Your Free Guide to Dental Insurance
Your Free Guide to Dental Insurance
We are privately owned and not affiliated with the government in any way or form. Our team of writers has researched dental insurance to create this guide to assist consumers.
What is dental insurance?
Just like health insurance provides benefits that offset some of the costs of visiting doctors and getting procedures, dental insurance provides benefits in regard to services such as dental checkups, cleanings and X-rays and often other services such as fillings, crowns, root canals and more.
Dental work can be expensive, resulting in many individuals delaying or neglecting necessary procedures. However, having a dental insurance policy can cost less in the long term because preventive services can often prevent major problems down the road.
Cost of Dental Care Without Dental Insurance
Dental costs vary depending on a few factors, including location, provider, and specific type of service. However, the purpose of having a dental insurance policy is to reduce an individual’s expected out-of-pocket costs.
Without dental insurance, individuals are generally responsible for paying all the costs associated with their dental services. Even the most common services, like dental cleanings, could cost several hundreds of dollars without dental insurance. More comprehensive dental care, like root canals, fillings, and tooth extractions, could cost the average person thousands of dollars without insurance.
Potential Risks of Neglecting Dental Care
Untreated tooth infections and other issues can cause a variety of health problems, including pain, trouble eating, bad breath, gum disease, tooth loss and others. Cavities that are not filled right away may get bigger and can end up requiring expensive and painful procedures like root canals and extractions.
Poor oral health has side effects on other aspects of personal health. For example, it can increase the risk of oral HPV infections, oral cancer, dementia, respiratory infections, diabetic complications, rheumatoid arthritis and heart disease.
How Dental Insurance Offsets the Cost
Having dental insurance generally makes it more affordable to get preventive care and to pay for restorative care when it is needed. Depending on your plan, dental insurance covers all or part of preventive care, such as regular cleanings and checkups. Sometimes, policies cover a portion of the costs of restorative care, such as fillings and crowns, up to an annual maximum amount.
Typically, the more people you have in your family, the higher the cost of dental insurance, but the greater your potential savings. Most dentists and oral health professionals recommend everyone older than age 1 visit the dentist at least once every six months for optimal oral health.
Similar to health insurance policies, dental insurance policies usually have in-network dentists and other dental professionals who participate in their plans. The dental insurance providers negotiate rates for each procedure with their in-network dentists that are usually lower than the rates from out-of-network dentists. This means that even once you have exhausted your benefits for the year, you could still pay less for any additional dental work with an in-network provider you have done that year.
Most Common Dental Insurance Coverage Options
Basic plans cover preventive care, and possibly some basic services like fillings and have lower premiums each month. In contrast, a full-coverage plan covers preventive care, basic services and major services and entails a higher monthly premium. Be sure to read the policy documents to find out what each dental plan covers before you sign up.
How Much Do Dental Insurance Plans Pay?
Nearly all dental insurance plans cover basic preventive care like checkups, periodic X-rays and teeth cleanings. Some plans also cover all or part of the cost of crowns, bridges, periodontics, fillings and tooth bondings. The highest-tier plans may even cover more extensive work, such as orthodontia (braces) and dental implants.
According to a 2021 Forbes article, most full-coverage dental insurance plans pay according to the following 100/80/50 formula:
- Routine and preventive services like cleanings and checkups every six months with annual or biannual X-rays: 100%
- Basic services including fillings, extractions and root canals: 80%
- Major services such as crowns, dentures and implants: 50%
The amount of money that you pay the dentist – which is usually 20% of the total cost for basic services and 50% of the cost for major services – until you hit your annual maximum is called the copayment, or copay.
What Don’t Dental Insurance Plans Pay For?
Other than the routine and preventive care, there are usually deductibles that must be paid out-of-pocket before the plan pays a percentage of the cost. Deductibles typically range between $50 and $200.
For example, a patient who needs three fillings at $80 each – or $240 total – and has paid nothing so far toward her $200 annual deductible needs to pay $200 out of pocket to meet the deductible, which leaves $40 left to pay. The insurance pays 80% of the remaining $40, or $32, and the patient pays the additional $8 for a total of $208. After this, the insurance often pays according to the 100/80/50 rule outlined above until the end of the coverage year, at which point the deductible resets.
There is also usually an annual maximum allowance, past which the dental insurance plan pays nothing. About half of dental PPOs (see the Types of Dental Insurance section of this guide to learn more) have annual maximums of less than $1,500 per covered person. This means that after the insurer has paid $1,500 for its share of the patient’s dental costs in a year, the patient is responsible for all the rest of the costs.
There may also be a separate lifetime maximum for orthodontics, if that is included in your plan. However, even once you have exceeded the annual maximum, you may still qualify for the lower negotiated rates for any additional services you require.
