is no annual maximum on care, and no deductible.

The middle option, a traditional fee-for-service plan, had a $1,000 annual maximum, and the cap on the most expensive plan begins at $1,000 and maxes out at $1,500 if you keep your coverage for three or more years. There is a $50 deductible for individuals and $150 for families.

Routine care has a $15 copay with the cheapest managed-care option; otherwise, there is no charge. For fillings, there is a $30 copay, or 50% co-insurance for the next step up in price. The most expensive plan offers a tiered level of co-insurance that drops to 30% in year three. Extractions follow a similar pattern: $55 copay on the managed plan, 50% coinsurance, or tiered coinsurance dropping to 30%. There are no waiting periods.

Humana also offers another low-cost option: A dental discount plan for $7.99 a month for individuals. It isn’t insurance, but patients can receive discounts of 20% to 40% through participating providers by paying out of pocket, which could be a viable option for those who don’t often need more than basic dental care.

Delta Dental

Delta Dental, the nation’s largest dental insurer, wasn’t the least expensive option, but it stood out for its simple, easy-to-understand offerings that offer a bit beefier coverage than the norm.

The cheaper option, $29.99 a person or $105.97 a family, requires a copay for adult diagnostic and preventive services. For just a few dollars more, at $32.78 per person or $112.46 per family, you can forgo the copay. Adults are capped at a $1,000-per-year plan maximum, but there is no such cap on pediatric care. The deductible is $50 per person or $150 per family.

For adults, staying in network means no coinsurance for preventive care, or 20% out of network. Co-insurance for basic care is 20% in network, 40% out of network; for major care, it’s 50% in network or 60% out of network. There is no orthodontic care for adults, but kids are eligible for 50% benefits for medically necessary work.

Basic work, including fillings and root canals, has a six-month waiting period, while major work such as crowns and dentures have a 12-month waiting period.

Dental Insurance 101

There are a few major types of dental plans: traditional, managed, and discount. Here’s what you should know:

• Traditional/indemnity, or fee-for-service: With this kind of plan, much like a medical preferred provider organization (PPO), you can choose your dentist from a network of providers that accepts your insurance plan. You may be able to go outside your network and receive some insurance benefits, but a larger portion of your services will be paid when you stay in network.
• Managed care, or pre-paid: Like a medical HMO (health maintenance organization), you go through one dentist or facility for your dental needs with a pre-paid plan. If you need more specialized care, that dentist must refer you to any other care providers.
• Discount: Though not technically dental insurance, discount plans are another way to save on dental services. Through these plans, you can join a network of dental providers that have agreed to provide services at a reduced cost to members. However, you’ll typically need to pay upfront before services are rendered.

Which kind of dental insurance is right for me?

There is no one-size-fits-all answer to this question, but in general, a traditional plan will be the most costly — something to consider if budget is king. However, you’ll also enjoy a greater degree of freedom with your traditional plan. Generally, you’ll have a fairly wide choice of providers within your network, and you can go outside of your network and still receive some benefits. This could be the way to go if you think you’ll need more than basic dental care, or don’t want to choose just one dentist to coordinate any more specialized needs.

With a managed care plan, your treatment will generally be less costly. Another big benefit: You probably won’t have to deal with annoying paperwork or unexpected bills if you see your primary provider. The downside here is that you must get the OK from that provider before you can seek specialized treatment from someone else. You may also find that the provider you really want to see isn’t an option, forcing you to pay the full cost out of pocket.

A discount plan is probably the cheapest of all, and the simplest. Copays, deductibles, coinsurance — you don’t have to deal with any of it, instead paying a small annual or monthly fee to be a plan member. You also only pay for treatment when you actually receive it. However, the discounts you receive may not be that great, which can be especially painful if you end up needing major work done. You may also find that the provider you want to see isn’t a member of your discount plan. If you’re interested in dental discount plans, a good place to start is DentalPlans.com.

What does dental insurance cover?

Every plan is different, so you’ll need to closely examine plan paperwork to get an accurate answer to this question. Here are a few rules of thumb for a typical traditional dental plan, the most common type of coverage:

• Routine care: Your yearly checkup and the services you typically receive — cleanings, sealants, and so on — is usually covered at a level anywhere from 80% to 100%, according to Angie’s List.
• Basic and major care: Got a lot of cavities? Things can get more expensive. Expect your plan to cover about 70% to 80% of the cost for fillings, root canals, and similar work. You may only receive up to 50% coverage for crowns and dentures, however.
• Cosmetic dentistry/orthodontics: With few exceptions, cosmetic procedures such as veneers, teeth whitening, and bonding will not be covered at all unless your provider can show that they’re medically necessary. Orthodontics such as braces are often treated the same way, especially for adults. However, there may be some coverage for kids — again, this varies widely by plan.

Dental insurance: Terms to know

While you’re wading through dental insurance bills and paperwork, chances are you’ll see some familiar words. Make sure you know the following key terms for your plan or any plan that you’re considering:

Deductibles

This is how much you have to pay out of pocket during a given period (commonly a year) before your benefits kick in. For instance, if you have a $50 deductible, you have to pay the first $50 toward your dental care before you’ll receive any benefits from your insurer. Typically, plans with higher deductibles have lower premiums (the upfront cost of your plan) because you are absorbing some of the risk for the insurer.

