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Finding the best dental insurance provider is not as easy as going to the dentist and finding out which provider makes getting a root canal the least painful.
Rather, the best dental insurance plan for you depends on many factors, such as what type of coverage you need, how many people you need to cover and what is available in your area.
During our research, we got quotes for individuals, couples and families from the biggest cities in each region of the United States.
We considered the available coverage options, deductibles, which dentists were in-network and premiums. We also talked to dentists to get their perspective on how to buy the best plan for your situation.
No matter which type of plan you choose, we recommend that you carefully review your contract so you know exactly what your insurance will cover. Additionally, in most cases, your dentist's office will be familiar with what your insurance may or may not cover. Since many dental offices will require you to pay the estimated uncovered balance upfront, you will need to make sure you know what that is in advance so you can plan your budget. If you cannot cover the remaining balance you may want to ask if your dentist provides financing.
If you are changing insurance and want to continue with your current dentist, you can visit the websites of insurance companies you are thinking about signing up with and search to see if your dentist accepts the new type of insurance. However, sometimes these search results aren't updated or only show offices seeking new patients, so you'll want to verify by calling your dental office.
Best All-Around Coverage
Delta Dental is one of the few insurance providers to specialize in dental insurance. While the typical comprehensive coverage plan had an average premium on each quote, the midrange and basic coverage packages were the most affordable in the most regions. The basic coverage plans were generally the most affordable, costing around just $16.40 per month for an individual, $32.47 per month for a couple and $57.39 per month for a family of four.
While Delta Dental didn’t receive the highest grades in any region for cost, coverage and option evaluation, it was typically among the top three providers. Each region also had at least a comprehensive plan, a mid-tier plan and a basic plan, although Delta Dental had six plans in the Southwest and five plans in the Northwest region.
One advantage Delta Dental has is its maximum out-of-pocket expense limit. For example, a plan may specify that you pay no more than $250 for a root canal. Most dental insurance companies list a percentage rather than a set amount. Delta Dental's approach makes it easy to budget your dental work so you know what you pay before you commit to a procedure. This is the reason they were recommended by the dentists I consulted.
Read the full review of Delta Dental.
Among the quotes we received, Physicians Mutual had the most consistent pricing, region to region, and the overall best value for comprehensive coverage. For example, the average premium for comprehensive coverage was just $37.55 per month for an individual, $74.05 per month for a couple and $118.12 per month for a family of four. By comparison, most dental insurance providers averaged $15 more per month for each person covered.
The mid-tier and basic coverages also averaged good premiums, though they were not quite as competitive as the comprehensive plans. For example, Delta Dental’s basic coverage plan averaged $7 per person below what Physicians Mutual's basic plan. In fact, the average premiums for this provider’s basic and mid-tier plans were only between $2 and $4 below what most insurance providers quoted for similar coverage. Still, it’s among the best values.
Unfortunately, like many dental insurance providers, Physicians Mutual doesn’t have plans in the Northwest. That said, it had three plans in each of the other regions with very little change in monthly premiums, which means you should be able to find a plan to suit your needs and your premiums won’t change much, even if you move to a new region.
Read the full review of Physicians Mutual.
Best Regional Coverage
In four of the seven regions, Guardian Direct provided the best quotes for all levels of coverage. And it provided the second best quotes in two other regions. Only the quotes in the West were lackluster compared to other dental insurance providers. So, regardless of where you live, Guardian Direct dental is likely to have at least three coverage options at very good prices.
One standout feature of Guardian Direct is the ability to choose any dentist you want with a 35-percent-off deal with in-network dentists. And with 114,000 in-network dentists nationwide, there’s a good chance you can save even more. In addition, some plans provide partial coverage for sealants on kids up to 19 years old, which can help protect their teeth for up to ten years.
Guardian Direct’s quote process is exceptional. Rather than simply providing a list of available plans in your area after entering your age and location, it takes you through a step-by-step quiz to ask you what kind of dental work you expect to need and provides helpful information about how each plan fits your needs, which is exactly what dentists recommend you do before you choose a plan.
Read the full review of Guardian Direct.
- Mid-tier plan doesn’t cover cleanings at 100-percent
- Major procedures have a 12-month wait
- Doesn’t cover cosmetic procedures
Best Family Cover
For families, the MetLife TakeAlong Dental plans are the best option in most areas. While the basic coverage for a family of four is about $93.83 per month for MetLife, the comprehensive coverage is just $124.25 per month; this is nearly $50 less than the average cost of a comprehensive plan for a family of four. Only Physicians Mutual had a cheaper average quote for families at $118.12 per month.