Some dental insurance plans specifically exclude certain procedures or services, such as sealants or laughing gas administration. Procedures which are purely cosmetic are not usually covered by dental insurance. This includes teeth whitening services and non-essential veneers.
If you are looking to receive cosmetic dental services, you are often responsible for the total cost. Additionally, some insurance plans only pay for a lower cost alternative, like metal fillings rather than white porcelain fillings. If you want to get the more expensive option, you would likely need to pay the difference in cost.
Many plans also have a waiting period for certain types of dental work to prevent individuals from signing up for insurance coverage only when they have expensive dental work to be done. Many plans exclude pre-existing conditions. So, if you already have a missing tooth, the plan may not cover getting an implant.
Where to Get Dental Insurance
With nearly two-thirds (64%) of Americans covered, dental insurance is more common today than it has been in previous decades, due in large part to the Affordable Care Act (ACA). The ACA outlines dental coverage as an essential benefit for children younger than 18 years of age and requires insurance companies to offer parents the option of dental coverage for their children, regardless of whether the insurance is employer-sponsored or private. Therefore, if you are a parent and you are signing up for a new health insurance policy, you can also be offered a dental insurance policy at an additional cost.
There are three primary ways to get dental insurance coverage:
- Through your employer
- Through the federal government’s online Health Insurance Marketplace
- Through a private dental insurance company
You are not required to purchase dental insurance, and there is no tax penalty for declining it. Dental coverage is not considered to be an essential benefit for adults with no children.
Dental services are typically not included in regular health insurance coverage, so dental insurance must usually be purchased as a separate policy. As a stand-alone policy, it generally has its own required monthly premium payments, deductibles, limits and coverage details that are separate from your health insurance policy. You may have a different dental insurance company in addition to your health insurance provider, with a separate insurance card.
Employer-Sponsored Dental Insurance
About half of all Americans get their health insurance coverage through their employers, and about half of these employers also offer dental insurance to employees. If you work for a large company, you may be more likely to have access to employer-sponsored dental insurance since around 90% of companies with 500 or more employees offer dental coverage. People who are self-employed are the least likely to have dental insurance.
If you work for a company that provides dental insurance, you can generally sign up for it when you start employment, or when you sign up for health insurance. Employers choose the dental insurance provider, which may or may not be the same as the health insurance provider. The person in charge of company benefits will usually send you information detailing the available dental benefits so that you can decide to elect or decline coverage.
There may be one or more plans available to you, each with different monthly premiums. You may consider choosing a plan that provides you with the level of coverage you need at a price you can afford. If you have a spouse and/or children, you may also be able to choose which of your family members needs coverage under the dental insurance plan.
The cost of the dental insurance is often deducted from your paycheck, although some employers pay all or a portion of the monthly cost as an employee benefit. Check with your human resources department to find out if your employer pays anything toward your dental insurance premium.
Private Dental Insurance
If you are self-employed or your employer does not provide dental insurance, you can buy it on your own. There are two options to buy private dental insurance:
- Purchase a plan through the federal government’s Health Insurance Marketplace</span
- Purchase a plan directly from a dental insurance company
Purchasing Dental Insurance Through the Health Insurance Marketplace
The Health Insurance Marketplace is an online healthcare coverage platform that offers a variety of health insurance plans. Some of these plans are overall healthcare plans that include dental insurance as one component of coverage. Other plans are stand alone dental insurance policies that you can mix and match with a different health insurance plan. You can only get dental insurance through the Health Insurance Marketplace if you are also getting your health insurance through the Marketplace.
If you purchase a separate dental insurance plan from your overall health insurance plan, you have the option of canceling the dental coverage at any time. However, if you get a health
insurance plan that includes dental, you cannot cancel just the dental part of the plan. You can switch to a new Marketplace plan during the open enrollment period or if you qualify for a special enrollment period (SEP).
Open enrollment for the Marketplace generally occurs each year beginning on November 1 and ending on or around January 15. Policies purchased during this period start in January of the following year. For example, open enrollment for coverage in 2023 begins on November 1, 2022.
A special enrollment period (SEP) is a limited period of time for which an individual can enroll in a Marketplace plan outside of the open enrollment period. There are certain life events that qualify people to enroll outside of open enrollment periods:
- Losing healthcare coverage – this can occur due to changing jobs, losing coverage due to an income change, or reaching age 26 and losing coverage from a parent
- Changes in household size – such as having a baby, getting married, getting divorced and losing coverage, adopting a child, or losing a family member
- Changes in living arrangements – such as moving or relocating
Among Marketplace dental insurance plans, you can choose either a high coverage level or a low coverage level. Generally, the high coverage level has a higher monthly premium, but lower copayments and deductibles. Low coverage plans have lower monthly premiums, but higher copayments and deductibles.