It’s important to know not only how high your deductible is, but what kind of care counts toward your deductible. Some plans will count just about everything — others will be stingier, exempting preventive and diagnostic care. You’ll also want to note whether you have a “family deductible” if there is more than one person on your plan. That means each person doesn’t have to meet the deductible individually.

Coinsurance and copays

So you’ve met your deductible, and your benefits have kicked in. You’re all set, right? Alas, you’re still not off the hook with many plans. You’ll probably have to pay coinsurance, which is a certain percentage of costs you’ll have to pay out of pocket.

For instance, you may still have to pay 20% of the costs for routine care, or up to 50% of the cost of a crown. You’ll typically be billed after you receive service. Those percentages can be greater if you go out of network.

With a copay, you pay a fixed amount when you show up to receive treatment — for instance, $20 for a routine checkup. In most cases this is all you’ll pay, but certain plans may require both a copay and coinsurance in some instances.

Plan maximums

Unlike major medical plans, dental insurance plans are still allowed to cap your benefits from year to year. So your maximum is the amount at which your insurer will stop paying on your behalf.

Go over your maximum, and you’ll be on the hook for any other dental costs you incur before your benefit period resets (typically every year). Note that dental plan maximums are relatively low — a $1,000 limit isn’t uncommon.

Waiting periods

The good news is that you won’t be turned down for dental insurance because of pre-existing conditions. The bad news is that you may be forced to wait for a lengthy period — perhaps six months or a year — before getting covered for much more than routine preventative care.

Dental insurers want to guard against people who need a lot of costly work simply picking up coverage when they need it, and then dropping it once the work is done.

Dental Insurance and the Affordable Care Act: What You Need to Know

The Affordable Care Act, or Obamacare, established a lot of new benefits for medical patients. Most notably, major medical plans can no longer impose annual maximums or coverage limits, and you’ll also only ever have to shell out up to a certain set amount (right now, that’s $6,600 for individual plans, and $13,200 for family plans) before your insurer is on the hook for the rest.

Unfortunately, unless you’re a child, dental coverage has largely been left out of health-care reforms. Pediatric dental care is one of Obamacare’s 10 essential health benefits, so it must be made available through federal and state marketplaces. Unfortunately, that’s not the case for adults. While there are a limited number of adult dental plans on offer, they’re not subject to the same out-of-pocket maximums, and they can still impose a cap on your coverage.

Practically, and perhaps most importantly, note that you cannot buy a dental plan through the federal health insurance marketplace unless you’re also buying a medical plan. There are a limited number of combination plans with adult dental benefits as well as standalone dental plans, but you cannot buy one of the standalone dental plans without purchasing separate medical coverage as well. If your state runs a separate health exchange, you’ll want to check to see if you can buy dental only; this is a perk in a handful of states including California, Connecticut, Maryland, and Vermont.

On the plus side, you can buy individual dental coverage directly from several providers without waiting for open enrollment, which dictates when you can enroll in major medical plans. (This year, open enrollment is Nov. 1, 2015, through Jan. 31, 2016). To learn more about health insurance, check out our guide to The Best Health Insurance Plans in 2015.

Is Dental Insurance Worth It?

Skimpy dental coverage has many budget-minded people wondering whether it’s worth paying a monthly premium unless your dental plan is generously subsidized by an employer. There is no clear-cut answer, but it is possible to pay more in premiums than what you might pay out of pocket if you need very little care (for instance, if you only find yourself at the dentist just once a year for a routine cleaning).

Another thing to consider: Many plans have $1,000 plan maximums per year. While medical insurance will quickly pay for itself if you need tens of thousands of dollars in care, a dental plan could still leave you on the hook for a substantial sum after you exhaust your benefits.

If you decide to forgo dental insurance, there are still some ways to cut costs:

• Use a discount plan. As I discussed above, a discount plan isn’t insurance. But they can help you save on dental costs without costly premiums, copays, or coinsurance.
• Shop around, and negotiate. Make a few phone calls. If you need more than a cleaning, ask if you can get a package deal, or whether there’s a discount for cash payments. See whether you can implement a payment plan if things are tight.
• Think outside the box. Your neighborhood dentist isn’t your only option. A rural dentist may be much cheaper, and a local dental school may offer the same services at lower prices performed by capable students. If you make under a certain amount, you may also qualify for subsidized care at a dental clinic.
• Take advantage of a health savings account. If you opt for a high-deductible health plan, you have the option to use a tax-friendly health savings account to put away money for qualified medical expenses, including dental care.

If you do decide to get dental insurance, you can start comparison shopping at a site such as eHealthInsurance. If you’re interested in dental discount plans, try DentalPlans.com.

Whatever you do, make sure you have enough cash stashed away in your emergency fund to cover a dental health emergency. Doing so can keep you out of debt — and out of financial trouble — if your teeth end up needing much more than a simple cleaning.

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