How much is dental insurance?
December 12, 2023 8 min read
“Put your money where your mouth is” is an expression that—when taken literally—could be good advice about investing in dental insurance.
Taking good care of your teeth and gums can be expensive. That’s why over 80% of Americans have dental insurance to help pay their medical bills. But understanding all the different types of dental plans, coverages, limits and costs can get complicated.
Here are some key things to know about shopping for health insurance.
Dental insurance can help you pay your dentist bills.
You can get dental insurance through your employer, a private company or a public program.
Dental plans typically don’t cover 100% of costs, and they cap the amount they’ll pay each year.
You generally pay some out-of-pocket expenses such as deductibles, copayments and coinsurance.
Those costs can vary depending on your plan, the type of dental care you receive and the state where you live.
What is dental insurance?
Dental insurance is a health benefit plan that helps you pay a portion of your dentist bills. It’s similar to how medical, auto, homeowners and other insurance types protect you from exorbitant bills.
Some dental plans may allow you to see any dentist you want. Other plans may want you to see a dentist who’s in their network because they’ve already agreed to negotiated prices for dental care.
Some plans may reimburse you for some of the money you paid your dentist. But most insurance companies commonly act as the middleman. That means your dentist submits your bill to your insurance company, which determines how much your plan covers. Then you may or may not have to pay the rest, depending on your plan.
It’s important to understand that dental insurance typically doesn’t pay 100% of all costs. Nor does it cover all types of dental care. Nor does it cover an unlimited amount each year.
Most insurance companies generally pay 100% for diagnostic and preventive services, 80% for basic restorative services and 50% for major restorative services.
Plus, you can expect some common out-of-pocket costs such as deductibles, copayments and coinsurance. Those amounts depend on your plan.
Most people get dental insurance through their employer. Others get private insurance. For eligible seniors, veterans, active military and low-income families, there are public programs such as Medicaid, the Children’s Health Insurance Program (CHIP), the Department of Veterans Affairs (VA) and Medicare Advantage or Medicare Supplement plans.
Average cost of dental insurance
Whether you have an employer, private or public dental plan.
What type of dental plan you choose.
The type of dental care you receive.
What state you live in.
The National Association of Dental Plans estimates the national average cost of dental insurance per month is:
$10 to $12 for a dental discount plan.
$13.83 for a private HMO.
$16.64 to $18.31 for an employer-provided HMO.
$20 to $30 for a family discount plan.
$28.70 to $30.71 for an employer-provided PPO.
$35.16 for a private PPO.
$35.97 to $37.35 for an employer-provided indemnity plan.
Dental insurance coverage
Preventing dental issues costs less than fixing them. One incentive to take care of your teeth is that dental insurance generally pays more for preventive care. The more major the work needed, the less it pays—and the more you have to pay out of pocket.
Plans often categorize dental care into four different classes of service. Most plans cover preventive, restorative, endodontic and oral surgery in the first year. Periodontics and prosthodontics can have waiting periods. And orthodontics may or may not be added at an extra cost.
Most plans typically pay 100% for diagnostic and preventive care. That usually includes routine office visits for X-rays, exams and teeth cleanings two times a year.
Most plans typically pay 80% for basic restorative care. That includes fillings, crowns, pulling teeth, root canals and treatments for gum disease.
Most plans typically pay 50% for major restorative care. That includes crowns, bridges, inlays and dentures. Certain plans may cover a limited number of implants too.
Orthodontic care includes things like braces, aligners and retainers.
Not all plans cover orthodontics. If they do, they may not cover adults—only children. And they may have a lifetime maximum amount they’ll pay that’s separate from your regular dental insurance plan.
Out-of-pocket dental insurance costs
Even if you have the best dental insurance, you can expect to pay some out-of-pocket costs such as:
A deductible: A fixed annual amount you pay your dentist for services before your insurance starts to pay. The amount varies depending on your plan. Generally, the lower the deductible, the higher the monthly premium. And the higher the deductible, the lower the monthly premium.
Coinsurance: After you’ve paid your deductible, this is the percentage of the cost you pay for services. It’s usually somewhere around 20%.
A copay: After you’ve paid your deductible, this is the fixed amount you pay for services. It’s usually somewhere around $20-$25 for an office visit and $50 for a specialist.