The Marketplace has detailed information on each plan’s costs, copayments, deductibles and services that are covered so you can make an informed decision. Access the Marketplace here: https://www.healthcare.gov/
Purchasing Dental Insurance Directly from Providers
If you don’t have employer-sponsored dental insurance and do not have the ability to sign up through the Healthcare Marketplace, you can go directly to dental insurance companies and sign up for dental insurance. There are several companies that offer dental insurance policies, both as standalone plans or as add-ons to standard health insurance.
The major providers of dental insurance are listed below:
- Delta Dental (https://www1.deltadentalins.com/)
- Cigna (https://www.cigna.com/individuals-families/plans-services/dental-insurance-plans/)
- Aetna Dental Access (https://www.aetna.com/individuals-families/buy-dental-coverage.html)
- Metlife (https://www.metlife.com/exchange/dental/)
Before you sign up for a dental insurance plan from a private company, you may consider shopping around to compare plans. Research each company’s policies and keep the following in mind as you compare:
- Monthly premium cost
- Coverage levels
- Types of dental services covered
Types of Dental Insurance
Not all kinds of dental insurance work the same way. It all depends on not only the provider but also the type of dental coverage you need. Here are some of the most common types of dental insurance.
Dental Preferred Provider Organization (PPO)
A dental PPO is the most common type of dental insurance policy and works similarly to health insurance PPOs. With a dental PPO, the plan has a network of dental providers, each of whom agree to the insurance company’s fee schedule for each type of procedure.
The plan pays a higher percentage to in-network providers compared to out-of-network providers. Out-of-network providers also usually charge a higher fee for procedures, and patients would be responsible for paying the difference between the provider’s fee and the amount the insurance company is willing to pay.
Dental PPOs have an annual deductible, coinsurance and an annual maximum. Each dental insurance company may have different costs, but usually, routine and preventive services are paid 100%, according to the 100/80/50 formula. Learn more about the 100/80/50 formula in the “How Much Do Dental Insurance Plans Pay?” section of this guide.
Dental Health Maintenance Organization (HMO)
Dental HMO plans tend to have lower monthly premiums than dental PPO plans and cost less overall. There is usually no deductible, and routine services are paid 100%. Major dental services are generally covered but are charged at a predetermined fee.
With a dental HMO, a patient can choose a primary care dentist from the network. If a specialist is needed, the primary care dentist will make a referral to an in-network specialist. A referral is an approval from the primary care dentist for specialized care that he or she cannot provide. The approved specialist is within the policy’s network.
However, these networks are usually smaller than with a PPO, and the plans do not cover any services from providers outside of the network (except for sometimes in the case of emergencies). Another benefit to a dental HMO is that there is no annual maximum, which may make it a good choice for individuals who need extensive dental work.
Dental Exclusive Provider Organization (EPO)
A dental EPO is like an HMO, where you need to choose your providers from within the network. However, there is no need to choose a primary care dentist. Also, referrals to specialists are typically required. EPOs generally have lower monthly premiums than PPOs, but tend to have higher deductibles and coinsurance.
Dental Indemnity Plans
Dental indemnity plans have the least amount of restrictions and are among the most difficult to find. There is no network or primary care dentist and no referrals are needed. When you enroll in a dental indemnity plan, you generally have a deductible and coinsurance.
Once your deductible has been met, the insurance company reimburses you for a portion of what you spent, which is usually according to the 100/80/50 formula based on “reasonable and customary rates.” Learn more about the 100/80/50 formula in the “How Much Do Dental Insurance Plans Pay?” section of this guide.
These rates may be less than what the dentist is actually charging. If this is the case, the patient would need to pay the difference. Preventive care is usually paid at 100%. Some dental indemnity plans have an annual maximum, while others do not. You may want to choose this type of plan if you already have a dentist that you use, but who does not participate in many insurance networks.
Point of Service (POS) Plans
Dental POS plans combine aspects of dental HMOs and PPOs. Like an HMO, you select a primary care dentist from within the network. However, you have the freedom to use the services of out-of-network providers as well (typically at a higher cost) as long as you have a referral from your primary care dentist.
With POS plans, you typically won’t have a deductible as long as you choose a primary care dentist from your plan’s network. Since POS plans have fewer options and are generally less flexible than other types of plans, the costs may be lower.
You might choose this option if your existing dentist is in-network but you want to go to an out-of-network specialist such as a periodontist, orthodontist or endodontist. Most POS plans have an annual maximum.
Dental Savings Plans
Although these are not strictly insurance plans, they do provide some of the same benefits and are often sold by dental insurance companies. With this kind of plan, you pay a small monthly fee in order to access a network of dental providers who offer reduced fees to members. Usually, this also includes cosmetic procedures.
