Even With Dental Insurance, You Still Could Face a Large Bill

Russell Anthony made eight trips to the dentist last year. The 65-year-old retiree in Nashville, Tennessee, hopes to go less often in 2026, but he’s already made a few visits.

“I had a root canal just last week that was like $500,” he said. “The week before that, I had a crown that cost me several hundred dollars. And as we speak, I have a broken tooth, and I have to go and see the dentist soon.”

In all, Anthony — uncle of HealthQ host Cara Anthony — expects to pay about $2,000 for dental care this year, even though he has dental insurance.

“Trying to weigh the cost of when to go to get dental care and paying for it, versus the other needs that I have, is something that’s very important,” Russell Anthony said.

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.

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.

2. Facing a Big Dental Bill? You Have Options

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.

Olim welcomes patients no matter how long it’s been since their last visit. But she cautioned that patients who wait a few years between visits may find their appointments are more expensive and more uncomfortable.

The reason? Dental problems often don’t resolve on their own. For example, a small cavity that needs a quick filling might cost $200. If left untreated, it could turn into a larger issue requiring a root canal and crown — and cost thousands.

Your dentist will also encourage you to follow the best preventive maintenance: brushing your teeth for two minutes twice a day. Olim tells her patients to use a timer or listen to a favorite song to make sure they brush long enough.

People and Policy

Federal lawmakers have tried to increase children’s access to dental insurance. Under the Affordable Care Act, dental care is considered an essential health benefit for children, so health insurance plans on the individual marketplace must offer dental coverage for those 18 or younger. State Medicaid programs are also required to cover dental care for children.

 

Source Link

Recommended Articles

Hospitals, Clinics Want Nevada To Bolster Protections For Discount Drug Program

Nevada hospitals and health clinics say drug manufacturers are restricting the number of pharmacies in the state that can participate in a federal discount drug program. The limitations put in place by drug companies make it harder for patients to refill prescriptions at reduced rates, and they affect a revenue stream hospitals rely on to ...

Read More

Trump Administration Warns Over 500 Hospitals To Provide More Price Information Or Face Fines

The Trump administration has warned more than 500 hospitals that they are failing to provide the public with basic pricing information — arguing that the lack of disclosure is keeping healthcare costs higher than they should be. The Associated Press obtained exclusively the list of hospitals that since April have either received letters of warning or, in more severe ...

Read More

States Starting To See Major Obamacare Coverage Losses

Newly released state enrollment data show ObamaCare coverage losses could be even more severe than initially anticipated, due to Congress’s unwillingness to renew enhanced subsidies. Monthly enrollment data through April from Arkansas, Colorado, Maryland, Massachusetts, New Mexico and New York showed a significant number of people canceled their coverage or did not pay their premium bills after signing up for coverage in 2026, according to an analysis from Georgetown University. Federal officials have so far only released data ...

Read More

New NFIB Survey: Small Businesses Report Reduced Optimism

The NFIB Small Business Optimism Index fell 0.6 points in May to 95.3, remaining below its 52-year average of 98.0. The Uncertainty Index rose 3 points from April to 91, remaining well above its historical average of 68. As reported in NFIB’s monthly Jobs Report, the NFIB Small Business Employment Index remained essentially flat, registering 100.3 in May. ...

Read More
arrowcaret-downclosefacebook-squarehamburgerinstagram-squarelinkedin-squarepauseplaytwitter-squareyoutube-square