Types of Dental Plans | MouthHealthy - Oral Health Information from the ADA

Plans that help you pay for dental care

A person researching dental benefits options on a computer.

Plans that help you pay for dental care

Are you concerned about the cost of dental services? If so, you’re not alone. Many people worry about how they’ll pay their dental bills, whether they’re living on their own or caring for a family.

When it comes to paying dental costs, having a dental benefits plan can help. There are many kinds of plans, and knowing how they work can help you choose the best one for your budget and needs.

Where can I find dental coverage?

If you are currently working, check with your employer first. You may be able to sign up for an employer-sponsored plan that helps pay for regular checkups and cleanings, fillings and more.

If you’re not working but your spouse or domestic partner is employed, find out if their employer offers dental benefits for family members. Depending on the terms of the plan(s) available, you may qualify for coverage.

If your employer does not offer dental benefits or you are self-employed, you can buy dental coverage through the federal Health Insurance Marketplace.

If you are 65 or older, you can find coverage through the Health Insurance Marketplace or opt for a Medicare Advantage plan that covers dental services.

How different dental plans work

Whether you find dental coverage through your employer, the federal marketplace or another source, you will need to know the basics of how dental plans work. Here’s a look at how different plans help you pay for dental care.

Dental insurance plans work like most health insurance plans, but they focus specifically on dental care. You will pay a fee (premium) for your coverage. If you have access to an employer-sponsored plan, your employer may pay part or all of the premium. If you will be responsible for some of the premium, you may be able to have payments automatically deducted from your paycheck.

Your dental insurance plan may have a deductible, which is the total amount you will need to pay on your own before the plan begins paying benefits. Once you reach the deductible, your plan will pay part or all of your qualified dental costs, up to an annual limit. Your plan may also require a copayment, which is a set amount you pay to your dental provider upfront. After the copayment is applied, your plan will pay some or all of the remaining cost.

With a traditional dental insurance plan — sometimes called an indemnity plan — you can work with any dental provider or office that accepts your plan. The insurance company may pay your provider directly, or they may require you to pay the full amount upfront, then file a claim for reimbursement.

A dental health maintenance organization (DHMO) is a type of insurance plan that works slightly differently than standard dental insurance. With a dental HMO, you will need to choose a primary care dentist who will coordinate all dental care for you.

Most of the services you need, such as regular cleanings, fillings, and checkups, will be handled by your primary care dentist. If you need specialized care — for example, you need to have a tooth removed by an oral surgeon — your primary care dentist will refer you to a specialist. If you decide to see a dentist outside the DHMO network or a specialist without a referral, your plan may not pay for those services.

Although most DHMOs do not have deductibles, they may have yearly benefit limits, and may include copayments.

A dental preferred provider organization (PPO) is another kind of insurance plan that lets you choose any dental professional in the plan’s provider network. But unlike a DHMO, a PPO plan will usually allow benefits for dentists and other providers outside the plan’s network.

With a dental PPO, you do not need to choose a primary care dentist or get a referral if you need to see a dental specialist. But there is an advantage to choosing a dentist in the plan’s network, since the plan will typically pay a larger share of the cost (vs. a smaller share if you see an out-of-network provider).

Dental PPOs usually have deductibles and yearly benefit limits. They typically cover a percentage of each procedure, based on the type of care and the terms of the plan.

Dental discount plans are different from traditional dental insurance plans, DHMOs or PPOs because they do not pay dental expenses for you. Instead, they give you access to lower prices available only from participating dental providers. You are responsible for paying your dental bill directly, but you will benefit from the discounted price. With a dental discount plan, there are usually no deductibles or annual limits. You will pay a yearly membership fee to join and then choose a dentist or specialist from the list of participating providers. The amount of your discount will vary, depending on the terms spelled out in your plan.

Using a Flexible Spending Account for dental costs

A Flexible Spending Account (FSA) is an account you can set up through your employer. During the open enrollment period for benefits at work, you will choose how much money to put into this account each year and each paycheck. The amount you specify will be deducted from each paycheck on a pre-tax basis. You will be able to use the money in your account to cover some of your dental expenses.

FSAs generally cover products and services that help keep your mouth healthy, including dental cleanings, braces needed for dental health reasons, coinsurance payments, dentures and more. Many FSAs work like debit cards, allowing you to use the card to pay your dentist directly or purchase eligible dental products at your local drugstore or retailer.

Keep in mind that FSAs are available only through an employer. If you don’t have access to one at work, or you are self-employed, you can still consider setting up a Health Savings Account (HSA) – a personal savings account that is similar to an FSA. However, there are several issues to consider before you opt for an HSA. Learn more about HSAs and FSAs here.

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