However, since MetLife is among the biggest and financially stable insurance companies in the world, you’re less likely to have claims denied due to financial instability. In addition, the plans include orthodontic coverage, which is ideal if you have children who need braces.
In each region, MetLife included three options: a high PPO, medium PPO and low PPO. The quotes varied in prices from region to region, with the West and Central regions being more expensive than other regions. In addition, while the comprehensive plans were very competitive, the basic coverage plans (for people who just want cleanings, x-rays and basic preventive care covered) were among the most expensive.
Read the full review of MetLife TakeAlong Dental.
If choosing the best dental plan means finding a plan that best fits the care you need, then the more options, the better. And United Healthcare, while not the most affordable option, had the most plans available in each region except for the East. Most dental insurance providers provide two or three coverage options - a comprehensive, high-deductible PPO plan and a basic, affordable PPO plan. However, United Healthcare provided quotes for between 6 and 10 plans in each region, providing greater flexibility in choosing a plan to fit your specific requirements.
The basic plans were also some of the most affordable plans I was quoted. On average, basic United Healthcare plans cost an individual just $21 per month, about $5 below the average dental insurance provider. However, the comprehensive plans are among the most expensive. Each region’s most comprehensive plan was well above the average plan. However, since there are so many options in each region, the comprehensive plans tend to cover more procedures than other comprehensive plans.
Read the full review of United Healthcare.
Best of the Rest
Cigna is one of the biggest health insurance companies in the U.S. In my evaluation, Cigna was above-average all around in its offerings and premiums, but it mostly hovers around average. There’s nothing about it that particularly stands out in comparison to the best picks.
As with other big insurance providers, Humana is a good option if you want the peace of mind of knowing your insurance provider is financially stable enough to handle your claims. However, despite being one of the biggest providers of insurance I reviewed, it wasn’t available in the Northwest, and the quoted premiums were on the more expensive side.
Despite being another well-known health insurance provider, Aetna’s dental plans are mostly packaged with its employer-provided health insurance. I was unable to get quotes for private, non-employer dental insurance plans in three of the seven regions. In the regions where you can purchase individual plans, the basic plans were significantly more expensive than most providers, but the comprehensive plans were on the more affordable side.
Ameritas was available in most regions, but the options were few, and it doesn’t provide dental insurance plans in the Northwest. In addition, the quotes I received were significantly more expensive than most dental insurance providers.
Spirit Dental & Vision
Spirit Dental & Vision was another insurance provider that doesn’t provide plans in the Northwest. However, it’s also the most expensive insurance provider I reviewed at each level of coverage. For example, it’s nearly $100 per month more expensive for a family looking for comprehensive coverage than the average insurance provider.
How We Evaluated the Best Dental Insurance Providers
We gathered quotes and researched dental insurance plans from all major dental insurance providers. We read their policies and talked to several dentists to get their perspective on what insurance providers are easiest to work with from a dentist’s perspective, as well as how they wish their patients would choose insurance.
Prior to receiving quotes, we consulted with three dentists to get their perspective on dental insurance providers. However, since they often have to negotiate prices with insurance providers, we have decided to keep them anonymous to protect those interactions. That said, each of the dentists said the same thing – you should be wary of choosing the cheapest provider in your area because they are typically the worst when it comes to approving procedures or reimbursements. And while it didn’t affect our evaluations, each dentist named Delta Dental and MetLife as the most reliable and easiest to work with on their end.
The dentists recommended you start by assessing your current dental health. What work do you expect you’ll need in the next two to three years? For example, if you haven’t been to a dentist in a long time, you should consider a comprehensive coverage plan. Do you have children who may need braces? Do you need implants? Most insurance plans don’t cover these procedures until you’ve been on the plan for at least 12 months, so it’s worth taking the time to evaluate your oral health, even if it means getting a checkup with a dentist prior to deciding on a plan. Your dentist can help you project what kind of work you may need.
Once you’ve figured out what kind of dental work you and your family need, finding the best plan depends on three factors: age, location and budget. As such, I got quotes for individuals under 50 and over 50, middle-aged couples and families of four. For location I got quotes from the biggest metropolitan areas of various U.S. regions. Then I averaged the premiums and compared the results. I also evaluated the options and the available coverage in each area.
