Dental Insurance

Dental Coverage Explained

Updated on April 15, 2020


Having dental insurance can provide you with much-needed peace of mind—especially considering the high cost of dental work. With a quality dental insurance policy, you can receive coverage for anything from routine exams and cleanings to more complex procedures such as root canals and extractions.

Dental plans typically fall into one of three categories: employer-based, self-purchased, or “riders” attached to medical insurance policies.

Whether you currently have coverage or not, you should understand the basics of dental insurance.

What’s Usually Covered in Dental Insurance

Typically, a dental insurance policy will cover regular checkups and cleanings twice a year, although there may or may not be an out-of-pocket copay required for each appointment. Most dental insurance plans will also cover the majority or all of the expenses related to cavity fillings.

In addition to check-ups and fillings, dental insurance should cover annual X-rays, crowns, root canals, and other necessary repair work. Dental insurance should also cover a portion of complicated and emergency dental procedures. However, it is possible that policy holders will be responsible for paying a deductible before coverage will kick in for these types of procedures.

What’s Not Usually Covered in Dental Insurance

While most dental plans cover basic dental work and preventative procedures, there are some procedures that many do not provide coverage for. A prime example of this is composite (tooth-colored) fillings.  Often, coverage will only be provided for amalgam (silver) fillings, and policy holders will be responsible for paying the difference if they prefer composite fillings.

Cosmetic procedures, such as tooth-whitening treatments, are also usually not covered by insurance. Other non-covered treatments may include:

  • orthodontic treatments (braces)
  • dentures
  • dental implants
  • dental care related to a medical condition

Of course, all dental insurance policies differ, so policy holders should check their coverage limits to find out exactly what is and what is not covered in their unique cases.

Should You Buy Dental Coverage?

If you’re currently without dental coverage, you might be wondering whether or not it’s worth purchasing your own policy. There’s no universal answer here, as everybody’s financial situation and oral health needs are different.

Generally, you’ll want to start by considering the costs associated with a dental plan versus your typical annual dental care costs. Break down what your dentist charges for twice-a-year cleanings, X-rays, fillings, and other routine care. Then, compare these costs the premiums your quoted for dental coveage under different plans. Keep in mind that you may be able to deduct your insurance expenses come tax time.

You’ll also want to consider your overall dental health when determining whether or not you want to buy a policy of your own; if you have a history of dental problems, it will probably be worth it to spend the money on coverage and have the additional peace of mind. And if you’re on Medicare, remember that Medicare will not cover dental work unless medically necessary.

Typical Costs of Dental Coverage

As you shop for quotes on dental coverage, there are some important factors you’ll want to consider to find the policy that’s right for you. First of all, understand that typical dental insurance premiums range from around $20 to $60 per month, but this can vary greatly depending on your coverage and even where you live.

For example, some plans will cover 80% of the costs associated with fillings, leaving the policy holder with 20% of the cost after the annual deductible is met. On the other hand, other policies may cover 100% of the fillings.

Tips for Buying Dental Insurance

As you’re shopping for a dental insurance policy, make sure that your current dentist will accept the plan you’re considering (unless you’re willing to switch dentists). Websites like eHealth can help you search for plans that will allow you to continue seeing your regular dentist.

Furthermore, be sure to read the fine print under any dental insurance plan to make sure you understand what you’ll be responsible for paying out-of-pocket, what’s covered versus what’s not, and what your deductible will be. You can save money by only buying what you need; stand-alone policies these days are very customizable to suit your needs and budget.

Finally, don’t put off shopping for a dental insurance plan. Most plans have a “waiting period” of up to a few months before coverage will officially kick in, so the sooner you purchase a policy, the sooner you can begin reaping the benefits.

Join Our Newsletter

Get healthcare news, wellness tips, and coverage resources