There is no annual maximum, but the patient is responsible for paying 100% of the reduced fees, including routine maintenance such as checkups. If you need very little dental care other than checkups or if you want discounts on cosmetic procedures like teeth whitening, this plan may benefit you.
Average Costs of Dental Insurance
There are several factors that influence the cost of dental insurance. These include the monthly premium, deductible, annual maximum, restrictions and each patient’s needs. Continue reading the section below for more information on each factor that contributes to the overall cost of dental insurance.
A monthly premium is a fixed amount of money you pay each month to keep your dental insurance. The amount of your premium varies by the type of plan you have, deductible, coverage, provider and location.
For example, a dental insurance plan for one person could cost $39.99 per month in Anniston, Alabama. The exact same dental plan could cost $59.99 per month in Los Angeles, California. This difference in cost can be explained by the higher cost of living in a city like Los Angeles.
Dental savings plans tend to have the lowest monthly premiums, followed by HMOs, EPOs, POS plans, PPOs and indemnity plans.
A deductible is the total amount of money you must pay toward covered services before the dental plan starts covering any costs. Plans with a higher deductible tend to have slightly lower premiums, but this can also increase your out-of-pocket costs.
An annual maximum is the total amount of money the dental provider will pay toward dental services in a 12-month period. Plans with higher annual maximums tend to have somewhat
higher premiums because the insurance company figures you are choosing that plan because you need more dental work.
Lower annual maximums increase your out-of-pocket costs if you need any major dental work or need a lot of basic dental work, such as fillings.
If your dental insurance plan restricts several types of services, you can expect your out-of-pocket costs to be high. However, plans with lots of restrictions tend to cost the least amount of money.
Restrictions may not affect you as much if you do not need extensive dental work. So, if you only visit the dentist for periodic cleanings or checkups, a highly restricted plan could help you save on monthly premiums.
Overall, the more dental work you need, the more money a full-coverage dental insurance plan could save you. However, full-coverage dental plans typically cost the most. Dental benefits are limited by the annual maximum more than any other factor, but you can still save from the negotiated insurance rates for in-network providers.
To keep your costs as low as possible, it might be beneficial to get regular checkups, brush and floss every day and fix problems while they are small.
How to Determine if It’s Worth It to Get Dental Insurance
If you are weighing the pros and cons of getting dental insurance, you may want to take some factors into consideration by following the steps outlined below.
- Determine the total cost of your premiums for one year.
This is your monthly premium multiplied by 12. Example: A family of four might have a monthly premium of $122, which is a total of $1,464 for the year.
- Calculate the cost of annual preventive care.
This is the number of people in your family multiplied by 2, since it is recommended to visit the dentist twice per year. Then, multiply this figure by the cost of the checkup, cleaning and X-rays. Since this is considered preventive care, your insurance company may pay this amount at 100%.
Consider the example from Step 1:
Four family members x 2 = 8 visits per year
- Estimate the cost of additional care over the course of one year.
It may be tricky to estimate the services you will need throughout the year. However, if you commonly need tooth fillings or get frequent cavities, you may be able to factor this into your total expected costs.
- Subtract the deductible from your expected costs and multiply by 80%.
Once you figure out your estimated yearly costs, subtract the dental insurance plan’s deductible. Multiple that figure by .80.
Government Health Insurance and Dental Coverage
There are a number of government health insurance programs that may provide dental coverage depending on your age, income and veteran status. Here’s how government programs treat dental coverage.
Does Medicare Cover Dental Care?
Medicare is the country’s primary health insurance plan for seniors aged 62 or older. This plan does not cover dental care, with the exception of certain dental procedures that you may get when you are in a hospital, which are covered by Medicare Part A (hospital insurance).
However, Medicare Part A would only cover the hospital stay portion of the costs in this instance. Medicare Part B (medical insurance) only covers dental work if the patient has suffered a traumatic injury that affected the mouth, teeth or jaw.
Some Medicare Advantage Plans (Part C) do cover dental care. Most Medicare Advantage plans include routine dental coverage with a $0 copay for services with in-network dentists. Some Medicare Advantage plans also include coverage for basic and major dental work. These plans are available for purchase through private health insurance companies that have contracts with Medicare.
According to the AARP, the UnitedHealthcare Dental National Medicare Advantage Network is the largest Medicare Advantage dental network in the United States. In addition, Dual Special Needs Plans (D-SNP) and Preferred Care Partners (PCP) have large dental networks in Arizona, Florida, New York and Pennsylvania.
If you qualify (or will soon qualify) for Medicare, it may be beneficial to check for Medicare Advantage plans in your state that have dental coverage options. You may be able to find several plans that you can compare and choose from.