It’s important to note this evaluation is anecdotal. The quotes I received are still likely to vary from the quotes you receive owing to your unique circumstance.
What Does Dental Insurance Cover?
Most full coverage dental insurance plans will cover two preventive maintenance visits per year without requiring a deductible payment; however, most will require a $50 deductible per person, per year to help cover costs beyond your preventive exams. If you need work done, most plans will cover a part of the costs.
We looked at root canals specifically and found that the majority of dental plans will cover about half the cost, which may not seem like a lot, but paying half is better than paying upfront for an $800 root canal. Keep in mind that most insurance policies, depending on your plan, top out at about $1000 to $1500 per year. Using conservative estimates that might be one or two root canals. If you need extensive work done you might have to pay the remaining amount out of pocket.
There are few procedures that most insurance companies will not cover or only provide a discount for. Most individual dental insurance plans do not cover what might be considered cosmetic procedures, such as tooth-colored fillings on molar or bicuspid teeth, dental implants or adult cosmetic orthodontics.
The majority of dental companies will also limit how often certain appliances can be replaced and, in most cases, will not replace lost items. The limitations are published in the disclosures and contracts for the plan, many of which you can peruse online.
Keep in mind that a new dental insurance plan is not going to cover an emergency you are experiencing right now; most have a waiting period of six to 12 months for major work. However, some will waive the waiting period if you recently had dental insurance.
Dental groups that offer dental discount plans will let you use your benefits right away, but they only provide a discount and not full coverage. Full coverage plans will, however, cover your initial evaluation so you can start planning your dental procedures.
What Kind of Dental Plans Are Available
Most dental insurance companies will offer a variety of plans in your area. You can find plans ranging from affordable discount plans to what might be considered "gold-level" plans. Here are a few types of plans you may choose from:
Dental Discount Plans
These are not full-coverage plans but do provide discounts for most common procedures. Discount plans usually only cost about $10 per month per person, and benefits can be used immediately.
These low-premium plans may be suitable for those who do not usually need dental work done. These plans will help you cover preventive exams and cleanings. To learn more about why preventive care is important, see What Is Plaque.
Standard Individual Plans
This is likely the most popular plan type for individuals since it will cover most of the costs of preventive exams. Most will cover two exams, cleanings and x-rays per year and will partially cover additional work. There may or may not be a small exam copay.
These plans are similar to standard individual plans. However, many insurance companies will offer the benefit of a family deductible. While most dental plans require a $50 deductible per person, many will have a maximum family deductible of $150, which could be beneficial to those who need to insure more than three people.
"Gold" or "Premium" Plans
Premiums for these plans will cost more but often may include a higher yearly payout rate. The plans may also allow more cleanings per year, such as one every four months rather than one every six months.
Other options to ask about include add-on plans for things like assisting with children orthodontics or adult implants.
How to Estimate Dental Expenses
Estimating your possible dental costs may help you decide whether dental insurance would be financially beneficial. Dental insurance companies will show you a quote online so you can easily see what your premiums might be. You may want to compare your estimated yearly premiums to the cost of a year of procedures. You can estimate how much your dental expenses might be either by talking with your dentist or by researching costs online.
You can use the estimates to help you decide whether you should pay out of pocket or plan your dental expenses based on your insurance coverage. Two resources for looking up procedure costs are The Fair Health Consumer Organization and the Guardian Insurance website. Estimated costs are sorted by zip code and will show a low and high rate so you can see a range of what a procedure may cost in your area.
Other factors can affect your yearly dental expenses as well. Unfortunately, senior premiums are usually more. Youth orthodontics may also cost more. Smokers are usually quoted higher premiums as well. Monthly premium rates can also vary greatly by region and area. We found that within the same insurance company rates may vary by as much as 30 percent depending on the zip code.
While some financial planners suggest dental insurance may not be worth paying for, we did the math to discover that it is usually worth it, provided you attend all of your allowable preventive exams and cleanings. We also learned that if you need any type of work, such as a root canal or filling, you will definitely notice cost savings.
However, as previously mentioned, premiums vary greatly by the type of plan, your location and your age. So you'll want to obtain a few quotes from insurance companies that provide coverage in your area. You'll also want to verify that your dentist accepts your chosen insurance before you sign up with a new provider.
