Jane Dotson
Dental insurance is a great way to make caring for your teeth and gums more accessible and affordable. It can help you reduce your risk of common issues such as cavities and gum disease, as well as the cost of dental care, from routine check-ups to major procedures. While dental coverage is essential for children, it is not for adults. There are two main ways to get dental insurance: through your employer or by purchasing a private dental insurance plan. If you have Medicare, you can supplement your plan with dental coverage.
| Characteristics | Values |
|---|---|
| Supplemental dental insurance | Can be purchased to supplement Medicare |
| Can be purchased from companies like Delta Dental and Aflac | |
| Can be offered by employers as part of their benefits package | |
| Can be purchased privately | |
| Can lower the amount of money you owe when paying for dental work | |
| Does not usually cover 100% of costs | |
| Does not cover cosmetic procedures | |
| May be free or low-cost for children through Medicaid and the Children's Health Insurance Program (CHIP) |
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$14.99 $19.95
What You'll Learn
- Supplemental dental insurance can lower out-of-pocket costs
- Medicare doesn't cover dental services like routine cleanings
- Employers often offer dental coverage as an employment benefit
- Supplemental dental insurance covers orthodontic treatments
- Children may qualify for free or low-cost dental care through Medicaid
Supplemental dental insurance can lower out-of-pocket costs
Dental care can be expensive, and many people may find themselves spending hundreds or even thousands on it. While an uninsured patient can quickly incur high medical costs, being without dental insurance will not directly lead to such financial ruin. However, untreated oral infections can cause other health issues that can be life-threatening.
Dental insurance is not usually included with major medical policies, so it often has to be purchased separately as a supplemental plan. This can be done privately or through an employer, who may offer dental coverage as part of their employment benefits. If you are enrolled in a health plan with dental coverage, you cannot remove the dental coverage, but you can change health plans.
Supplemental dental insurance offers additional coverage beyond the primary plan. It fills in the gaps in coverage and provides benefits for more extensive or specialized dental treatments such as root canals, dental implants, and orthodontics. It also helps manage the high costs associated with these procedures by reducing the financial burden and ensuring that individuals can access the dental care they need without worrying about excessive out-of-pocket expenses. This enhanced coverage is particularly beneficial for those with specific dental concerns or ongoing dental issues that may require more advanced treatments.
Most dental plans include coverage for preventive care like routine exams, cleanings, and X-rays. Some plans require a copay for preventive services, while others cover those services 100%. Many dental plans also include coverage for basic services like fillings and extractions, and major services like root canals. The amount of coverage for these services varies by plan.
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Medicare doesn't cover dental services like routine cleanings
Medicare typically does not cover dental services like routine cleanings, fillings, tooth extractions, or items like dentures. However, there are certain scenarios where Medicare may offer limited dental coverage. For instance, if you have a Medicare Advantage Plan, it may cover routine dental services such as checkups or cleanings. In addition, Medicare may provide coverage for dental care that is necessary for specific health services or in the case of certain underlying medical conditions.
For example, Medicare may cover an oral examination before a kidney transplant or heart valve replacement. Similarly, dental services required for radiation treatment for certain jaw-related diseases, such as oral cancer, may be covered. If you are in an inpatient hospital setting and require dental care due to an underlying medical condition or the severity of a procedure, Medicare may also provide coverage. This could include situations where dental services are integral to the success of another Medicare-covered procedure, such as an oral exam and treatment before a bone marrow or organ transplant, or chemotherapy for cancer.
However, it is important to note that Medicare will not pay for any follow-up dental care after the underlying health condition has been treated. Therefore, if you are seeking dental coverage, it may be beneficial to explore supplemental dental insurance or alternative forms of insurance that can help cover the cost of dental treatments and procedures.
Supplemental dental insurance can be obtained in a few ways. Some employers offer dental coverage as part of their benefits package, which can be applied for during the company's annual open enrollment. If your employer does not provide dental coverage, you can purchase a standalone dental plan from a private insurance company. These plans typically cover most or all of the cost of routine checkups and cleanings, and they can also help reduce costs for other procedures such as fillings and crowns. When considering a dental plan, it is important to compare different options to understand the potential out-of-pocket costs, including premiums, deductibles, and coinsurance.
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Employers often offer dental coverage as an employment benefit
Dental insurance is one of the most desired employee benefits. A robust benefits package is essential for attracting exceptional talent and retaining quality employees. Dental insurance is known to impact employees' overall health positively. People who don’t have dental insurance are more likely to have heart disease, osteoporosis, and diabetes.