If you already have a Medicare Advantage plan but it does not include dental coverage, you may be able to enroll in a stand-alone dental plan. Learn more in the “Private Dental Insurance” section of this guide.
Does Medicaid Cover Dental Care?
Medicaid is another government health insurance plan designed for low-income families, seniors and people with disabilities. It covers the costs associated with dental care for children who are covered by Medicaid and Children’s Health Insurance Program (CHIP) through Medicaid expansion.
Dental coverage for children on Medicaid or CHIP is part of coverage mandated by the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. At a minimum, dental services for children must include relief of pain and infections, restoration of teeth and maintenance of dental health. All services must be provided if they are deemed to be medically necessary.
Does CHIP Cover Dental Care?
CHIP covers all routine dental visits for children who are enrolled in the plan. However, states have different dental coverage options depending on how they choose to provide CHIP.
In states where CHIP is administered as an expansion of medicaid, children who are enrolled in CHIP are covered through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. This benefit includes an array of preventive dental care to try and prevent dental problems and treat issues early on.
Currently, the following states provide CHIP through Medicaid expansion:
- District of Columbia
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Dakota
- Rhode Island
- West Virginia
However, if the state has a standalone CHIP program it can offer dental coverage as one of two options:
- It can offer a dental benefit package that meets CHIP requirements
- It can offer a dental benefit package that is “substantially equal to” either:
- The most popular federal employee dental plan for dependents,
- The most popular plan selected for dependents in the state’s employee dental plan, or
- Dental coverage offered through the most popular commercial insurer in the state.
Currently, the following states have not adopted Medicaid expansion and offer CHIP separately:
- North Carolina
- South Carolina
- South Dakota
States must post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov. You can use the interactive map provided on this website to find CHIP dental providers in your state.
Access the map here: https://www.insurekidsnow.gov/coverage/index.html
Medicaid Dental Coverage for Adults
When it comes to dental coverage for adults, individual states may choose whether to extend dental benefits to adults who are enrolled in Medicaid.
The following table provides current information on dental coverage for adults in all 50 U.S. states.
|State||Dental Coverage for Adult Medicaid Beneficiaries|
|Alaska||Preventive and restorative care up to $1,150 annually. Covered services include cleanings, exams, crowns, root canals, and dentures. Also covers emergency dental services with no cost limit|
|Arizona||Total maximum dental benefit is $2,000 per member, per year split into the following allotments: Up to $1,000 for emergency dental services up to $1,000 per member per yearUp to $1,000 for diagnostic, therapeutic and/or preventive services|
|Arkansas||Up to $500 per member per year for most dental care, which includes one office visit, one cleaning, one set of X-rays and one fluoride treatment. Medicaid also pays for necessary simple tooth pulling, surgical tooth pulling, fillings and one set of dentures per member lifetime. Any fees paid to a lab for dentures and tooth-pulling do not count toward the $500 limit|
|California||Broader coverage with $1,800 annual limit, although additional services may be paid for if deemed medically necessary.|
|Colorado||Broader coverage with $1,500 annual limit|
|Connecticut||Broader coverage with $1,000 annual limit|
|District of Columbia||Broader coverage with two cleanings per year and all amalgams or restorative fillings; no annual limit|
|Florida||Emergency-based dental services only; no annual limit|
|Georgia||Emergency only if life-threatening or in an emergency room, decided on case-by-case basis; no annual limit|
|Hawaii||Emergency only to control dental pain and infection; no annual limit|
|Idaho||Broader coverage including preventive and diagnostic services as well as therapeutic benefits to treat cavities, gum or tooth pain, fillings, extractions, dentures and more; no annual limit|
|Illinois||Broader coverage, preventive services covered 100% for those on managed care plan but more expensive fee-for-service for those on traditional Medicaid program; no annual limit|
|Indiana||Limited coverage including one cleaning per year, X-rays and fillings, extractions (based on medical necessity), dentures (with prior approval), partials and repairs with limits, dental surgery with limits and prior approval, emergency dental services; no annual limit|
|Iowa||Broader coverage with an annual limit of $1,000. Members are required to meet healthy behavior measures to keep benefit.|
|Kansas||Limited coverage including dental exams and cleanings at least once per year. In addition, United Healthcare will provide one X-ray per year and those with a FE waiver may be eligible to receive dentures at no cost. Tooth extractions may be covered if they are considered medically necessary; no annual limit|
|Kentucky||Limited coverage including oral exams, emergency visits, X-rays, extractions and fillings; no annual limit|