Why Do Smokers Pay More for Dental Insurance?
Most dental insurance companies charge smokers higher premiums than they do those who don’t use tobacco. This is because insurance companies assume more financial risk when they cover a smoker.
In general, someone is considered a smoker if he or she has smoked in the past year. Some insurance companies extend that criterion back as far as five years, according to InsuranceQnA.com.
“The reason why smokers are charged higher dental insurance premiums is that those who smoke are more prone to diseases of the gums and teeth,” the article says. “In fact, smoking is considered one of the main reasons for tooth loss.”
The Oral Health Foundation argues that individuals who smoke tend to produce more bacterial plaque in their mouths than normal, which can ultimately cause gum disease. “The gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums don't heal. Smoking causes people to have more dental plaque and causes gum disease to get worse more quickly than in non-smokers.”
Can I Have More Than One Dental Insurance Plan?
It’s certainly possible to have more than one dental insurance plan, according to the American Dental Association. It’s common for an individual to have his or her own insurance through an employer and to also be covered by a spouse’s plan. Sometimes, people opt to pay for a secondary plan.
So who pays?
What happens is a process called “coordination of benefits’’ (COB), which works out which company pays all or most of the costs. “When both plans have a COB clause, the plan in which the patient is enrolled as an employee or as the main policyholder is considered the primary plan. The plan in which the patient is enrolled as a dependent would be secondary,” according to the ADA.
Typically, the secondary plan doesn’t pay anything until the primary plan pays the dentist. It’s common for a secondary plan to kick in to pay any remaining amount later, but only after the second insurance company gets an explanation of benefits attended to by the first plan.
How to Save on Dental Costs
One way you can save on your child’s dental costs – and ensure they have an attractive, healthy smile – is to have a dentist coat their teeth with a sealant. This plastic or plastic-like coating helps prevent cavities and can keep tiny cavities from expanding. Not only can it spare your child developing cavities, it also saves money in the long run.
In another article by the American Dental Association (ADA), the non-profit says sealants have been found to cut the risk of decay in molars by 80 percent. Citing a 2016 report from the Centers for Disease Control, the ADA suggests school-age children who don’t get sealants have almost three times as many cavities as children with sealants. Some adults can also benefit from sealants.
The process is easy. The dentist starts by cleaning and drying the teeth, then applies a gel to help them hold the sealant. After rinsing off the gel, they then apply the sealant and harden it with a special light. Sealants are clear, and they can last for several years.
All the insurance companies we reviewed cover some of the cost of sealants, although coverage varies by provider and policy. In the policies we looked at, the maximum age to qualify for sealant coverage ranged from 14 to 19 years old.
The Importance of Good Dental Health
It’s important to take care of your teeth and gums, not only to preserve your smile and ability to chew but also to enjoy good health in general. On its website, the Mayo Clinic states that oral health may contribute to diseases such as endocarditis, an infection of the inner lining of the heart, as well as other cardiovascular diseases, including clogged arteries and stroke. For pregnant women, poor dental health has been linked to premature birth and low birthweight.
Besides brushing and flossing, the Mayo Clinic’s experts recommend having a healthy diet, replacing your toothbrush every three to four months, staying away from tobacco and making sure you get regular dental checkups and cleanings. Ultimately, the organization states, “Taking care of your oral health is an investment in your overall health.”
Aside from better physical health, having access to good dental care can make an enormous difference for unemployed people seeking jobs, according to a 2013 NBC News report by senior writer JoNel Aleccia.
People who have dental problems, such as missing, discolored, broken or crooked teeth, have problems when searching for jobs, according to dentist and scientist Susan Hyde.
The report said that in the U.S., most people make "instant judgments" based on appearance, and that includes the way an individual's smile and teeth look.
“If you want to portray someone as being wicked, they have missing front teeth. If they’re ignorant, they have buck teeth,” Hyde said. “Even from a very early age, we associate how one presents their oral health with all kinds of biases that reflect some of the social biases that we have.”
“Those views can prevent employers from recognizing potential assets,” said Lindsey Robinson, a dentist and current president of the California Dental Association. “If they have a job that requires them to interact socially with the public, it’s almost impossible for them to get that job,” she said.
