Are you one of the 28% of Americans who doesn’t have dental insurance through an employer, group program or public program? Or do you have some level of cover but want to know if there is a better alternative for your needs?
With so many options available, it can be hard to know which is the best dental insurance plan for you and your family. That’s why we’ve compiled this guide to explain what types of insurance are available in the US and what you should consider when choosing a plan.
Find out which providers are best when it comes to:
- affordable dental insurance
- full coverage plans
- policies for families, seniors and individuals
- PPO and DHMO
- discount plans
The cost of dental care has increased by 20% over the past decade, and almost a third of uninsured Americans say they have avoided getting the treatment they needed for financial reasons. An insurance plan can help spread the cost and protect against any unexpected bills so you can give your teeth the care they deserve.
If you’re currently serving in the US armed forces, check out our article on military dental cover as well.
Table of contents
- 1 Types of dental insurance plan
- 2 Things to consider
- 3 Top dental insurance companies in the US
- 4 Do I need individual dental insurance?
Types of dental insurance plan
We’ll begin by looking at the different types of dental cover on offer. The type of plan you choose will have a big impact on your premium, deductible, and level of coverage. Be sure to familiarize yourself with these terms so you can compare like-for-like.
Dental indemnity insurance plans
Often the closest you’ll get to full coverage dental insurance, indemnity dental insurance will reimburse a percentage of your dental care costs with any dentist you choose. These plans usually cover the broadest range of treatments, although they still come with a handful of exceptions.
Maximum benefit caps are typically higher than with other types of dental insurance, but so are the premiums. You’ll also pay a deductible, either annually or per claim.
You may also hear this type of insurance referred to as ‘fee-for-service’. Since this indemnity insurance is generally only available to groups and through workplaces, we haven’t included any providers in this article.
Dental discount plans
Although not technically insurance, another way to lower the cost of dental care is with a dental savings plan. For a fixed annual fee you receive a certain discount off the standard price of dental treatment.
Discounts range from around 10-50% depending on the type of treatment. The annual fee often includes free dental checkups and cleanings. This preventive care is a good way to protect against and identify any potential problems before they become more costly.
Because there is a simple discount structure without annual limits and deductibles, this usually means there is no tedious paperwork to complete and you receive the discount straight away.
Some dentists will allow you to combine a dental discount plan with your insurance to minimize your out-of-pocket costs if you exceed your annual maximum. However, this is entirely at their discretion, and some dentists won’t let you apply both types of insurance to the same procedure.
If you’re considering ‘doubling up’ your coverage in this way, first check that your dentist is in both insurance networks and is willing to accept both policies at once.
There are two main types of discount plan:
DHMO (Dental Health Maintenance Organization)
Also known as Dental HMO, this type of plan offers coverage through a particular network of dentists. Members benefit from discounted rates for their treatment, and some services may be offered for free. DHMO networks are typically quite small and there is no cover if you are treated by a dentist from outside the network.
You’ll find the lowest premiums with this type of plan, often with the added benefit of no annual limits or deductibles. Some plans come with little or no waiting period, even for major dental work, so they can be a popular last-minute purchase for people facing otherwise unaffordable treatment.
PPO (Preferred Provider Organization)
PPO dental insurance plans are similar to DHMO, but usually with a wider network of approved dentists. These plans usually provide some level of coverage for treatment with dentists outside the network, too. However, you can expect to receive a smaller discount if you use a non-approved dentist.
In return for this flexibility and more generous benefits, customers pay higher premiums and deductibles.
Comparison of insurance types
The table below summarizes the main differences between these types of insurance plan:
|Plan Type||Pros||Cons||Best for...|
|Indemnity insurance||High annual caps for a broad range of treatments; see any dentist||High premiums and annual deductibles; usually only for groups||People who want high limits and less restrictive coverage|
|DHMO||Offer a % discount without deductibles or paperwork; low cost premium; some preventive care may be included||Restricted network of providers||People who need affordable dental insurance and are happy to stick to an approved provider network|
|PPO||Offer a % discount without deductibles or paperwork; more flexible and broader benefits than DHMO; can see any dentist||Higher premiums than DHMO; lower discounts for out-of-network dentists||People who need the flexibility to see any dentist for a range of treatments|
The best option for you will depend a lot on the products available in your state and the work you need to have done. If you already know what treatment you need, it can be well worth taking the time to work out exactly how much you’ll have to pay with different insurance plans.
