Dental Insurance for Kids: A Parent’s Guide

Dental Insurance Options For Kids — The Importance of Caring For Your Children’s Teeth

Knowing how to care for your child’s teeth is necessary to ensure good dental health. While tooth decay is the most common chronic disease of children in the United States, most tooth decay and cavities are preventable. Having dental insurance that provides preventative and corrective services, along with maintaining healthy dental habits, is crucial for a child’s dental health.

How Dental Insurance Works For Children

Like adult dental plans, children’s dental plans cover various preventative and corrective services. When you choose a plan for your child, you will know what services are covered, the cost, the co-pays, and deductibles.

With private health insurance plans, dental services are not usually covered under the medical portion of insurance and require a separate plan. However, children’s dental services are covered under the government-funded CHIP, Medicaid health insurance, and any ACA (Affordable Care Act) plan. Most private dental-specific plans have no set enrollment period, and parents can enroll their children in dental plans year-long.

For plans offered through a parent/guardian’s employer, there may be only certain times throughout the year when coverage can be purchased. CHIPS and Medicaid plans can be applied for at any time.

ACA Plans Must Include Dental Coverage For Children

An ACA plan must meet the requirements set forth by the government to offer minimum essential health coverage to policyholders, and when it comes to children, must include dental coverage for children. However, this is not the case with adult plans, as ACA adult plans do not have to include dental coverage. 

What Does Children’s Dental Insurance Cover?

While not all plans are guaranteed to offer the same coverages, it is likely to find the following services covered on a child’s dental plan:  

• Diagnostic appointments: A diagnostic appointment is an appointment where a child will be examined for any potential issues, such as cavities or gum disease. 
• Preventive care: Preventative care services reduce the risk of declining oral health. These are likely to include x-rays, cleanings, sealants, spacers, or education on how to care for teeth. 
• Restoration services: Restoration services include services that need to be performed due to a known issue, such as a cavity or damaged tooth. These services include fillings, crowns, inlays/outlays, root canals, and bridges. 
• Oral surgery: Oral surgery is a more intensive dental service than others and can include biopsies, any surgery of the mouth or gums, and surgical extraction of teeth. 
• Root canals: A root canal is a specific type of restoration service and is a procedure used to remove bacteria from the infected root and prevent reinfection. 

When to Seek Coverage

Parents should take their children to visit the dentist before their first birthday. It is important to get your child’s gums examined to look for any potential issues. A parent/guardian may also receive education on how to care for their child’s teeth at this initial visit. For this reason, you may choose to seek dental insurance for your child at birth. 

Types of Dental Insurance Options For Kids

There are many different types of dental insurance available for children. Parents/guardians may be able to add their children to their existing policies or may have to consider a standalone policy. Parents can explore many plans, such as employer-sponsored plans, private plans, Medicaid, and CHIPS. 

Employer-sponsored Dental Insurance

Employer-sponsored plans are offered through an employee’s work. Often, this coverage can be extended not only to the employee but the spouse and children of the employee. If this is an option, the employee would need to speak with their human resources department to gather information about the plan, such as pricing, co-pays, and coverage specifics.

Even though this plan is offered through an employer, the plan must still meet ACA guidelines. With an employer-sponsored plan, it is common that coverage can only be added at certain times. For example, coverage can be purchased when the employee first becomes eligible or during a qualifying life event, such as marriage or birth of a child. Otherwise, the employee must wait for the company’s open enrollment period to obtain coverage. 

Private Dental Insurance

If coverage through an employer is not an option, a parent/guardian may look into a private dental plan. These plans must also follow the guidelines set forth by the ACA. It is possible for the parent/guardian to add their child to an existing private plan or purchase a standalone policy for the child.

When looking at private policies, an individual may visit the Health Insurance Marketplace to review and compare plans or reach out to private insurance companies, both local and nationwide, to receive quotes.  

Medicaid

Medicaid is a government-funded health insurance program for low-income families. When a child has a Medicaid health plan, it will also include dental coverage.

Dental coverage provided to children through the Medicaid program offers preventative services, such as cleanings and screenings, as well as corrective services, such as fillings and extractions. For a child to be eligible for Medicaid, the parent/guardian must apply for coverage at their local Department of Health and Human Resources (DHHR) and meet certain income guidelines. If Medicaid is not an option due to income guidelines, then CHIP may be an option.