|Louisiana||Limited coverage including exams and X-rays, complete and partial dentures; no annual limit|
|Maine||Emergency services limited to surgery, extraction and treatment to relieve pain, eliminate infection or prevent imminent tooth loss; no annual limit|
|Massachusetts||Broader coverage including dental checkups twice a year, preventive services, cleanings, fluoride treatments and dental sealants, as well as pain relief, treatment of infections, fillings, crowns, and root canal treatment; no annual limit|
|Michigan||Limited coverage including dental check-ups, teeth cleaning, X-rays, fillings, extractions and partial and full dentures; no annual limit|
|Minnesota||Limited coverage including oral evaluations, preventive services, restorative, endodontics, periodontics and prosthodontics as long as deemed medically necessary and most cost effective option; no annual limit|
|Mississippi||Limited coverage including medically necessary dental procedures with prior authorization including dentures up to $2,500 annual limit, although this may be exceeded with prior authorization|
|Missouri||Limited coverage including exams, X-rays, cleanings, fillings and extractions; no annual limit|
|Montana||Broader coverage including dental exams and cleanings twice a year with an annual limit of $1,125. However, covered anesthesia, dentures, diagnostic, and preventive services do not count towards the annual cap. Noble metal crowns, bridges and orthodontia are not covered for adults.|
|Nebraska||Limited coverage with annual limit of $750 including exams, X-rays, cleanings, fillings, crowns, extractions, partial and full dentures and emergency services|
|New Hampshire||Dental coverage for adults is only available with AmeriHealth Caritas. Coverage includes exams, cleanings, X-rays, fillings, periodontal scaling and root planing|
|New Jersey||Broader benefits including exams, X-rays, cleanings, fluoride, fillings and the following with prior authorization: crowns, periodontal treatment, root canals, extractions and partial and complete dentures|
|New Mexico||Broader coverage including exams, cleanings, X-rays, fillings, extractions, root canals, extractions and partial and complete dentures|
|New York||Broader coverage with no spending limit. Covers preventive, periodontal, dentures and oral surgery but not orthodontia.|
|North Carolina||Broader coverage with no spending limit. Covers preventive, periodontal, dentures and oral surgery but not orthodontia.|
|North Dakota||Broader coverage including exams, X-rays, cleanings, fillings, surgery, extractions, crowns, root canals, dentures (full and partial) and anesthesia; no annual limit|
|Ohio||Broader coverage including exams, cleanings, X-rays, fillings; no annual limit|
|Oklahoma||Emergency extractions only; no annual limit|
|Oregon||Broader coverage including annual cleaning and exam, X-rays, fillings, fluoride, extractions, dentures, stainless steel crowns, emergency care; no annual limit|
|Pennsylvania||Limited coverage including surgical procedures and emergency services to treat symptoms and pain. Some adults may be eligible for other dental services, but this is not specified; no annual limit|
|Rhode Island||Broader coverage including diagnostic, preventive, restorative, periodontal, surgical, prosthetic and limited endodontic services; no annual limit|
|South Carolina||Limited coverage including medically necessary diagnostic, preventive, restorative services and extractions up to $750 per year; emergency services including infection, malignancies, injury or trauma are not subject to the annual maximum.|
|South Dakota||Limited coverage with $1,000 annual limit except for medically necessary emergency services, dentures and partials which are exempt from the limit. Coverage includes two exams and cleanings per year, fluoride, fillings, X-rays, extractions, crowns on front teeth, root canals on front teeth, dentures (full and partial) no more than every five years|
|Texas||Emergency coverage only; no annual limit|
|Utah||Emergency coverage only; no annual limit|
|Vermont||Limited coverage with annual maximum of $1,000, including two preventive service visits per year; prior authorization is required for most special dental procedures|
|Virginia||Emergency coverage only; no annual limit|
|Washington||Broader coverage including exams, X-rays, cleaning, fluoride, fillings, periodontal scaling and root planing and maintenance, root canals (front teeth only), extractions and other oral surgery, dentures (full and partial), anesthesia and sedation; no annual limit|
|West Virginia||Limited coverage including diagnostic, preventive and restorative with prior authorization and an annual limit of $1,000; emergency services to treat fractures, reduce pain or eliminate infection with prior authorization do not go against the $1,000 limit|
|Wisconsin||Full coverage including annual exam and cleaning but does not cover orthodontia and some services require prior approval; no annual limit|
|Wyoming||Limited preventive and emergency services, no restorative services; no annual limit|
VA Dental Care
The U.S. Department of Veteran Affairs (VA) is a government agency that oversees programs for veterans, service members, and their families. The agency offers several types of benefits, from health insurance to housing assistance.
To receive dental treatment and services through VA dental care, veterans must qualify for VA healthcare in general.
