Roughly 35.2% of adults still don’t have basic dental care, and it can be a challenge to find affordable dental insurance. Medicare doesn’t cover dental costs for adults, and their coverage for children isn’t available in every state. Medicaid is less restrictive in coverage since they include most services for children and some dental emergencies for adults. So, unless your employer or group program covers the high-costs, you are probably among the millions of Americans who must pay out of pocket for dental care.
On average Americans pay $360 a year in dental insurance, which is surprisingly close to the average cost without insurance – $370. Now, maybe you’re tempted to say, “Well, why do I need insurance then? It’s only $10.” Everyone’s teeth are different, though, and if you have an emergency without any coverage, you could be facing thousands and thousands of dollars in costs. A fact that could derail all of your other sound financial planning.
Even if you are fortunate to have insurance, most plans still limit the coverage. Some affordable dental insurance programs may only cover preventive dental care, such as regular check-ups, cleanings, and x-rays. These plans may or may not include fillings and extractions. And should you require major dental care, such as root canals and crowns, you will most likely pay a good portion of the bill.
Additionally, dental insurance operates like health insurance where you pay a monthly premium and a deductible on any services. You may even have to pay a co-pay to cover each trip to the dentist’s office. Oral health is expensive, so it most certainly pays to compare dental plans. (For helpful information on affordable health insurance, check out our article here.)
What to Know Before You Visit the Dentist
Not every dental insurance plan is the same since some offer more benefits than others. Here are the basics terms to know when shopping for an affordable dental insurance policy.
Preventive Care
All plans should provide basic care because preventing major surgery is much cheaper than having the actual procedure. Insurers know this, so they promote routine preventive care. A good plan should cover 100% of preventive care costs. Some policies include only 60% of those costs, so check to see the exact percentage your plan will cover.
Minor Restorative Care
Fillings, extractions, and re-cementing of previous crowns are costly. A good dental insurance plan should cover up to 80% of the costs associated with these dental procedures. But beware because although fillings fall under this coverage, you may not get to choose the type of filling. If you want a natural-colored filling instead of a metal one, you’ll most likely have to pay extra.
Major Restorative Care
Major dental work, such as crowns, bridges, implants, and root canals, are usually covered up to 50%, which could still leave you with a hefty bill. For example, a dental implant costs roughly $1,500, an amount already past the coverage limit of most insurance policies. Best case, you will owe $750. Check the percentage of your plan to avoid the worst case.
Corrective Services
Dental insurance plans don’t usually cover braces or other forms of cosmetic dentistry. If a corrective operation is necessary, however, you may be able to add it to your plan for an additional cost.
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Dental Care Waiting Period
Affordable dental insurance plans usually come with a waiting period. Don’t take out a plan and then head directly to the dentist for all the work you have been putting off. Dental insurance usually covers preventive care from the day your policy becomes active, but sometimes there is a 30-day waiting period. Even after the waiting period, some dental insurance policies might only cover work so many times a year.
Affordable dental insurance plans vary widely, so consider multiple insurers to find the best one for you.
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Types of Affordable Dental Insurance
Unfortunately, dental insurance isn’t as simple as ‘go-to dentist, have dental work, and ask the insurer to cover it.’ Now that you know the basic levels of care, let’s proceed to the different types of dental coverage:
A dental PPO or Preferred Provider Organization is similar to the health insurance variant, where you receive a list of insurer-approved dentists. You can still use an unapproved dentist, but your costs are higher.
Next, a Dental Health Maintenance Organization or HMO also provides a list of approved dentists, who will perform dental work for a set co-fee amount or no fee at all. Just know that this insurance policy may not cover out of network dentists at all.
Lastly, a discounted or referral dental plan won’t cover any dental work costs. However, they do provide a list of registered dentists who offer their services at a discounted price.
Affordable Dental Insurance for Older Adults
Most dental plans have no age restrictions, but few plans tailor to those 64 and older.
Medicare Advantage can offer some dental coverage, but it is not comprehensive. Insurance through a private insurer is available for seniors with premiums between $20 and $40 per month. The best alternative is the discounted or referral dental plan mentioned above.
Affordable Dental Insurance for Children
Children have more options for dental insurance. The children’s health insurance program or CHIP offers affordable dental coverage for children. Visit the Medicaid website to see what your state covers because disease prevention, emergency care, and good oral health are vital for this age group. By law, every state must post a listing of dentists who participate in Medicaid and CHIP.