Annual maximum: This is the most money your insurer will pay each year. It could be a dollar amount. Or it could be a cap on certain procedures or the number of doctor visits. After you hit the limit, you could be responsible for paying your dental bills in full for the rest of the plan year.
Keep in mind that when you start a new job, there might be a delay before your employer-provided insurance coverage becomes effective. This is known as a waiting period. Until then, you may have to pay in full.
In-network vs. out-of-network dental providers
Dental insurance costs can vary depending on whether your dentist is in or out of your insurer’s network.
In-network dental services often cost less than out-of-network dental services. That’s because insurance providers have negotiated with dental providers in their network to accept lower contracted prices for their members. Out-of-network providers have not agreed to that.
Your plan may cover out-of-network costs, but with higher copays, deductibles and coinsurance. But if your plan doesn’t cover out-of-network costs, you may have to pay the full cost.
What if no in-network provider offers the specialized procedure you need? With prior approval, your insurer may consider charging in-network prices for out-of-network care.
Types of dental insurance plans
There are four main types of dental insurance. Each plan has its pros and cons. Understanding them could help you choose what’s right for you.
Preferred provider organization (PPO) plans
Dental PPO plans are the most common type of health plan.
You can choose from a network of providers who’ve agreed to charge lower rates. You typically don’t need to choose a primary dentist or get referrals to see specialists.
When you visit the dentist, you may have to pay a deductible, copayment or coinsurance. Then your dentist usually sends the rest of the bill to the insurer to pay. In most cases, you’re not likely to be billed the difference between the dentist’s usual rate and the insurer’s discounted rate.
You may be able to see an out-of-network dentist without a referral. But expect to pay more—maybe even in full—directly to the dentist. Then send your insurer the bill for reimbursement.
Dental health maintenance organization (DHMO) plans
DHMO plans contract a network of dentists. They prepay a fixed monthly fee per patient to provide comprehensive care at no cost or low cost. The plan usually does not reimburse the dentist or patient.
You can select a primary care dentist, whose referral you’ll need to see a specialist.
The plan typically doesn’t cover out-of-network care, except in an emergency. You may be required to live or work in the DHMO’s service area so you’re close to your primary dentist.
Out-of-pocket costs are usually lower with DHMO plans. Patients may have a low-cost deductible or copay, but no annual cap on benefits.
A dental indemnity plan—sometimes called traditional or fee-for-service insurance—does not involve a network of providers, restrictions or negotiated rates for services.
You can choose any dentist, and you don’t need a referral to a specialist. But you can expect to pay out-of-pocket costs that aren’t discounted.
Like most dental insurance, an indemnity plan typically requires an annual deductible as well as coinsurance payments. And it typically has an annual benefit limit.
The most your insurance company typically will pay the dentist is a percentage of the “usual, customary and reasonable” fee for the service you received. If your dentist charges more than that, you could owe your dentist more.
Dental discount plans
There is a simpler plan, but it can be known by several different names. Whether it’s called dental discount, dental savings, dental access, discount dental or referral dental, the plan works the same.
It’s not insurance. Instead, it’s like club membership: You pay to join and get benefits in return. You simply enroll in a plan and pay 100% of a discounted rate directly to a participating dentist. Annual fees can be around $150. Discounts can range from 10% to 60% off.
The dentists typically discount all services. That could include cosmetic and advanced work that’s not always covered by dental insurance. A set of braces is one good example.
The Consumer Health Alliance (CHA) reports that 62% of dental discount plans cost less than $200 annually, resulting in about 40% savings on the cost of dental services.
How to reduce the cost of dental insurance
There are a number of ways to reduce the cost of dental insurance:
Get dental insurance through your employer.
Compare quotes from private insurance companies.
Consider a plan offered under the Affordable Care Act.
Check your eligibility for federal public programs such as Medicare, Medicaid, CHIP and the VA.
Consider a DHMO or discount plan.
Choose the right plan for you and your needs at different points in your life.
Avoid high out-of-network costs. Make sure there are enough in-network dentists and specialists in your area.
Maximize the plan’s benefits.
Dental insurance in a nutshell
Taking care of your teeth and gums is an important—but expensive—part of your overall health and wellness. But dental insurance can help you pay some of the high costs.
Learn more about investing in a health savings account (HSA) to help you pay the out-of-pocket expenses insurance doesn’t cover.