Those twice-annual exams and cleanings aren’t just for keeping your teeth sparkly—dental health is an important part of your overall health. But figuring out how to pay for dental work can be just as uncomfortable and anxiety-inducing as sitting in the dentist’s chair.
If you have dental insurance, it’s sometimes tough to figure out what exactly is covered. And if you don’t have insurance—or if you’ve already exceeded your dental benefits for the year—fronting out-of-pocket costs can feel overwhelming.
Understanding your benefits and payment options can make your next trip to the dentist less stressful. Here’s what you need to know about paying for dental care, according to experts.
How dental insurance works
Dental insurance isn’t included in most health insurance policies, except in rare cases (some Affordable Care Act plans combine medical and dental coverage, for example). Usually, dental insurance is an add-on to your medical insurance that you can opt into or skip, depending on your needs.
Dentists and doctors bill separate insurance companies, explains Teresa Duncan, a dental insurance consultant and founder of Odyssey Management. A medical insurance policy reimburses your doctor and a dental policy reimburses your dentist.
While it’s ill-advised to not have medical insurance, some patients skip out on dental insurance because of how it’s structured. With health insurance, you’re paying to protect yourself in the event of an incident that may or may not occur. Under the Affordable Care Act, health insurance companies are prohibited from setting dollar limits on what they’ll cover in a year, or even a lifetime.
With dental insurance, you can easily exhaust your full coverage within a year, depending on your plan and your care needs. Dental insurance covers specific types of dental treatment, but only up to a certain point—when your coverage limit kicks in. “It’s more of a ‘benefit’ than a typical insurance policy,” says Rick Garafalo, a consultant and founder of The Dental Practice Mechanics.
Here’s how it works: You pay an annual or monthly premium in exchange for a certain amount of dental care coverage. While costs can vary, dental plan premiums through an employer typically range from $40 to $160 a month, Duncan says. In some cases, employers pay for employees’ entire premiums. Most of the time, you’ll pay at least part of the premium, which is deducted from your paycheck just like your health insurance premium. If you have dental insurance that’s not through an employer, you’re responsible for the entire premium.
In exchange for your premium, the dental insurance company allots you (and your family members, on a family plan) a certain amount of coverage per year. You may pay $500 per year for up to $1,500 in dental coverage. But that coverage doesn’t fully kick in until you hit your deductible.
The deductible is the amount you have to pay out of pocket toward dental care before your insurance benefits kick in. Dental deductibles are usually pretty low compared to health insurance deductibles—you may have to pay a $50 or $100 deductible before your dental benefits kick in.
“But that amount isn’t insignificant, because many plans have $1,000 or $1,500 annual maximum coverage,” Garafalo says.
On the other hand, your deductible may not apply to some dental services, like routine cleanings. If you don’t end up needing additional dental care, you may not have to pay your deductible at all.
Types of dental plans: HMO vs. PPO
Dental benefits vary from plan to plan. As with health insurance, there are two types of dental insurance plans: health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
HMOs only pay for dental care from certain providers elected by the insurer, and relatively few dental offices participate in HMO plans, Garafalo says.
PPO plans, which allow you to choose your own provider from a large network, are far more common. That said, if you go to a dentist who’s outside of your insurance network, your insurance won’t cover as much as it would for an in-network provider. For example, insurance may pay for 100% of a cleaning from an in-network dentist but only 80% if you go to an out-of-network provider. It all depends on what’s outlined in your specific plan.
The good news is that with a PPO plan, out-of-network payments can usually be applied toward your deductible—although you may have a higher deductible for out-of-network services than in-network services, depending on your plan. Garafalo says many insurers are increasing deductibles to push patients toward in-network providers.
What dental insurance covers
Most plans cover the full cost of preventative and diagnostic procedures, like yearly X-rays and biannual cleanings, as long as you go to an in-network dentist, Garafalo says.
If you go to an out-of-network dentist with a PPO plan, those services will likely be covered only up to a certain amount—often referred to as the “allowed fee.” For example, an out-of-network dentist might charge $100 for a cleaning, and your insurance company might allow $80. You’ll be responsible for paying the remaining $20.
Dental procedures, such as basic fillings, are usually covered at 70% to 80% of the total cost. For dental work that costs $1,000, that means you may have to pay a few hundred dollars out of pocket. Major work, like root canals, bridges, crowns, or dentures, are often covered at about 50%.
“That said, I’ve seen commercial plans that cover fillings at 30%, and I’ve met someone with a plan that covered 100% of everything,” Garafalo says.
The key is that once you hit your coverage maximum for the year, you’re responsible for the rest—even if you need the dental work, it’s an emergency and you’re seeing an in-network dentist.
What dental insurance doesn’t cover
Most dental insurance plans have exclusions, which are procedures they won’t pay for in any circumstance, so it’s important to read the fine print. Your plan may have a missing tooth clause, for example, which means if you had a missing tooth before the day your policy started, it won’t be covered.
Cosmetic procedures, like teeth whitening, also may not be covered by your insurance—and dental work caused by accidents might not be either, Garafalo says.
Some plans also have frequency limitations, which means insurance will only pay for a certain number of dental visits per month or year.
Before you choose a plan, ask yourself how much dental work you might need. If you already have dental problems, or if you have young kids who might need fillings, it could be worth investing in a plan with more coverage. But if you’re single and you only go in for routine cleanings, a plan with a lower maximum amount might suit you.
If you’re not sure what your dental plan covers or you’re confused about the fine print, Duncan suggests inquiring with your insurer and confirming coverage with your dentist’s office before going in for an appointment or procedure.
“It’s important to confirm with both that they can actually see you so you’re not caught with a huge bill,” she says.
When to pay out of pocket instead of using insurance
Dental insurance can be helpful if you know you’re going to see the dentist, but it’s not a worthwhile investment for everyone. If you have a high premium and you want to see an out-of-network dentist, Duncan says you might be better off paying out-of-pocket, especially if you consider yourself low risk (meaning you don’t have existing dental problems and don’t anticipate any down the line).
Some dentists have in-house membership plans where you can pay a monthly fee instead of paying for dental insurance. These plans often come with perks, such as free X-rays and cleanings or 15% off certain procedures.
You can also use money in a health savings account to pay for dental care, Garafalo says. For some people, that’s a better deal than dental insurance.
“It’s not worth it to pay $1,400 for a $1,500 annual maximum if you won’t even use it,” he says. “So you can take that money, put it into your HSA pre-tax, and use it to get the dental care you need.”
Regardless of how you pay for dental care, staying on top of your routine visits is one of the best ways to prevent unexpected costs down the road. Paying for a cleaning and exam every six months could save you hundreds or even thousands on more expensive dental work in the future.
“It’s a lot better to spread the cost over the course of a long time than pay for expensive procedures all at once,” Garafalo says. “An ounce of prevention really is worth a pound of cure.”