Smart Ways to Pay Less for Dental Care

Sure, dental insurance is cheap. The most popular kind of group plan costs just $32 a month, on average, and three-fourths of employers help pay the tab, according to the National Association of Dental Plans (NADP). That cuts the average employee premium down to about half the original cost—or even less. But you get what you pay for. The coverage is awful.

As you choose benefits during open enrollment, it’s worth checking up on the coverage in your dental plan. If you anticipate needing an expensive procedure next year that your plan won’t pay for, you may be able to put money aside tax-free in a flexible spending account (if your employer offers one) or a health savings account (if you have a high-deductible health plan).

Assessing your group plan. If your employer subsidizes your coverage, you prob­ably should take it, says Evelyn Ireland, executive director of the NADP. The plan likely covers routine care, such as cleanings and exams every six months, and most of the cost of basic procedures, such as filling a cavity. But out-of-pocket costs pile up quickly with more-complicated procedures. For example, a single porcelain or resin crown goes for $650 to $1,600 in Los Angeles, according to estimates from Fair Health, a cost-lookup tool. A set of dentures runs about $1,600 in Indianapolis. A typical plan covers 50% of the cost for these services but limits coverage to once every five to seven years. And once your plan has reached its maximum annual benefit (often $1,000 to $2,000, if your plan has one), you’re paying out of pocket.

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Don’t expect your plan to cover cosmetic procedures, such as tooth whitening, and orthodontia may require a separate rider, if coverage is available at all. For dentally necessary veneers, inlays, onlays, implants and other procedures, the plan may pay out only once every few years or per tooth.

One promising trend: Implants are now covered by 59% of plan sponsors, according to Mercer’s National Survey of Employer-Sponsored Health Plans. In addition, many group carriers have started to add periodontic procedures, such as scaling and root planing (deep gum cleaning), at no cost for patients with certain high-cost medical conditions, says Ireland. And many plans will now roll over unused annual maximum amounts to the following year.

Buying insurance on your own

For the benefits it offers, an individual plan is generally pricier than a group plan, ranging from $12 to $45 a month nationwide. Some individual plans also impose a waiting period of six to 12 months before covering a major procedure.

To see whether the cost of dental insurance nets you more than you might pay, add up expenses over the past few years and the treatments you anticipate over the next few years. You can estimate costs for specific procedures by zip code at Fair Health, or call your dentist’s office and ask what it charges. Then weigh the plan’s annual maximums, coverage restrictions and premiums, as well as whether your dentist is in-network.

Compare plans on a Web site such as eHealth.com, or on DentalPlans.com for “discount” or “savings” plans. You can also search for agents in your area at the National Association of Health Underwriters’ Web site. An agent who sells health insurance is in the best position to help you navigate dental products, too, says Janet Trautwein, CEO of NAHU. You can also find a list of insurers that provide individual coverage in your state on www.nadp.org under “Find a Dental Plan.” Currently, you can buy dental insurance on the exchanges only if you enroll in health care at the same time.

When you have a choice of plan types for group or individual coverage, consider which one would be best for you. For example, HMOs offer low premiums, deductibles and co-payments, and often unlimited annual coverage caps, so if you need a lot of expensive work done, you’ll get more bang for your buck. However, they limit care to a specified pool of providers. You’ll usually pay higher premiums and deductibles for PPOs, but they are more flexible because they cover care both in-network and (at a reduced rate) out-of-network. Plus, even after you’ve maxed out your annual limit, services are billed at the negotiated rate.

Filling Gaps in Your Dental Coverage

If you’ve hit your annual limit or are facing treatment that’s barely covered by insurance—if at all—you need to find other ways to cover the costs. An FSA or an HSA can cover co-pays, deductibles and non-cosmetic expenses related to dental care. The money you contribute to FSAs and HSAs is pretax, meaning it’s exempt from income taxes, and FSAs avoid payroll taxes, too. “Paying for dental expenses through your employer’s FSA is like having a coupon for 30% to 40% savings,” says Jody Dietel, chief compliance officer for WageWorks, which administers FSAs and HSAs.

For 2015, the maximum amount you can stash in an FSA is $2,550. If you start treatment in December, you can use up the remaining balance in your FSA, then complete treatment in 2016 to dip into the coming year’s pot of FSA money, too.

Another smart option is an HSA. If your employer doesn’t offer one, you can set one up on your own as long as you have a health insurance policy with a high deductible—at least $1,300 for individual coverage or $2,600 for family coverage in 2015 and 2016 (ask your insurer or employer if the plan is HSA-eligible). In 2015 and 2016, you can contribute up to $3,350 to the HSA if you have individual coverage. If you have family coverage, the limits are $6,650 in 2015 and $6,750 in 2016. If you’re 55 or older anytime during the year, you can contribute an extra $1,000. Your contributions are pretax if made through your employer or tax-deductible if you’re on your own.

You generally can’t contribute to both an HSA and FSA in the same year, but more employers are offering “HSA-compatible” FSAs. With these accounts, you can fund an HSA as well as set aside up to $2,550 pretax in the FSA to use for dental (or vision) expenses until you reach your health plan’s deductible. After that, you can use the money for any out-of-pocket medical expenses.

If cash flow is an issue, ask your dentist to work out a payment plan, say by stretching out work over several months so you can pay in installments, or over two years to take advantage of two annual maximums for your dental plan (as long as treatments are billed in separate years). Alternatively, see if you can negotiate a discount by paying in cash up front. Before you agree to an extensive and costly procedure, “be very sure you need the work,” says Mark Wolff, an associate dean at New York University College of Dentistry. Seek a second opinion if you feel uncomfortable with the diagnosis, and ask for records to be transferred.

If you have more time than money, shop for care at one of the 64 accredited dental schools in the U.S.(www.ada.org/en/coda/find-a-program). Appointments take hours longer than regular dental visits, but students are heavily supervised and offer a full array of services at a reduced cost. “You can save hundreds to a thousand dollars on a single tooth implant,” says Wolff. For other sources of low-cost or pro bono dental treatment, look up community health centers at http://findahealthcenter.hrsa.gov. You can also consult your state or local dental society for resources.

Fill the Medicare dental gap

Medicare doesn’t cover routine dental care, so after you enroll, you’re pretty much on your own. In addition to individual plans, look into Medicare Advantage plans with dental benefits, although the care can be limited. AARP’s dental plans cost about $28 to $71 a month, depending on the type and your location. You can still withdraw funds from your health savings account tax-free after you sign up for Medicare, but you can no longer contribute to the HSA. Oral Health America, a nonprofit educational group, lists resources by state at www.toothwisdom.org.