Key Takeaways
- Dental insurance often disappoints consumers—it charges monthly premiums, but offers limited coverage compared to health insurance.
- It functions more like a discount plan, covering only a percentage of non-preventive care and often requiring lengthy waiting periods before coverage begins.
- To get the most value, choose employer-sponsored plans when possible, review policy details carefully, and confirm your dentist is in-network.
- Alternatives include dental discount programs, health savings accounts (HSAs), and low-cost community providers.
About 76% of Americans under 65 have dental insurance, but not all policyholders are satisfied with their coverage. In fact, social forums like Reddit are rife with comments from disgruntled patients questioning their plan’s value, with some even calling dental insurance an outright scam.
“Dental insurance is 100% a scam,” one Redditor wrote in response to another’s claim that they had to pay $2,200 to fix a cracked tooth despite having coverage. “It is almost never worth it,” they said, adding that the premiums cost more than annual cleanings, and plans often don’t fully cover more expensive procedures like surgery.
Learn what drives this negative public perception—and how to determine if dental insurance is worth the cost for you.
Why Dental Insurance Can Be Frustrating
Customers often expect dental insurance—with its shiny white ID cards and familiar terminology—to function similarly to health insurance, but, in reality, the coverages are quite distinct.
“Health insurance is designed to protect against catastrophic, high-cost events, like hospitalizations or surgeries,” said Dr. Sandip Sachar, D.D.S. at Sachar Dental in New York City. “Dental insurance is designed to be a preventative and maintenance plan.”
The best dental plans use a 100/80/50 payment structure, meaning they cover:
- 100% of preventive care, like annual or semiannual checkups, cleanings, and X-rays
- 80% of basic procedures, such as filings, extractions, and root canals
- 50% of advanced treatments, including crowns, dentures, and inlays.
But many plans cover less. Investopedia’s research into 17 independent dental plans found the average coverage level for basic care is 54%, and for major care, it’s just 34%.
On top of this cost-sharing, policyholders pay monthly premiums, deductibles, and copays. These costs vary by plan, but Humana puts premiums (your monthly bill for dental insurance) at around $20 to $50 per month for an individual or $50 to $150 per month for a family.
Lots of Fine Print
Further complicating matters, some dental insurance plans come with waiting periods of three to six months before they cover basic procedures and three to 12 months before covering major care.
Important
Some dental insurance comes with no waiting periods for basic or major care, but the premiums will be higher.
Plus, once you reach your plan’s annual maximum coverage limit, you’ll pay out-of-pocket for all additional services until a new benefit period begins. This caveat directly contrasts with medical health care plans, where reaching an out-of-pocket maximum means your health insurer pays 100% for services.
The maximum annual benefits for dental plans typically range from $1,000 to $2,000 per year.
“There’s definitely confusion,” said Dr. Sara Stuefen, a general dentist in Vinton, Iowa, and spokesperson for the American Dental Association. She said it helps to “think of [dental insurance] as a coupon … It’s going to pick up some of the cost but not all of it.”
When Dental Insurance Makes Sense—and When It Doesn’t
Despite its limitations, dental insurance generally makes sense for families with children, patients with chronic periodontal needs, and seniors, given the costs associated with multiple or frequent procedures.
It makes less sense if your plan’s maximum benefits fail to exceed the amount you’ll pay in premiums over the course of the year. In other words, if a plan’s premium is high, but its annual benefit maximum is low, “the math may not add up,” Dr. Sachar said.
Beyond that, people with high incomes may consider self-insuring, which involves using savings to cover future dental costs rather than paying for insurance to achieve the same goal. So might young adults or others who anticipate only needing a routine cleaning or two, which costs, on average, $125. People who just think they’ll only need preventive care might opt to skip the extra monthly bill and pay for the cleanings themselves.
Keep in mind, however, that it’s often tricky to predict the level of care you’ll need. And, while dental insurance may be imperfect, there aren’t many great alternatives when it comes to affording pricey procedures.
For instance, the Redditor at the start of this article said they would have paid $4,000 for their procedure instead of $2,200 without coverage.
“While dental insurance may not offer the same financial safety net as health insurance, it still provides meaningful value,” Dr. Sachar said. “A well-structured plan can help reduce out-of-pocket costs for cleanings, X-rays, and even major treatments when they arise.”
Tips When Considering Dental Insurance
The key phrase, however, is “well-structured plan,” as not all dental plans are equal. To find a worthwhile policy during open enrollment season, keep these tips in mind.
- Take advantage of employer-sponsored dental insurance if you have the option. These plans “usually offer better coverage because employers subsidize part of the premium, making the cost of buying the plan lower for employees,” Dr. Sachar said.
- Avoid long waiting periods. Some plans have no waiting periods, while others may have waivers you can take advantage of. For instance, you can sometimes get a waiting period waived if you’re switching plans without any breaks in coverage.
- Look at network limitations. PPO (Preferred Provider Organization) plans offer more provider flexibility, but charge a higher premium. HMO (Health Maintenance Organization) plans are cheaper, but have more restrictive networks. “Check to be sure your dentist accepts your new plan,” Dr. Sachar said.
- Understand what’s covered. Comprehensive dental plans help cover both preventive care and more costly procedures, such as tooth extractions, root canals, and dental implants. Basic preventive plans only cover routine exams and cleanings. Confirm the plan you’re considering actually provides the care you want.
- Check for costly caveats. Some policies, for instance, won’t replace a tooth that was missing before you got coverage. Or a plan might specify that it only covers amalgam (silver) fillings as opposed to composite (tooth-colored) fillings. “A lot of dentists don’t even do silver fillings anymore,” Dr. Stuefen said.
Start your search for quality coverage with these top dental insurance companies.
Dental Insurance Alternatives
If you can’t find or don’t have worthwhile dental insurance options, these alternatives could help you cover and afford care.
- Consider Dental Discount Plans: These plans, also called dental savings plans, offer discounts on common dental services, such as cleanings, crowns, and fillings, in exchange for an annual membership fee, usually around $150. They could be an option for young or healthy individuals with limited dental needs.
- Tap a Health Savings Account (HSA): You can use money in these tax-deferred accounts, typically associated with high-deductible health care plans (HDHPs), to cover most dental and orthodontic services.
- Visit low-cost providers: “Dental schools are a great place to receive discounted dental care,” Dr. Stuefen said, adding that local clinics might also “provide care on a sliding fee scale depending on income.”