In this detailed case study from Policygenius, a patient needing basic preventive care, a filling, and an extraction could get their annual expenses down from $1,488 to $420 with one particular insurer. A patient requiring a root canal and porcelain crown saved almost nothing with that same insurer, but could more than halve their expenses with a discount plan.
Things to consider
It can be hard to compare dental insurance policies and discount plans since there are so many variables to consider. Most providers offer different levels of dental cover and you’ll need to decide which things are must-haves for you and your family. If you’re looking specifically for a family plan, check out our full article about family dental insurance as well.
Even the most comprehensive dental insurance will have some exclusions. To complicate the matter, insurance companies are often not upfront with the full details of their policy. You may have to do some digging to find out what you are signing up for.
Here we have listed some of the factors you’ll need to think about when selecting the best dental insurance coverage for you.
Annual maximum benefit limit
Most insurance providers apply a maximum annual payout to each policy or each insured person. This can be one limit across all types of care, or there may be individual limits for each treatment type. If you exceed your annual limit you’ll need to pay the additional cost yourself. Annual maximums reset each year, usually on the anniversary of the policy.
Policies with an annual deductible require you to pay a fixed amount before any reimbursement is given. Some insurers waive the deductible for routine diagnostic and preventive treatment.
What percentage discount will you receive on each particular treatment – and what will you have to pay yourself? Some treatments, especially preventive care, may be included for free with your insurance.
So you just realized you need a load of expensive treatment and NOW you’ve decided to get insurance? Guess what – insurers protect themselves against this kind of thing by applying waiting periods. You might get some treatment right away (like a checkup and x-rays) but more complex and costly dental work might have to wait 3-12 months.
Insurance claims processes are notoriously lengthy and tiresome. If your plan doesn’t involve an up-front discount on your treatment, you’ll more than likely have to pay the full amount up-front and then claim back whatever your insurance allows for. Check what this process involves and your insurer’s processing times.
Another way insurers protect themselves is by excluding treatment of any conditions you had when you took the policy out. In order to check this, they may require you to have a checkup before your policy starts. Alternatively, they may state that any problems identified at your first checkup won’t be covered.
Accident & emergency cover
If you suffered dental trauma in an accident and needed emergency treatment, what would your insurance cover? Would you have the freedom to visit any dentist out-of-hours?
Dental implant insurance
Although dental implants are not usually covered as standard, many insurers will allow you to add this on as an extra. Since implants are so expensive, expect this coverage to come with lots of conditions and a fairly high premium.
Cosmetic dentistry coverage
Other cosmetic dental treatment like teeth whitening, braces, veneers, and cosmetic contouring is rarely included in cheap dental insurance plans. However, more premium plans may offer some level of cover. Orthodontic treatment for children is more likely to be included than for adults.
Depending on the type of cover, there may be a number of other exclusions. All dental treatments in the US are classified according to the ADA code. D0191 is assessment of a patient, for instance, while D2140 is an amalgam filling on one surface. There are hundreds of them.
If you want to check exactly what your policy covers – especially if your dentist has already given you a treatment plan – find the ADA codes in your policy documentation.
Watch the video below to discover some more important aspects of choosing the right insurance plan for you:
Top dental insurance companies in the US
So, which insurer should you choose?
Let’s take a look at some of the top dental providers you might be considering. This list of dental insurance companies gives the main benefits of each plan so you can more easily see what sets them apart from one another.