New Study Claims Link Between Gum Ailment and Alzheimer’s
Neglecting to take good care of your mouth and to go to the dentist are associated with various oral health problems. However, bad oral health isn’t the only consequence of failing to care for your teeth. Recent media reports cite a new study that links gum infections to Alzheimer’s disease. The original publication, Science Advances, shows how a kind of bacteria called Porphyromonas gingivalis, which is linked to gum disease, has been identified in the brains of Alzheimer's patients.
Testing on lab mice also showed how gum infections heightened the production of amyloid beta, which is part of the plaque deposits in the brain associated with Alzheimer’s, an incurable disease affecting as many as 5 million Americans.
While some researchers are encouraged by the study’s findings, others caution that no one should jump to any conclusions. More information is needed to prove the correlation. "In research we’ve supported to uncover the key risk factors for Alzheimer’s disease, gum disease hasn’t emerged as a major cause for concern," James Pickett, the head of research at Alzheimer’s Society, said in a statement obtained by USA Today. He was not connected with this latest study, however.
Is There a Waiting Period for Dental Insurance?
Like many things, the best time to buy dental insurance is when you don’t need it, or at least when you don’t need it urgently. It’s not uncommon for dental insurance companies to have waiting periods before they will cover certain major – and typically the more expensive – procedures. This could come as an ugly surprise if you wait until you’ve got a dental emergency to buy insurance, because you might end up having to pay the entire cost yourself.
An article in the online publication DentalPlans.com notes, “There is usually no waiting period for preventive care. You may have to wait for three to six months for basic procedures, and six months to a year for major procedures.” The article defines preventive care as things like checkups, x-rays, cleanings, etc. Basic care includes filling cavities, simple tooth extractions, etc. And major procedures are root canals, bridges, crowns, etc.
DentalPlans.com recommends that you look at the waiting period connected with various procedures before you buy a dental insurance plan.
How Can I Reduce My Dental Care Costs?
A smart start to reducing dental costs is to visit the dentist, since preventive care – such as routine checkups and cleanings – can help you avoid more expensive procedures in the future. Lacie Glover, writing in NerdWallet, cites Centers for Disease Control and Prevention statistics that show that between 40 and 60 percent of American don’t make dental appointments as frequently as they should – and for 42 percent, a key reason is cost.
Glover lists several ways to trim dental expenses, including investigating the cost of dental insurance strategically. If your oral health is generally good, you could weigh the cost of two simple annual cleanings against the cost of insurance to see what makes the most financial sense.
However, if it has been a long time since you’ve been to the dentist or you are experiencing pain, you’ll probably need more than basic procedures, and that’s where dental insurance can help. And you can sign up for it at any time during the year rather than only during a specific open enrollment period, which is the case with health insurance. If you opt to not buy dental insurance, Glover cites other options, such as a dental savings plan, health savings account or flexible spending account. You can also look into getting care at dental schools or working with your dentist to arrange payment options.
Money Is Tight – Should I Skip Dental Insurance?
If your budget is tight, you might be rethinking paying for dental insurance. It’s true that some people can get by without insurance coverage and that going without can save a substantial amount of money. However, whether it’s worth forgoing coverage depends on how much you are willing to gamble that you won’t need costly procedures during a given year.
It is possible to come out ahead by not paying for dental insurance – assuming all you need is basic work, according to the online financial website Investopedia. For example, if you simply need exams, x-rays and cleanings in a year, you’ll probably pay about $400 out of pocket. According to the website’s calculations, most insurance premiums add up to approximately $600 a year.
However, things get dicey if you need more complex – and therefore more expensive – work done. If you need a crown, root canal or some fillings on top of your semi-annual cleanings, the cost could add up fast, even with insurance. That’s because many dental insurance plans have rather low annual maximums, possibly as low as $1,000, according to Investopedia. Once you rack up more than $1,000 in bills, you’re on the hook for the rest.
Still, dental plan proponents note that going without dental treatments can end up costing you vastly more in the end because tooth and gum problems typically don’t get better on their own. However, many dental insurance plans have waiting periods before you can use them. And if you don’t have insurance and need dental work, you can possibly negotiate a payment plan or lower price with your dentist.
No matter how you look at it, the answer to this question isn’t a simple one.
Why Is Dental Care Considered a Luxury?
Health insurance is a big deal in the United States. Many worry more about losing their health insurance than their paycheck if they lose a job. However, dental insurance is often overlooked and is generally considered a luxury rather than a necessity.