Four Main Programs of Dental Insurance
Now that you know the different types of overarching structures, let’s move on to the four main programs:
Direct Reimbursement Program
Direct reimbursement programs are comprehensive plans. This arrangement covers a certain percentage of the total amount spent on dental care, regardless of the dental treatment required. There is also little restriction on which dentist you can see for dental care.
Usual, Customary, and Reasonable
A UCA allows you to choose your dentist, too. It will either pay a percentage of the dentist’s fee or a “reasonable”/”customary” amount set by the plan’s administrator (whichever is less). Although these limits are called “reasonable” and “customary,” they may not reflect the cost of a procedure in your area. Metropolitan areas will be more expensive than rural ones. Read the terms carefully and research average prices before committing to this type of plan, because there is little government regulation to help determine a “reasonable” limit.
Table or Schedule of Allowance
This program sets a list of covered services with an assigned dollar amount. That amount represents just how much the insurance plan will cover for each procedure. Also, if the dentist’s actual fees are higher than the set amount, you will have to cover the difference.
Capitation Programs
A capitation plan pays contracted dentists a fixed amount (usually per month) per family or patient. The dentist agrees to perform most treatments at no charge (some procedures require a co-payment from the user). The premium paid by the insurer to the dentist can significantly differ from the amount of the patient’s actual dental care.
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A Few Other Notable Points
Some dental plans require a treatment proposal, and approval before dental work takes place. The insurer can review the proposal and determine what will be covered by the insurance plan.
Dental Insurance plans can also come with annual benefit limitations, such as the waiting period previously mentioned. Boundaries are set to ensure adequate coverage. If you and your dentist know how much will be covered, then you can create a plan that lowers costs. That saves you money on dental expenses and gets the best use out of your policy.
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Best Affordable Dental Plans of 2019
A great dental plan is both affordable AND comprehensive. Dental plan providers should list all costs for you, so when making your choice, consider what is best for you. Some employers may mandate a specific dental coverage plan as part of their benefits package. If not, here are some dental insurance companies and plans to consider:
Delta Dental Insurance
Delta Dental is the most widely used dental insurance provider in America. Coverage is available in 15 US states, as well as the District of Columbia. Their various plans include over 140,000 participating dental offices. Both individual dental and group dental plans are available with specific programs available for families on a budget. The discounted plans come with a scheduled service chart that lists fees for the three types of dental work, namely preventive, minor, and major. Seeing these fees upfront make getting the most out of your insurance that much easier.
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DeltaCare USA vs. Delta Dental PPO
DeltaCare USA is an HMO plan that requires you to choose a dentist from an approved list. This list also has the approved costs for each service. There is no waiting period with this plan and no deductible fee. Co-pay costs can apply, but these are listed so you can plan for your expenses before committing.
Delta Dental PPO allows you to use any licensed dentist. However, if you choose one from an approved list of dentists, you can get discounts on dental care. The insurer pays a percentage of the service cost covered by the plan. Depending on the service and your state of residence, you may be required to pay a deductible and/or any remaining balance.
Humana Dental Insurance
Humana is another large, well-known dental insurance provider that offers plans for individuals, families, and employers. They provide vision insurance too, so if you combine your dental and vision insurance, you can earn a $35 discount. You can also save on prescriptions by using in-network pharmacies. Below are three of their affordable dental plans:
- Dental Loyalty Plus gives you a choice of dentist, whether in-network or out-of-network. There is a one-time deductible of $150 per person or $450 per family. Insurance coverage can increase yearly up to $1,500 over three years.
- Dental Preventive covers preventive care, including x-rays and cleaning. There is a $50 per person or $150 per family deductible. There are no co-pays.
- Dental Savings Plus is not an insurance package but a dental discount plan. You pay a one-time $15 fee and then select a valid, in-network dentist for discounts.
United Health One Dental Insurance
Coverage through United Health One is available to individuals and employers in 40 states and Columbia. Individual plan deductibles start at $50. There are six plans with varying benefits, but we categorize them into three for convenience:
Dental Primary and Dental Primary Preferred
This basic plan has a $50 deductible per person. After the deductible, the plan covers 50% of the cost for primary care. The yearly amount of coverage per person is $1000. The preferred plan differs slightly with a $50 deductible on basic and major services if provided by an in-network dentist. After the deductible, the policy covers 35% of the costs for primary care and 15% for major services. The annual maximum amount is again $1,000.