Aetna offers both an individual and a family dental plan which give a 15-50% discount on “most” dental procedures. The annual fee for these DHMO plans is $119.95 and $169.95 respectively, plus a $20 processing fee. You can save by paying for two years up-front. Cover includes braces and other cosmetic procedures, and there is no waiting period.
Although their sample savings table shows discounts ranging from 44-64%, the exact discount you receive will depend on your dentist. Avoid being drawn in by any marketing, and instead speak to your local dentist to find out what discount they offer for different procedures under the plan.
Exact details on Aetna’s website are sketchy. If you sign up for the family plan, for instance, it’s not clear how many family members are included. There is also no way of seeing which treatments are excluded. However, all plans come with a 30-day money back guarantee so if you are unhappy when you see the full policy details you can request a refund (minus the $20 processing fee).
Other features include:
- Active within 72 hours
- No waiting period for any included treatments, even root canals and crowns
- No claims process – deal directly with the dentist
- You must visit a participating dentist who is part of their 161,000+ network
Aetna also offers vision, hearing and prescription insurance for an additional premium.
Delta dental / AARP
One of the biggest names in the market, Delta dental, offers both DHMO and PPO plans. Under-50s can purchase directly through Delta, while Delta dental insurance for seniors is offered through AARP. You can read more about dental plans for seniors here.
DeltaCare USA, a DHMO-style plan, offers immediate cover with no annual maximum and no deductible. Over 250 common treatments are included with this plan.
You pay an annual fee for coverage, then any treatment you need is provided at a pre-determined, discounted rate. This includes treatment for pre-existing conditions, dentures, crowns, and up to 24 months of orthodontic work.
You’re limited to visiting just one dentist, which you must choose in advance from Delta’s extensive approved network.
The table below compares the main benefits of the two DHMO plans just mentioned. Another popular provider of this type of plan is CareFirst, but cover is limited to certain states.
|DHMO Plan||Aetna||DeltaCare USA|
|Individual annual fee||From $119.95 + $20 processing fee||Contact insurer|
|Family annual fee||From $169.95 + $20 processing fee||Contact insurer|
|Discount||15% - 50% on most procedures||Fixed rates agreed with your dentist|
|Annual maximum benefit||None||None|
|Includes orthodontics?||Yes, and some cosmetic work||Yes, and teeth whitening|
|Treatment valid with...||Only dentists in their network||Only your chosen primary care dentist|
|Details correct at time of writing; check with insurer for current and complete policy details.|
Delta Dental PPO offers two levels of coverage. Plan A is more comprehensive than Plan B, giving free diagnostic and preventive care as well as more generous benefits, a higher annual maximum, and a lower deductible.
Basic treatment such as fillings and root canals don’t have a waiting period. After one year of membership you gain access to additional benefits including discounts on periodontal treatment, dentures, and dental implants.
You may visit any licensed dentist with this cover, but reduced fees are available through the Delta-approved network.
You’ll need to contact the insurer directly to get a quote for your annual premium.
Cigna has three levels of dental PPO plans. The most basic plan covers just preventive care and costs from $18 per month. You may get preferential rates on other treatment just from being a Cigna member, but there is no guarantee of this. There is no waiting period, no deductible, and no maximum benefit, although there are limits on the frequency of each treatment type.
The Cigna Dental 1000 Plan costs from $30 per month and after a 6-month waiting period you receive an 80% discount on basic restorative work. Major restorative work comes with a 50% discount after 12 months. A $1,000 annual benefit and $50 deductible applies for individuals.
If you upgrade to the Cigna Dental 1500 plan, from $35 per month, the annual benefit increases to $1,500. The plan also covers orthodontic work after a 1-year waiting period, at a rate of 50% up to a $1,000 lifetime limit.
With all of these plans, you may choose to visit any dentist. However, the stated discounts only apply to network dentists. If you visit a dentist outside of the network, a Maximum Allowable Charge is applied to calculate your discount.
There are two levels of PPO cover available from Guardian: Gold and Silver. Benefits of paying the higher premium for Gold include free preventive care and more extensive benefits such as orthodontic cover for under-19s up to $1,000.