Shanna McGettrick, a dentist, addressed this question on Quora in 2017, observing that dental care is regarded as a luxury because people are “ignorant” about how important dental care is to their overall health. She partly faults the healthcare system for this, adding that health care providers tend to treat “systems and body parts instead of a whole person.”
McGettrick also faults dental insurance for not keeping pace with the cost of dental care. Additionally, she says she also “partially blames the profession of dentistry for not getting loud and obnoxious enough to wake people up” to the fact that dentists are regarded as “technicians” rather than “health care providers” – a perception she says needs to change.
A 2014 Atlantic article draws the same conclusions. “About a third of people in the U.S. don’t visit the dentist every year, and more than 800,000 annual ER visits arise from preventable dental problems,” the article states. This is due in part to dentistry and medicine being regarded as separate and unrelated professions and may stem from historic prejudices during the 1800s,because barbers and hairdressers did basic dental work.
Does Dental Insurance Cover Cosmetic Dental Work?
According to a 2018 article on the Texas Center for Cosmetic Dentistry website, nearly all insurance plans handle “restorative” dentistry that is deemed to be medically necessary, but they don’t cover cosmetic work. They’ll only cover procedures that are needed because of decay, disease or accidents. For example, insurance may cover medical interventions used to replace missing teeth or fix a patient’s bite, the article states.
If you want a more beautiful smile and there’s no medical reason for any particular dental work, then it’s unlikely you’ll find a dental insurance company to cover the procedure. Any dental work that simply makes you look better is considered elective.
However, there are gray areas. For example, if you’ve been in an accident that harmed your teeth and you need work done on them, most dentists want the outcome to be aesthetically pleasing as well as medically correct. You could also make a case for cosmetic work if you need crowns or veneers to take care of “diseased, injured, broken or missing teeth.” In addition, insurance may cover gum contouring surgery needed because of infection or injury and orthodontia to fix teeth that have been harmed in an accident.
If you think you have a legitimate reason for cosmetic dentistry, look over your dental insurance plan and check with the company.
Is It Safe to See the Dentist If I Am Pregnant?
Skimping on dental care at any stage in life is a bad idea, according to the American Dental Association (ADA). In an article on its website, the ADA says pregnant women face specific oral health challenges during pregnancy that can safely be taken care of by dentists. For example, pregnant women are more likely to develop gingivitis because of hormonal changes that affect bacteria in gum tissue, cavities from snacking due to food cravings, and tooth enamel erosion from morning sickness and vomiting. In addition, they are more prone to developing a pyogenic granuloma, a growth caused by hormonal changes.
Further, the ADA says several studies have indicated that a pregnant mother’s gum problems, such as periodontitis, can have ill effects on her unborn child. “While findings of individual studies have been mixed, an overview of 23 systematic reviews conducted through 2016 concluded that associations exist between periodontitis and preterm birth, low birthweight babies and the development of pre-eclampsia.”
The ADA recommends that moms-to-be take good care of their teeth and mouths at home and discuss oral health with their obstetricians and dentists. “Regular and emergency dental care, including the use of local anesthetics and radiographs, is safe at any stage during pregnancy.”
Does Dental Insurance Cover TMJ Treatments?
Coverage for temporomandibular joint disorder (TMJ) depends on which dental insurance plan you choose and which treatment option or options you select. Costs vary dramatically, and intrusive measures like surgery can be expensive. Many dental insurance plans cap the amount they’ll spend on TMJ treatment because of uncertainties about the causes and correct treatments.
“Because there is no certified specialty for TMJ disorders in either dentistry or medicine, finding the right care can be difficult. Look for a health care provider who understands musculoskeletal disorders (affecting muscle, bone and joints) and who is trained in treating pain conditions. Pain clinics in hospitals and universities are often a good source of advice,” says the National Institute of Dental and Craniofacial Research (NIDCR).
The temporomandibular joint connects your upper and lower jaws, and if there is something amiss, you may be one of the many people who suffer from TMJ. TMJ affects millions of Americans – possibly as many as 10 million, according to the NIDCR.
TMJ often consists of several joint and muscle disorders that cause mild to severe pain, headaches, jaw and neck aches, difficulty opening and closing your mouth, and numerous other unpleasant and frequently painful symptoms. There are indications it is caused by injuries to the jaw, a misaligned bite or arthritis, but experts have not pinpointed specific causes. Stress can exacerbate the condition, and it’s not uncommon for it to be accompanied by teeth grinding during sleep.
