How to Buy Dental Insurance (2024)

When you’re looking to buy a dental insurance policy, not every plan will make sense. It’s important to determine the type of care you need, find out where you can get coverage, decide on the right plan type, and shop around for the best coverage and value. By understanding how to buy dental insurance, you can find the right fit for your budget and needs.

Assess Your Needs

Individuals and families have unique dental care needs. If you’re single, relatively young, with few or no cavities or other dental problems, basic dental coverage that includes biannual checkups and teeth cleanings will probably suffice. But if you have children who likely need braces in the future, look for a dental plan that includes orthodontic treatments. Likewise, if you are middle-aged or older and foresee the need for dental implants or dentures in the future, search for insurance that covers these types of procedures.

“Dental procedures can be expensive, especially treatments like root canals or crowns,” said Shawn Plummer, CEO of online insurance broker The Annuity Expert. “Insurance helps manage these costs, making dental care more affordable. Regular dental check-ups, which are often covered by insurance, are also crucial for maintaining oral health and can prevent more serious issues down the line.”

Without dental insurance, you’ll foot the bill for all your dental costs, from bi-annual cleanings to expensive treatments such as crowns. While costs vary among dentists, without dental insurance you might pay:

• Routine cleaning: $75 to $200
• X-rays: $100 to $200
• Fillings: $200 to $400
• Simple tooth extractions: $75 to $250
• Root canals: $500 to $1,500
• Crowns: $500 to $3,000
• Basic and midrange dentures: $800 to $3,000 per set
• Premium dentures: $4,000 to $8,000 per set

Although these costs are only examples, this data can help you determine how much money you might need to spend in the near and distant future. For instance, if you believe you only need biannual examinations, teeth cleanings, and X-rays, your costs could be as low as $300 per year. But bear in mind that your dental health can change quickly. The cost of dental treatments such as extractions, fillings, and root canals can easily surpass $1,000.

When deciding whether to purchase a dental plan, weigh the cost of monthly premiums against paying out of pocket for expensive dental treatments. In some cases, it’s more cost-effective to pay out of pocket for dental care.

Determine Where You Can Buy Dental Insurance

When shopping for dental insurance, you may have more options than you realize.

Through Your Employer

Certain employers offer dental insurance as part of an employee benefits package, which is usually the cheapest way to buy coverage. Some employers pay all or a portion of their employees’ dental insurance premiums, while others require workers to bear all premium costs. Even if your employer pays the premium, you’re still responsible for other costs, such as coinsurance, copayments, and deductibles.

Often, employers offer dental health maintenance organization (DHMO) and dental preferred provider organization (DPPO) plans that are provided and administered by a major insurance company. Very large companies may be self-insured. That means the employer pays all claims, though it may use a commercial insurance carrier to administer the plan and provide a dentist network.

An employer-sponsored dental insurance program may require you to sign up for coverage (or make all changes to an existing plan) during an open enrollment period. Open enrollment usually spans a 30- to 60-day period in the fall. During open enrollment, you can sign up for a new dental plan, cancel a plan, or change your coverage. You may also be allowed to enroll when you first join the company or after a life-changing event such as a marriage. After enrollment, dental policies typically cover a 12-month period.

On the Health Insurance Marketplace

The government-operated Health Insurance Marketplace offers two ways to purchase dental insurance. You can buy a health insurance plan that includes dental insurance or choose a standalone dental plan. Note that you can only purchase a Marketplace dental plan if you also buy health insurance at the same time. If you choose standalone health and dental plans, you must pay two separate premiums.

All Marketplace plans must include a dental insurance option for children, which may require paying an additional cost.

The Marketplace offers dental plans with two coverage levels:

• High coverage level: These plans feature lower copayments and deductibles, but higher premiums.
• Low coverage level: This option offers lower premiums but imposes higher copayments and deductibles.

From a Dental Insurance Provider

Many insurers sell standalone dental plans that cover you or your entire family. Individual plans usually cover preventive care, basic care, and major care, much like other types of policies. While insurance companies sell a variety of individual plans, many require you to seek care within a network of dental providers to receive full benefits. Although individual indemnity dental plans, which cover care from any provider, do exist, they are not as common as DHMO and DPPO plans, and they carry higher premiums.

With an individual plan, you don’t have to wait until an open enrollment period to purchase coverage: You can enroll at any time.

Decide Which Type of Plan Fits Your Needs

There are several types of dental insurance plans, which can vary by insurer. Factors such as benefits, costs, and flexibility differ among plans. While one type of plan might fit your dental needs when you're young and single, you might want a different type of plan if you start a family, or as you age. The most common types of dental plans include the plans below.

Dental Preferred Provider Organizations (DPPO)

With a DPPO plan, the most common type of dental plan, your insurer provides a list of in-network dentists from whom you must obtain dental care to receive your policy’s full benefits. Typically, DPPOs impose annual coverage limits, deductibles, coinsurance, and waiting periods.

Dental Health Maintenance Organizations (DHMO)

To receive full policy benefits, DHMOs also require you to seek care from a dentist within an insurer-approved network, but the network is usually smaller than the networks provided by DPPOs. A DHMO will not cover costs for services received outside the network. But while DHMOs require you to make a copayment (or copay) for services, they do not impose an annual maximum limit or deductible.

Indemnity Plans

Indemnity plans pay a fixed percentage for specified dental services. For instance, a policy might pay 80% of filling costs and 60% for root canal procedures. Typically, this type of plan sets a dollar limit for each type of dental service. Some indemnity plans allow you to choose any dentist, but others pair with PPOs and require you to seek care within a network of dentists.