If you’re considering offering dental coverage to your employees, there are some key basics employers should be aware of when considering which dental plan is right for their team. Firstly, it’s important to know that there are many different types of dental plans. A “typical” dental policy will cover preventive care (generally two preventative visits each year), fillings, crowns, root canals, and oral surgery, such as tooth extractions. More comprehensive plans can be selected to cover orthodontics, periodontics, and prosthodontics, for example, dentures and bridges. A great deal of dental plans available today adhere to what’s known as a “100-80-50” coverage structure, where dental insurance will cover 100% of preventive and diagnostic care, 80% of basic procedures, and 50% of major procedures.
There are other ways, besides traditional dental insurance, for employers to offer dental coverage to their employees. One of the most common ways to go about providing dental benefits is through a Health Reimbursement Arrangement, or HRAS. This is a particularly attractive option for smaller businesses. An HRA is a type of health spending account. Funds are deposited into the HRA ahead of time, and those funds can go toward paying for anything that is deemed a “qualified expense.”
If you do offer a health plan, you can still use an HRA for dental benefits using a dental or vision HRA, as opposed to a QSEHRA. QSEHRAs are available to any company that does not offer a group health plan and has fewer than fifty employees.
When choosing a dental insurance company, look for a company with plans available in your area and make sure their plan designs are flexible enough to fit your employees’ needs and your company’s objectives. Find a plan design that allows you to choose what services and what percentage of treatment costs are covered. By visiting an in-network dentist, your employees are protected from balance billing and can save money because those dentists have often agreed to lower fees. It also saves you money on claims.
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Supplemental dental insurance covers orthodontic treatments
Supplemental dental insurance is a great option for individuals and families with limited dental coverage from their primary insurance. It offers additional benefits and services beyond primary dental coverage, filling in the gaps in coverage and providing benefits for more extensive or specialized dental treatments. While primary dental insurance usually covers routine dental care and basic services, supplemental insurance extends coverage to include more specialized and costly treatments.
Orthodontic treatments can be very expensive, and not every dental plan includes coverage for braces and other orthodontic services. For example, a plan may cover braces for children but not for adults. If your primary dental insurance doesn’t cover orthodontics, it may be a good idea to consider a supplemental dental plan to help make the costs of the treatments more manageable. Supplemental dental insurance often covers orthodontic treatments, including braces, clear aligners such as Invisalign, or other types of dental appliances.
There are several options for purchasing supplemental dental insurance. One option is to go directly to an insurer like Delta Dental, which offers a wide variety of plan options for individuals and groups. Another option is to purchase insurance through your employer during the company's annual open enrollment. Additionally, some children may qualify for free or low-cost dental care through Medicaid and the Children's Health Insurance Program (CHIP).
It is important to carefully review the details of any dental plan before purchasing it to ensure that it provides the coverage you need. Most dental plans come with a network of dental providers and orthodontists, and you can save money by staying in-network. Your dental plan may also have a maximum amount that you can spend per year on orthodontic services or other exclusions and limits on coverage. By understanding the specifics of your plan, you can take advantage of any discounts you are qualified for and avoid unexpected costs.
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Children may qualify for free or low-cost dental care through Medicaid
Dental health is an important part of overall health. Children from low-income families may qualify for free or low-cost dental care through Medicaid and the Children's Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP also covers pregnant women. Like Medicaid, CHIP is a joint federal and state program. CHIP provides medical coverage and, in most cases, dental services to children who qualify. CHIP-covered dental services vary from state to state.
Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Dental services may not be limited to emergency services for children entitled to EPSDT. Dental services must be provided at intervals that meet reasonable standards of dental practice and at other intervals, as indicated by medical necessity, to determine the existence of a suspected illness or condition. States must consult with recognized dental organizations involved in child health care to establish those intervals. A referral to a dentist is required for every child in accordance with each state's periodicity schedule and at other intervals as medically necessary.
The Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services (CMS) hosts a series of webinars to support states and their collaborative partners to improve access to dental services for children enrolled in Medicaid and CHIP. The Bureau of Primary Health Care, a part of the Health Resources and Services Administration, supports federally-funded community health centers across the country that provide free or reduced-cost health services, including dental care. InsureKidsNow.gov helps families find low-cost health insurance for children and teens.
While it is possible to supplement your Medicare plan with dental coverage, it is not possible to remove dental coverage from your Marketplace health plan. However, you can change health plans (with or without dental coverage). Many employers also offer dental coverage as part of their employment benefits, which can be applied for during the company's annual open enrollment.
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Frequently asked questions
Supplemental dental insurance is a separate dental plan that can be paired with a primary dental plan or Medicare Advantage plan to enhance your dental benefits. It covers costly orthodontic treatments and dental cosmetics.
Depending on the plan, it can cover most or all of the cost of routine check-ups and cleanings, as well as reduce costs for fillings and crowns, deep cleanings, and many other procedures. It also covers preventive and diagnostic care.
The cost of supplemental dental insurance varies by plan. The annual premium is usually between $400 and $700, but there may also be deductibles, copayments, and coinsurance to consider.