There are many treatments to prevent teeth grinding, including custom-made mouth guards, relaxation exercises, medications, teeth realignment options and jaw surgeries. It may take years to find a treatment plan that works for you. If you experience TMJ pain, you might need to visit different dentists to learn about the various ways to treat TMJ and investigate what your dental insurance plan will pay for.
Can Medical Insurance Pay for A Part of Dental Bills?
It is certainly possible. In fact, in the United States, some dentists are investigating whether certain mouth and jaw procedures should be billed first through medical insurance and then dental insurance if they are genuinely medical matters.
Medical insurance often pays more than dental insurance, which sometimes caps what it will pay, according to a 2018 New York Times article. Dental insurance covers certain expensive procedures at just 50 percent, and some are not covered at all.
The result is that some people end up paying thousands of dollars in out-of-pocket expenses or have to forego treatment because they cannot afford it. Dr. Chris Farrugia, a dentist in Florida, led a two-day course in medical billing to teach dentists and dental staffers how to code procedures for medical insurance, according to The New York Times.
He recommends getting a medical insurer to pay for full head, neck and mouth exams conducted by a dentist on a new patient “since the goal is to assess more than just the teeth,” the article said. “Medical insurers should also cover oral problems attributable to an underlying medical condition, such as diabetes or dry mouth, a common side effect of many medications,” Dr. Farrugia said.
Dentists also check for temporomandibular joint (TMJ) problems, look at the lymph nodes, do oral cancer screenings, examine soft tissues in the mouth, and inspect muscles and bones in that area “. . . so that is a comprehensive medical exam,” according to Dr. Rashpal Deol, another dentist quoted in the article.
Kristine Grow, a spokesperson for America’s Health Insurance Plans, said that some dental work can be covered by medical insurance but also said that those insurers are careful to watch for inappropriate or fraudulent billing.
What to Do When You've Hit Your Dental Insurance Cap
Many dental insurance plans have a maximum amount they will pay each year. If you have already hit that limit for the year, what do you do if you need an expensive procedure? In many cases, it’s unwise to delay dental work – the condition could get worse, and you could end up losing a tooth or getting a serious gum infection. Luckily, you have options, including the following:
1 – Try negotiating with your dentist, especially if you have to pay out of pocket. Some dentists allow you to set up payment plans, so you can get the care you need and then pay for it in increments.
2 – Anticipate future needs and work with your dentist to set up appointments and treatment so you can get the greatest use out of your dental insurance. An article on DentalPlans.com recommends planning non-emergency treatments to span two years. “For example, if your plan provides a year’s coverage starting in January and you need a root canal and crown that will cost about $3,000 you might be able to get $1500 worth of care in December, and finish your treatment in January,” the article says. It goes on to say that this assumes you haven’t used your entire dental coverage amount in December and aren’t experiencing a painful emergency.
3 – Buy supplemental insurance to augment your dental insurance plan. DentalPlans.com says that, unlike regular dental insurance, supplemental dental insurance typically has no waiting period and no constraints on pre-existing conditions. Unfortunately, supplemental plans can be costly.
What If My Favorite Dentist Is Out of Network?
Dentists can choose to join insurance providers’ preferred networks so patients can get the most out of their insurance benefits. If your favorite dentist isn’t part of your insurance provider’s network, you may end up paying more for your visits.
As with other types of insurance, dental insurance companies prefer you use an in-network dentist and will cover a larger share of the cost than if you visit an out-of-network dentist. As part of their agreement with the insurance company, in-network dentists don’t charge patients more than the costs covered by the insurance plan.
Many dental insurance companies have a list of in-network dentists on their websites. This makes it easy to find a provider your insurance will cover. However, if you choose to see your prefered dentist even though they are out of network, you could end up paying much more out of pocket.
If your dentist isn’t an in-network provider, you need to make some decisions. According to a 2018 article on Benefits Bridge, which is sponsored by United Concordia Dental, you have four choices:
- Stay with your insurance plan, see the dentist you like and simply pay more.
- Try finding a new dentist that is included in your dental insurance plan’s network.
- Try switching to a new dental plan that includes your preferred dentist.
- See if you can join a dental savings plan to help cover the costs of going to your out-of-network provider.