When 8-year-old Arya fell off her bike and knocked out her front two teeth, roots and all, her Glenmoore, PA parents rushed her to a pediatric dentist, who was able to re-implant her teeth. Even with dental insurance, though, her family paid nearly $1,000 out of pocket. “Overall, we’re happy with our dental insurance,” says her mom Lindsay, who noted that follow-up visits have been covered. “But it’s frustrating that we had to pay that much out of pocket.”
Insurance of all types protects you in a worst-case scenario. For health insurance, the potential risk is so high that you can’t afford to go uninsured, but with dental insurance, the potential risk is not as high, leaving consumers to wonder if it’s worth the cost. Because unexpected dental treatments can be expensive, dental professionals recommend carrying dental insurance when possible.
Dental insurance as part of your employee benefits
Consumer Reports recommends families get dental insurance through an employer if it’s available. “Because it’s not very expensive, it’s kind of silly not to,” says Donna Rosato, senior money editor. In fact, many employers will cover half of the cost of plan premiums.
“Dental insurance is pretty cut and dry, meaning they cover exactly what is listed,” says Franklin T. Pyle, director of the Delaware Insurance Department. Most plans provide 100-80-50 coverage:
- 100 percent coverage of preventative care such as exams, cleanings, x-rays and, perhaps, fluoride treatments and sealants
- 80 percent coverage of basic treatments like fillings
- 50 percent coverage of complicated procedures, such as crowns. Unlike medical plans, many dental plans cap benefits at $1,500 a year per person. However, as Dr. Joseph Kelly, DDS, president of the Delaware State Dental Society points out, all plans are different. “There is variability to the plans,” he says, so be sure to verify your coverage with your provider.
Dentists will typically work with families to investigate what your insurer will cover. Call your provider to see what you can expect in terms of co-pays and coverage. “Dentists don’t want surprises for the patient either,” says Kelly.
Dental insurance on ACA exchanges
• Parents who get ACA medical coverage have the option to purchase a dental plan through the exchange as well.
• Unlike medical insurance, parents will not pay a penalty if they don’t purchase it.
• Covers kids until age 19.
Private dental insurance
• Only 4 percent of Americans have private dental insurance.
• Private insurance is often very expensive.
• There are often waiting periods before you qualify for certain services, such as root canals.
Medicaid, CHIP dental coverage
• Parents without dental insurance may be able to insure their children through Medicaid or CHIP if they meet income eligibility.
Discount dental plans
• Pay an annual fee of up to $200.
• Dentists who participate in the plan offer discounts of up to 50 percent for members. Health Savings Accounts (HSAs) are also an option, says Dr. James Nickman, DDS, immediate past president of the American Academy of Pediatric Dentistry. These plans allow you to set aside pre-tax income for health expenses like dental work. However, there may be restrictions on the timing and what procedures qualify.
No dental insurance
“If you need something serious, dental treatment is very expensive,” says Rosato. Because many families don’t have savings put aside for dental emergencies, going without dental insurance is risky. “In general, I’d say it’s not worth the risk to choose to be without dental insurance,” says Nickman. But if you find yourself without dental insurance, prevention is key, he says. Brush, floss and visit the dentist regularly.
“We strongly encourage families to have their children seen early and often for preventative care,” he says. “It is far more cost effective this way than dealing crisis to crisis.”
If you don’t have insurance, Consumer Reports says your dentist might help ease the financial pain.
• Ask your dentist for a discount if you pay in full.
• Ask for a payment plan; the dentist should be willing to work with you.
Orthodontics coverage in dental plans
“Don’t have the expectation that it will be covered 100 percent,” says Rosato of orthodontics for your children. Orthodontics may be covered if they are considered medically necessary, but that is not very common. Orthodontic plans typically have different deductibles and maximums than the primary dental plans, says Marquita Fulton, office manager at Holdbrook Pediatric Dental in Swedesboro, NJ.
Special needs
Many parents may not know that anesthesia may be covered for cleanings if a child has a severe disability, says Pyle. Generally, children under the age of 21 with a diagnosis of a significant mental or physical condition will qualify. Speak to your child’s physician or psychologist to get written certification to qualify for coverage. Check our SpecialKids Guide for dentists that specialize in treating children with special needs.
Suzanne Koup-Larsen is a contributing writer for MetroKids.