To qualify for VA healthcare, all of the following must be true:
- Served in the active military, naval, or air service (including being called up from the National Guard or Reserve by a federal order)
- Did not receive a dishonorable discharge
- Meet at least one of the service requirements for enrollment (see below)
Veterans must meet one of the following service requirements:
- Served at least 24 months in a row without a break (called continuous) or for the full active-duty period
- Were discharged for a service-connected disability
- Were discharged for a hardship or “early out”
- Served before September 7, 1980
Free Dental Care Through the VA
Certain beneficiaries may meet the VA’s qualifications to receive free dental care. Whether you qualify for free dental care through the VA depends on your military service history, current health status and living situation.
You can view all requirements on the VA website. When you click the scenario that best applies to you, you can view the VA dental benefits you may qualify for. Access the website here: https://www.va.gov/health-care/about-va-health-benefits/dental-care/
Getting All Necessary Dental Care Through the VA for Free
If you fall into one of the following categories, you may be able to seek free dental care for any services deemed necessary by a dentist:
- You are a former Prisoner of War (POW)
- You have a service-connected disability or condition related to dental work for which you receive monthly payments
- The VA considers you unemployable and you currently receive disability compensation at the 100% rate due to your service-related conditions
- The condition must not be considered temporary by the VA
Getting Free One-Time Dental Care Through the VA
You may be able to receive one-time dental care if you fall into one of the following categories:
- You served on active duty for 90 days or more during the Persian Gulf War era
- You must not have received a dishonorable discharge
- You must apply for dental care within 180 days of discharge or release
- Your DD214 certificate of discharge doesn’t show that you had a complete dental exam and all needed dental treatment before you were discharged
- You signed up to get care through the Homeless Veterans Dental Program and you need dental care to achieve one of the following:
- Relieve your pain
- Help you get a job
- Treat your moderate, severe, or complicated and severe gingival and periodontal conditions
Getting Free Dental Care Necessary to Have and Keep a Functioning Set of Teeth
Some dental services may be necessary to keep your teeth fully functional. A dentist must conclude that these services are imperative to maintaining tooth function. To qualify, you must have a service-connected, non-compensable dental condition or a disability that is the result of combat wounds or service trauma.
Getting Free Dental Care for Specific Oral Conditions Impacting a Service-Connected Health Condition
Veterans may require specific treatment to care for dental conditions that directly affect an established service-connected health condition. To receive care, the veteran must visit a VA dental care provider who concludes that the veteran’s dental condition is making the service-connected health condition worse.
Getting Free Dental Care Necessary for Employment
Some dental treatment services may be considered necessary in order for a veteran to obtain and maintain employment. To receive this type of care through the VA, the veteran must be active in a 38 U.S.C. Chapter 31 Veteran Readiness and Employment Program and requires dental care to achieve one of the following goals:
- The treatment is necessary for the veteran to be in the employment program
- The treatment is necessary to reach the goals of the Veteran Readiness and Employment program
- The treatment will prevent the veteran from having to stop the employment program
- The treatment will help the veteran get back to the employment program faster if they have had to stop and are in “interrupted” or “leave” status, or are in “discontinued” status due to an illness, injury or dental condition
- The treatment will make it possible for the veteran to get and adjust to a job during the period of employment assistance
- The treatment will make it possible for the veteran to be fully independent in your daily living
Getting Free Dental Care to Treat a Health Condition Being Treated at a VA Inpatient Facility
In some cases, dental care may be necessary to help treat another health condition. Veterans who are receiving inpatient care in a hospital, nursing home or other supervised home care setting may be able to receive dental services that a VA dental provider concludes is necessary to manage a health condition for which the veteran is being treated.
Applying for VA Dental Care
Veterans who believe they qualify for dental care provided through the VA can apply for treatment online or by mail using the 10-10EZ health care application form. This form is a standard application method for all types of VA health care, not just dental services.
Access the 10-10EZ form here: https://www.va.gov/Vaforms/medical/pdf/10-10EZ-fillable.pdf
Once the form is complete, mail it along with all supporting documents to:
Health Eligibility Center
2957 Clairmont Road, Suite 200,
Atlanta, GA 30329
Veterans can also complete application completely online here using their VA account and clicking “Sign in to start your application:” https://www.va.gov/health-care/apply/application/introduction
Veterans must meet the requirements for VA health care in order to receive dental treatment. Learn more about these requirements in the “VA Dental Care” section of this guide.
After verifying their eligibility, veterans must gather certain information and documents necessary to prove they meet the conditions for receiving VA healthcare. Veterans must present all of the following documents during the application process:
- Social Security number
Veterans who plan to add their spouses or dependents must also present their Social Security numbers.
- Military discharge information
Veterans who apply online with a VA account may be able to get this information filled in automatically. Those who apply using another method may be asked to provide a copy of their DD214 or other separation documents.
