What is dental insurance?
Dental insurance is a contract with an insurer that defines how you and the insurer will share the costs of your dental care. It outlines how much you pay each month for coverage (your premium) and how much of your covered dental costs your insurance will pay for. Dental insurance works similar to how health insurance works.
Common dental insurance definitions include:
Deductible: The amount you pay out of pocket (typically annually) before your dental insurance contributes to paying for certain covered care. Monthly premiums don't count toward your deductible. Not all plans have a deductible, and preventive care might be excluded from your deductible requirements.
Copay: A fixed amount you pay for dental visits and procedures. May or may not count toward your yearly deductible, depending on your plan.
Co-insurance: The percentage of dental expenses you pay after you've reached your deductible. If your plan has an out-of-pocket limit, co-insurance will no longer apply once you reach that limit.
Maximum benefit: The most your insurer will pay each year toward your covered dental expenses. After you reach this amount, you'll need to pay for the full costs of your dental care.
What does dental insurance cover?
Depending on your insurer and plan, dental insurance may cover a wide variety of procedures ranging from routine care like cleanings and X-rays to procedures like oral surgery, fillings, and crowns. In some cases, dental insurance may also cover some orthodontia, but possibly only if the orthodontic work is necessary for a child on your plan. Certain care may be covered differently based on your plan's terms. For example, preventive maintenance may be covered even before you meet your yearly deductible.
Covered procedures typically include:
Necessary repair (including but not limited to fillings and extractions)
Oral implants, surgery, and emergency procedures
What does dental insurance not cover?
Dental insurance typically doesn't cover procedures that aren't medically necessary. Depending on your plan, that might include elective cosmetic procedures and orthodontic work for adults. Some plans for adults may exclude pre-existing conditions. In some cases, a dental insurance plan may cover some versions of a procedure but not others.
Is dental insurance worth it?
Dental insurance isn't required by law, but even routine cleanings can get expensive and make having dental insurance worth it. Start by weighing your potential dental insurance premium against your average dental care costs for a year. Consider your dental care habits and how often you've needed treatment for cavities or other problems. Accounting for these scenarios can help you estimate your dental expenses for a normal year and compare that to the cost of insurance. Remember to factor in any deductible, copay, and co-insurance when you compare dental plans.
Note: Dental insurance is typically a standalone insurance policy, separate from your health insurance coverage, but some health plans do include dental coverage. Dental coverage may be offered as an optional benefit through your employer, or you can purchase it from a private company or through the government Marketplace.
Find out if dental insurance is worth it for kids.
Frequently asked questions
How do I use my dental insurance?
Once you have proof of dental insurance, use it by presenting your plan information to your dental care provider at your next appointment. Typically, your dentist or other provider can bill your insurance directly, and you'll be sent a bill later for any remaining costs not covered by insurance.
If you have a co-pay, your dentist may ask for that payment at the office after your appointment. If you already paid your full dental bill without it going through insurance, you may be able to request reimbursement from your insurer for covered costs. To do this, contact your insurer and have your dentist send the insurer your care records.
Does dental insurance cover fillings and crowns?
Yes, typically dental insurance covers these procedures. However, every plan is different, and insurers may only cover certain kinds of fillings or crowns. For example, an insurer may cover fillings made from some materials but not others.
How do I get dental insurance?
You can quote dental insurance through Progressive Health by eHealth to compare your plan and pricing options. Or call 1-888-831-1065 to speak with a licensed representative about which plan is right for you.