Even the Silver level of cover gives dental implant insurance after 12 months, although a lifetime maximum of $700 applies.
Both levels have a tiered annual limit which increases in the second and third year to a maximum of $1,000 for Silver and $1,500 for Gold.
Refreshingly, Guardian provides a clear list of limitations and exclusions up-front after you enter a few details to get a quote. This makes it much easier to know whether the insurance covers everything you need. For example, purely cosmetic work is excluded, as is any treatment for teeth missing before the policy begins.
In the table below you can view more information about selected PPO plans from the providers mentioned:
|PPO plan||Delta PPO Plan A||Cigna Dental 1000||Guardian Silver|
|Annual fee||Contact insurer||From $360||From around $300|
|Annual deductible||$50 (waived for diagnostic and preventive treatment)||$50 (waived for preventive treatment)||$50 (waived for preventive treatment at in-network dentists)|
|Annual maximum benefit||$1,500||$1,000||$500 increasing to $1,000 in year 3|
|Treatment valid with...||Any dentist, but approved dentists may offer lower rates||Any dentist, but the fixed discounts below apply to approved dentists||Any dentist, but the fixed discounts below apply to approved dentists|
|Discounts offered for common treatments|
|Diagnostic and preventive care||100%||100%||80%|
|Filling||80%||80% (6 month waiting period)||50% (6 month waiting period)|
|Root canal||50%||50% (1 year waiting period)||50% (1 year waiting period)|
|Crown||50% (1 year waiting period)||50% (1 year waiting period)||50% (1 year waiting period)|
|Dental implants||50% (1 year waiting period)||N/A||50% (1 year waiting period); $700 lifetime maximum|
|Details correct at time of writing; check with insurer for current and complete policy details.|
Do I need individual dental insurance?
As with any type of insurance, you’re protecting yourself against the unknown. You might maintain an excellent bill of dental health for the rest of your life, or you might develop gum disease leading to the loss of several teeth. Plus, accidents can happen at any time.
Don’t assume that just because you brush and floss carefully your teeth will be fine. Plaque and tartar can build up without you realizing and, left untreated, they can cost a lot more in the long run. Preventive care (which is usually free or heavily discounted with insurance) is essential for catching any problems early.
In deciding whether it’s worth signing up for a plan, you’ll need to weigh up all the factors we mentioned earlier on. Also consider your overall oral health to date – if you seem to have more problems than most people then it could be worth investing in a higher level of cover. If you know you’re likely to lose one or more teeth soon, consider dental implant insurance too.
Many insurance providers bundle dental and vision insurance, and even hearing services. If you want the added protection, you’ll usually get a better deal by buying everything together in this way.
An alternative: dental payment plans
Finally, it’s worth mentioning that if you have left it too late to get insurance and you need immediate dental care, you can still make it more affordable with a dental payment plan. Most dentists offer payment plans to help their patients spread the cost of treatment.
They often offer a small discount if you can pay a certain amount up-front. If you have the full amount in cash, you may be able to negotiate a discount of around 10% – the longer you have been a patient with your dentist, the more flexible they are likely to be.
This can be an appealing alternative for people who don’t like the idea of paying for insurance they may never use. However, be aware that you will be responsible for the full cost of any treatment you need. Also try to get a 0% interest payment plan so you don’t end up paying more in the long run.
We have a full article on dental payment plans with more information on how they work and things to consider before you sign up for one.
Things to check first
Before you pay for new dental coverage, first double-check whether you have existing cover. Your employer may provide this, or it may even come with a credit card or another insurance product you have.
If you discover you are already covered, next you need to check the policy limits. Is the level of cover enough for your needs? If not, you may still want to go down the route of taking out an individual policy.
When taking out insurance with a specific treatment in mind, always read the fine print to check if and when you’ll be covered. This is especially important with any pre-existing conditions. But whatever your situation, take the time to understand exactly what your insurer will and won’t pay out for, and what your out-of-pocket costs will be.