Children’s Health Insurance Program (CHIP)

CHIP, Children’s Health Insurance Program, is another government-funded health plan for children of low-income households. If a child is denied Medicaid coverage due to the income guidelines, they may still be eligible for a CHIP plan. CHIP plans are administrated on the state level, and each state’s requirements and coverages may be different, but all CHIP plans meet ACA guidelines. Parents/guardians can visit their local DHHR or benefits.gov to research plans in their state. 

How Much Does Children’s Dental Insurance Cost?

One important factor when looking for dental insurance is the cost. The premium for a dental plan will vary depending on many factors. For example, an employer-offered policy that offers less coverage may be less expensive than a standalone policy with more comprehensive coverage.

With Medicaid, there is usually no or a minimal premium each month, with premiums ranging from $5-$74. Regarding CHIP plans, the premium cannot exceed 5% of a family’s income. For example, if the family income is $3,500 per month, the premium cannot exceed $175 per month. With employer-based plans, the average cost may range from $15-$30 monthly, and standalone policies through the Health Insurance Marketplace have an average cost between $26-$47 a month.

While monthly premiums are a key factor in overall plan cost, other costs that are associated with a dental plan include premiums, deductibles, and copays.  

• Premium: A premium is the amount paid on a regular basis to maintain coverage for the dental plan itself. If a plan has a premium of $25 per month, that will need to be paid to keep the policy in force. 
• Deductible: A deductible is the amount that must be paid by the policyholder before the plan’s benefits are paid out. For example, if a plan has a $250 annual deductible, the policy will not pay out until the first $250 of dental services is paid for by the policyholder. 
• Copay and coinsurance: A copay is a fixed fee the policyholder pays for a routine service before insurance covers the remaining balance. For example, cleanings may have a $20 copay meaning that the policyholder will pay $20 at the dental visit, and the insurance plan will pay the rest. Coinsurance is the percentage of a service the policyholder pays before insurance covers the remaining balance. For example, if a plan has a 20% coinsurance on a specific service, the plan will pay 80% of the costs, and the policyholder will pay the remaining 20%.
• Annual out-of-pocket maximum: An annual out-of-pocket maximum is the maximum amount a policyholder will pay in deductibles, copays, and coinsurance during the plan year. For example, if a plan has a maximum out-of-pocket of $1,000, the policyholder will not pay anymore more than $1,000 in out-of-pocket costs during that year. 

Choosing The Right Plan For Your Child

It is important that a parent/guardian chooses the right plan for their child. Although cost is an important factor, there are other significant aspects of a plan that should be considered. 

Determine The Coverages You’re Looking For

When looking for coverage, a parent/guardian should consider what services they want covered for their child. Some plans will offer minimum coverage, with coverage for only a few services, such as cleanings. Other plans may offer more comprehensive coverage to include orthodontics.

Although coverage may vary by plan, there are minimum essential coverages that every plan must offer to follow the ACA regulations. These coverages include the following:  

• Preventative services – including two cleanings per year 
• Fluoride treatments
• Fillings 
• Tooth extractions 
• Root removal 
• Control and prevention of oral and dental pain

Review Your Preferred Dentist and Facility Networks

Just like a medical insurance plan, the network of approved providers for a plan is important. Certain plans may only pay for services from approved providers, meaning that if your current dentist is not in that network, you may have to change providers.

It may also be that the dental plan will allow you to continue seeing that dentist but will only pay a portion of the cost. For example, a service may be covered at 80% in-network but only 50% out-of-network. 

Consider Future Needs

The dental needs of child are likely to change over time. Therefore, it is important to consider future needs when looking for a plan. For example, when a child is young, there may be no need for services such as fillings or sealants. However, as the child grows, these may be essential services.

Orthodontic services are also something to consider. While most plans will not cover orthodontics, such as braces for only cosmetic reasons, it is important to know if a plan will cover them at all. This is especially important as a child enters their teen years. 

Compare Policy Options

After knowing what to look for in a policy, it will be time to start looking into plans. For some parents/guardians, the first step may be applying for Medicaid or a CHIP plan. These programs are both government-funded and have strict income guidelines but offer the lowest out-of-pocket costs for policyholders. To apply for these plans, a parent/guardian should visit their local DHHR or screen for services online.