Dental Essential and Dental Essential Preferred
Again, the basic plan comes with a $50 deductible per person. After the deductible, this plan covers 50% of the cost for primary care when you use an in-network provider. Also, you don’t have a co-pay for preventive services. The preferred plan comes with a $50 deductible on basic and major services if provided by an in-network dentist. After the deductible, the plan covers 50% of the costs of basic care and 15% for major services. Both plans again have a $1,000 limit per year.
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Dental Premier Choice and Dental Premier Elite
There is a $50 deductible on basic and major services when performed by an in-network provider. You don’t need to pay a co-pay for preventive services. After the deductible, the plan covers 50% of the costs of basic care and 10% for major services. The maximum amount for this plan is $1,500. The elite version has the same terms but allows the use of an out-of-network dentist with an allowance up to $2,000.
Aetna Dental
Aetna has offered insurance for over 150 years, beginning with health insurance in 1899. Premiums on your dental insurance will usually cost between $30 and $60 per month, depending on your plan.
With an Aetna insurance plan, your two cleanings a year are covered. An important thing to note is that the plan’s accessibility is restricted. Aetna dental plans are only accessible as part of their health insurance plans. There are only four states where this is not the case: Arizona, Delaware, Illinois, and Pennsylvania. There are three plans offered by Aetna, each with different primary dental benefits and dental savings.
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Dental Maintenance Organizational Plan
This plan is a low-cost dental plan that lets you choose your primary dentist. It’s possible to see a specialist, but this requires a referral. There are no deductibles or annual maximum amount to worry about. One item to note is that once you select a dentist, you cannot change it until the start of a new year. This plan covers 100% of preventive care.
Preferred Provider Organization Plan
This PPO plan allows you to use any dentist, but in-network providers are cheaper. In-network deductibles are $50 per person or $150 per family, while out-of-network deductibles are $100 per person and $300 per family. This insurance policy covers 100% of preventive care, though it has a maximum lifetime amount of $1,500.
Dental Indemnity Plan
This plan is the most flexible of the three offered. You can use any licensed dentist in the country. This extensive coverage, however, comes with high deductibles.
Aetna also offers a discount plan for those who can’t commit to a full insurance plan. The Aetna Dental Access plan provides discounts from 15% to 50%. One of the main benefits of this dental savings plan is that there is no waiting period, which means direct access to procedures, no matter how costly.
Blue Cross Blue Shield of North Carolina
Blue Cross dental insurance comes in two plans. One is tailored to individuals, while the other is for families.
- Dental Blue for Individuals PPO – This plan offers routine dental care at a low rate of $22.95 per month regardless of age. All (100%) preventive care is covered when performed by an in-network provider. You won’t have to pay a deductible on this service. If you opt for an out-of-network provider, then 100% of the costs are covered up to an agreed amount with a $20 co-pay fee. This plan also covers up to 30% of the price on basic and major care work when performed by an in-network dentist. There is a large deductible ($250) but no waiting fees.
- Dental Blue for Individuals: Core Plan – This plan costs $37.88 per month if you are under the age of 65, and $44.79 per month, if over 65. You’ll get all (100%) preventive care covered with any licensed dentist. Blue Cross will cover 70% of basic service fees after a $75 deductible. The costs for major work are split 50/50 after a $75 deductible. This plan does come with waiting terms though – none for preventive work but six months for basic care and 12 months for significant care.
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Let the cleaning begin.
Unfortunately, affordable dental insurance is still limited nationwide, but you can find decent coverage for basic and significant work with a little research. Some insurers offer better packages for families, while others are better for individuals.
No matter the provider, you should check the terms to make sure there are no hidden co-pay costs. If possible, it is always better to use an in-network provider to get the most out of your insurance policy. If a full insurance plan is not in your budget, then the dental savings plans offered by some insurers are best. The discount offered on dental procedures can go a long way.
And no matter what plan or provider you choose, check to see if your dentist is registered with the American dental association to ensure the highest quality dental care.
Know a great dentist or plan? Please leave comments below and help more Americans get affordable dental care.
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