- Insurance cards
Veterans must present any and all health insurance cards for their current insurance plans. This includes any coverage that they get through a spouse or significant other. It includes Medicare, private insurance, or insurance from an employer.
When to Enroll in Dental Insurance
When you can enroll in dental insurance depends on how you are getting it. Some plans have year-round enrollment while others restrict enrollment to a specific period of time. Continue reading the sections below to learn when you may be able to enroll in dental insurance based on how you’re covered.
Employer-Sponsored Dental Insurance
If you are getting dental insurance through your or your spouse’s employer, you can sign up whenever you enroll in your health insurance and other employee benefits plans. This typically occurs during a period of time known as an “annual enrollment period.” You can usually contact your employer’s human resources department or benefits coordinator to find out when that enrollment period is for your company.
You may also be able to enroll in an employer-sponsored dental plan when you first get hired, even if the hiring date falls outside of the company’s annual enrollment period. Some employers may require newly hired employees to work for at least 90 days before offering health benefits.
ACA Healthcare Marketplace
If you want to get dental insurance through the ACA Healthcare Marketplace, you can do so either during the open enrollment period starting on November 1 or during a special enrollment period.
Learn more about special enrollment periods in the “Purchasing Dental Insurance Through the ACA Healthcare Marketplace” section of this guide.
Private Insurance Plans
If you are getting a private individual or family dental insurance policy, you can enroll any time throughout the year. Private plans are not limited to the open enrollment or special enrollment limitations established by the ACA Healthcare Marketplace.
Government Health Care
You can only enroll in a Medicare Advantage Plan that offers dental coverage if you are at least 65 years of age. There are three periods of time during which you may enroll:
- During your initial enrollment period (when you first become eligible for Medicare)
- During general Medicare open enrollment, which occurs from October 15 to December 7
- During Medicare Advantage open enrollment, which occurs from January 1 to March 31
Medicaid or CHIP
If you have children who qualify for Medicaid or CHIP, they are automatically enrolled in dental coverage upon enrolling in healthcare.
Some states may allow adults who receive Medicaid coverage to enroll in a dental insurance plan. Refer to the table provided in the “Medicaid Dental Coverage for Adults” section of this guide to learn if your state extends dental coverage to adults.
If your state provides dental coverage for adults on Medicaid, you can enroll during any time throughout the year, just like you can for Medicaid health insurance.
VA Dental Insurance
If you qualify to receive free dental care through the VA, you may be restricted to certain enrollment periods depending on how you qualify. If you are interested in purchasing a VADIP plan, you can typically enroll any time throughout the year as long as you meet the qualifications.
Alternatives to Dental Insurance
Purchasing dental insurance may not make financial sense for you and your family. However, if you still want affordable dental care but do not qualify for government dental coverage, you have a few options.
Federally Funded Community Health Clinics
The Bureau of Primary Health Care supports federally funded community health clinics across the country. These clinics provide free or reduced cost health services including dental services.
You can find a clinic in your area by searching for your zipcode on the Health Resources and Services Administration’s (HRSA’s) website here: https://findahealthcenter.hrsa.gov/.
If you have a dental school in your area, you may be able to get quality, reduced cost dental treatment. Dental students often perform procedures under the supervision of experienced, licensed dentists for a reduced cost.
You can search for a dental school using the Commission on Dental Accredidation’s website here: http://www.ada.org/en/coda/find-a-program/search-dental-programs#t=us&sort=relevancy.
If you need a cleaning, you may be able to get one for a reduced price at a dental hygiene school. The American Dental Hygienists’ Association has a downloadable spreadsheet that provides information on dental programs and schools throughout the country. Download the spreadsheet by visiting the following link and clicking “Dental Hygiene Education Programs:” https://www.adha.org/dental-hygiene-programs
State and Local Health Departments
Your local or state health department may have a clinic near you that offers free or reduced cost dental care. You may be able to find these clinics by doing a quick online search for “free dental clinic” or a similar term. Alternatively, you can visit your state’s website to research dental clinic options in your area.
You can find a link to your state’s health department website using the table below.
The United Way is a national non-profit organization that may be able to assist you in finding free or reduced cost dental care in your community. Check their website at https://www.unitedway.org/ to find a chapter near you.
Dental Lifeline Network
The Dental Lifeline Network is a non-profit organization that provides dental services to people aged 65 and older and individuals with disabilities or who are medically fragile. There is usually a waiting list for these services. You can contact them at https://dentallifeline.org/about-us/.
Negotiate with Your Dentist
Some dentists may be willing to give patients a discount from their normal rates when they do not have dental insurance. Talk to your dentist to see if they can lower their rates. You are more likely to be successful if you give them a valid reason why you cannot afford their normal rates.