If available, another option may be to add the child to the parent/guardian’s employer-provided plan. To do this, one would speak with their human resource department to get a breakdown of costs, coverages, and how to add the child. If neither of those options is available, a private plan from the Health Insurance Marketplace may be the best choice. When looking into a private plan, it is best to get several quotes from different companies and compare costs and coverages. 

Make Your Selection and Enroll

Once a parent/guardian has decided which option to choose, it is time to enroll. Each plan may vary on the steps to take to enroll a child; however, they will all consist of filling out an application and paying a premium if applicable.

Basic information, such as the child’s name, date of birth, and social security number will be required. Once the application is complete, it will be submitted, and the parent/guardian will receive correspondence from the insurance company, such as any follow-up information they may need.

Alternatives to Children’s Dental Insurance

Although the most common way to cover a child’s dental services is through a dental plan, there are other options that a parent/guardian could consider. These options include paying out-of-pocket, visiting a dental school, exploring clinical studies, or using a community clinic. 

Out-of-pocket Payment

A parent/guardian may decide they do not want to carry a dental plan for their child and simply pay out-of-pocket. This means they would have to pay the dental provider directly. Some providers may offer a discounted price if the services are paid for in a lump sum, but even with discounts, the out-of-pocket option may become costly over time.  

Dental Schools

A dental school is part of an educational organization, such as a college or university, that teaches dental practices to soon-to-be dentists.

At a dental school, prospective dentists can perform services on patients under supervision to prepare them for their careers. For this reason, a dental school may offer services at a reduced price. Although this may be a great option for some services, it may not be a reliable source of primary dental coverage as not all dental schools offer every service needed, and a parent/guardian may have to travel to find a dental school that offers the necessary services. 

Clinical Studies with the NIDCR

Another option for dental care may be joining a clinical study with the NIDCR, National Institute of Dental and Craniofacial Research. The NIDCR often offers reduced-cost services for patients that partake in clinical studies. Although this is one way to receive dental care, this may not be a stable option. The type of clinical study underway and the location of the study may not align with a child’s ongoing needs. To find a list of studies, a parent/guardian can visit clinicaltrials.gov.

Community Clinics or Events

A community dental clinic or event may be an option that a parent/guardian may consider. These are low or no-cost options, but they may not be consistent and only offer limited services. For example, a community event may be offered twice a year where dental providers set up a common area for children to receive cleanings. Although it is a valued event, it may not be enough to rely on for primary dental care.

Maximizing Your Child’s Dental Health

There are many habits that a child and their parent/guardian can adopt to maximize the child’s dental health. Such as, 

• Supervise your child’s brushing habits:  Depending on a child’s age, daily brushing habits may vary. A parent/guardian should wipe a baby’s gums twice daily with a clean cloth. Children under the age of six should be monitored while brushing to ensure they are cleaning their teeth properly.
• Brush twice daily: It is important for a child’s teeth to be brushed twice daily. The American Dental Association recommends following the 2/2 rule: brushing twice daily for two minutes each. 
• Encourage flossing and rinsing with kid-safe mouthwash: Brushing is not the only important daily habit to maximize dental health. Flossing should be done at least once daily to remove plaque, bacteria, and food debris. 
• Use toothpaste with fluoride: Fluoride can prevent nearly one-third of cavities in children. For this reason, it is important to use a toothpaste with fluoride. It may also be a good idea to consult a dentist regarding any additional fluoride needed, such as a rinse. 
• Reduce sugar intake: Reducing sugar in a child’s diet is one of the most important habits for dental health. According to the National Institute of Health, a sugary diet contributes to dental issues. Reducing sugar or a sugar-free diet can protect dental health for life. 

Putting It All Together

All in all, dental care is of utmost importance for children. There are several options to ensure that a child is receiving adequate dental coverage. A parent/guardian may decide to go with a minimum plan and pay out-of-pocket for more intensive services or choose a more comprehensive plan. At the very minimum, there are low-cost options, such as dental schools and community events, where a child can receive basic cleaning services. By knowing the differences in types of plans and coverages, a parent/guardian can make a more informed decision.