Dental Discount Plans

This type of plan works like a membership program, but is not dental insurance. Dental discount plans feature a network of dentists who have agreed to offer discounts of 10% to 60% on specific dental services. For example, a plan might offer a 60% discount on dental cleanings and examinations and a 50% savings on fillings. A dental savings plan charges a flat-rate annual fee and usually does not impose annual maximums, deductibles, or waiting periods.

Consider These Factors When Examining Plans

Several factors can affect the amount you’ll pay for dental insurance and the level of coverage you can expect from a plan. It’s important to understand all these factors before enrolling in a dental plan or using your coverage.

Premiums, Deductibles, and Other Costs

A dental insurance policy includes numerous costs, such as:

• Premiums: The premium is the amount of money you must pay each month to continue to keep your dental insurance active. Typically, an individual dental insurance plan costs $20 to $50 per month, while a family plan runs $50 to $150 per month.
• Deductibles: Usually, dental PPO plans require you to pay an annual deductible, which may range from $50 to $150. This is the amount you must pay from your own funds before your policy begins to share the cost of dental services. For example, if you buy a policy with a $100 deductible, you’ll have to pay the first $100 of dental expenses before your insurance kicks in.
• Annual maximum: Some dental insurance plans cap the annual amount of benefits they will pay. For example, If your policy has a $2,000 annual limit, that’s the maximum it will pay for the policy year. If you exceed the annual limit, you’ll have to pay the remainder of the costs out of pocket. While annual maximums are common, some policies do not set a limit (mostly DHMOs).
• Copayments: Dental insurance policies may require you to make a copay: a relatively small fee for a particular covered dental service. For instance, you might have to pay a $25 copayment each time you get a dental cleaning and examination. The insurance company pays the rest.
• Coinsurance: Other plans require you to pay a percentage of most dental services. Coinsurance is similar to a copay, but it’s a percentage of the expense rather than a flat fee. A policy might require you to pay 20% of filling or root canal costs. So, if a service costs $1,000, you would pay $200, and your policy would pay the balance.
• Waiting periods: Many, but not all, dental plans impose a waiting period: a length of time you must wait before a policy will begin paying certain kinds of benefits. Many policies will immediately cover preventive care, such as cleanings and examinations. But they may impose a three- to six-month waiting period for basic work such as teeth extractions and fillings, and a three- to 12-month waiting period for major work such as crowns or dentures.
• Pre-existing conditions: Most dental plans exclude coverage for dental conditions that already existed at the time of enrollment. For example, many policies won't cover missing teeth. But pre-existing conditions don't include dental conditions you weren’t aware of, such as cavities.

Coverage Options

Many dental insurance plans provide four types of coverage.

• Preventive care: This includes costs such as dental cleanings, examinations, fluoride treatments, and X-rays.
• Basic care: This category includes minor dental work such as tooth extractions and fillings.
• Major care: Procedures such as bridges, crowns, dentures, and root canals fall within this category.
• Orthodontic treatment: Some policies cover braces for teeth alignment.

“Orthodontic benefits are generally lifetime benefits, meaning you get to use a certain amount of insurance money to apply toward orthodontics over the lifetime of the patient with that particular insurance plan,” said Scott Cardall, DMD, a dentist at Orem Orthodontics in Orem, Utah. “The only way to get more of a lifetime orthodontic insurance benefit would be if your insurance plan changes. Different plans may or may not cover these benefits at all or only for certain ages, so it's important to look up specifically if the plan you are considering will cover what you're looking to have done.”

Dental insurance plans typically do not cover:

• Cosmetic procedures, such as teeth whitening
• Pre-existing conditions, such as missing teeth

Many of the best dental plans follow a 100/80/50 coinsurance structure, which means they cover:

• 100% of preventive care costs
• 80% of basic care costs
• 50% of major care costs

Network of Dentists

A dental insurance plan may or may not require you to seek care within a specified network of dentists to receive full benefits. “For out-of-network dentists, a benefit will be provided and can be applied in many situations. However, the cost may be higher because dentists use their own fees rather than the contracted rate assigned by the insurance company,” Dr. Cardall said.

Reputation and Customer Satisfaction Ratings

Coverages and premium costs are important, but always choose a dental insurance provider that has a good reputation and high consumer ratings. The National Association of Insurance Commissioners operates a database of customer complaints lodged against insurers. You can also search internet forums and insurance company websites to find patient complaints and reviews. Finally, check with your state’s department of insurance to find out if the provider holds a license to sell dental insurance in your state.

Gather Quotes and Apply

When shopping for dental insurance, it’s wise to request quotes from several providers. Compare costs, coverages, deductibles, annual coverage limits, and copayment or coinsurance requirements.

The steps to apply for a plan depend on where you plan to buy a policy.

• If your employer offers dental insurance, you’ll have to apply for coverage during the open enrollment period. Typically, open enrollment begins in the fall and often continues until the end of the year. Check with your employer’s human resources department to learn more about available dental insurance plans and open enrollment requirements.
• You can shop for and purchase private dental insurance that you buy on your own at any time.
• If you’re going to buy your health insurance through an ACA Marketplace, you can also buy a dental plan there. To shop for dental coverage on healthcare.gov, enter your ZIP code or location to see all plans available in your area.

Marketplace plans give you the option to purchase an adult health insurance policy that includes dental insurance, or a separate dental plan. When purchasing separate health and dental plans, you’ll need to pay two premiums. All Marketplace health insurance plans for kids aged 18 and younger must offer the option to also purchase dental coverage.

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