Dental Cost Concerns… Even with Insurance!

Costs keep many Americans, even those with insurance, from getting dental care. Understanding how dental insurance works and leaning into preventive care can help keep dental problems — and bills — manageable.

The American Dental Association reported that 77% of adults in the U.S. had dental insurance in 2021. But that coverage does not necessarily protect against large bills. In fact, 1 in 4 adults with dental insurance reported costs as a barrier to care, according to a 2023 survey by KFF, a health information nonprofit that includes KFF Health News.

Here are three things to know to better understand your insurance plan and keep your dental costs as low as possible:

1. Even With Dental Insurance, You’ll Have to Pay for Procedures

Dental plans typically cover routine care in full but pay only a portion of additional work. Benefits vary, but many plans follow the “100/80/50” rule, covering 100% of preventive care like cleanings and exams, 80% of basic procedures like fillings and root canals, and 50% of other major procedures, like crowns, inlays, onlays and bridges.

Plus, dental plans often have a maximum annual payout, usually between $1,000 and $2,000. Patients are responsible for any costs above that. For example, if your plan maxes out at $1,500 and you need $4,000 of dental treatments, you will be on the hook for the difference of $2,500.

Remember, if you have access to an FSA, or HSA savings plans you can use these pretax dollars to pay for unreimbursed dental expenses!

2. Facing a Big Dental Bill? You Have Options

Almost all dental plans have a Preferred Provider Network, much like health insurance. It is important to understand that these providers have generally agreed to a discounted fee structure, which they must pass on to you!  This leads to lower out-of-pocket expenses and a stretching of your maximum benefit amount.

You don’t have this same pricing benefit with Out-of-Network dentists, but you can negotiate fees. We recommend doing this BEFORE you have the service done, if possible. It might feel uncomfortable to talk about finances directly with a dentist, but it’s helpful to be up-front about what you can afford.

Many dentist offices offer financial options to help patients manage the cost of care, including pretreatment estimates and payment plans. If you get an estimate that seems especially high, talk through the items and consider getting a second opinion. It never hurts to ask the office for a discount.

If you need a lower-cost alternative, consider looking into dental schools, which often offer discounted care, or federal community health centers, which use sliding scales based on a patient’s income.

3. Seeing Your Dentist Regularly Can Help Keep Costs Low

Sarah Olim, a general dentist in Katy, Texas, encourages her patients to come in for visits every six months.

 “The best thing that you can do to mitigate the cost of going to the dentist is make sure that you are going regularly and trying to take care of things early,” she said. This is very sound advice especially when you consider most dental policies cover 100% of allowed charges for preventive services, such as cleanings, exams and X-rays.

Going to the dentist is never fun, but being prepared in advance can at least reduce the financial pain after the visit!