Keeping your mouth healthy is essential for a variety of reasons. One way to do that is with regular cleaning and exams at your dentist. But unless you have dental insurance, even routine visits can add up. If you need help paying for dental care, it’s possible to find low-income dental insurance. These low-income dental plans can cover routine and emergency care to help you keep your teeth and gums in good shape.
The Importance of Dental Care
Without regular dental care, you are at a higher risk of problems like cavities, gum disease, and tooth loss. The Centers for Disease Control and Prevention estimate that over 1 in 4 adults have untreated tooth decay, while almost half of adults have signs of gum disease. While the number of people losing teeth is decreasing, around 6% of adults have lost every tooth.
Left unchecked, these problems can prevent you from eating a healthy diet of fruits, vegetables, and meats, which could impact your overall health. You might also have trouble speaking clearly. And if you develop an infection in your mouth, it could spread to other parts of your body and cause sepsis, endocarditis, a brain abscess, or even death.
U.S. dental spending went down from $145 billion in 2019 to $142.4 billion in 2020, suggesting that not enough people are heading to the dentist for care.
Routine Dental Care
Routine dental care is preventative care to keep your oral health in check. It involves a cleaning and exam from your dentist every six months. A hygienist cleans your teeth at this appointment by scraping away built-up plaque and stains. Then, your dentist examines your mouth to look for signs of cavities, oral cancer, or other issues.
X-rays are another part of routine dental care. They let your dentist see what’s happening inside your teeth to check for damage to your teeth’s roots and other internal structures. Usually, you get X-rays once a year.
Emergency Dental Care
Emergency dental care is whenever you need immediate treatment to help fix a sudden problem. For example, if you crack or knock out a tooth, heading to a dentist right away may allow you to save the tooth. Other examples of emergency dental care could include:
- A severe toothache that isn’t responding to over-the-counter painkillers
- A loose tooth that feels like it’s falling out
- A dental abscess that’s swollen and causing pain
These visits are likely more expensive than routine care because you need to be seen immediately and require more specialized treatment.
Affordable Dental Insurance for Low-Income Families
Affordable dental insurance for low-income families can help pay for routine and emergency dental care without going over budget. Many of these coverages require you to make under a certain income to be eligible. If you are, they might offer protection for standard cleanings and some emergency procedures, so you don’t have to pay the entire cost of treatment out of pocket.
Medicaid Dental Coverage
Medicaid is a health insurance program run by each state for low-income individuals and families. If you’re on Medicaid, plans are required to provide dental care for children. However, they’re not required to offer dental plans for adults, though some do anyway.
Since every state manages its own Medicaid services, there are no overarching requirements for what dental care has to include for adults. In children, however, the Early and Periodic Screening, Diagnostic, and Treatment benefits require coverage to include dental health maintenance, teeth restoration, and relief of pain and infections at a minimum.
People eligible for Medicaid include low-income families and children, pregnant women, people with disabilities, and the elderly. However, specific income requirements vary by state.
Children may be able to receive both routine and emergency dental care, including exams and cleanings. Adult coverage is often emergency based, meaning they can receive care if they suffer extreme pain.
CHIP Dental Coverage
CHIP stands for Child Health Insurance Program and offers a child dental plan for low-income families that make too much money to be eligible for Medicaid. It’s managed independently by each state, so rules and requirements vary. However, the Social Security Act requires CHIP plans to offer coverage “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.”
Usually, you have the choice between two plans: a plan approved by the Secretary of State that includes CHIP-required benefits or a benchmark dental benefit package comparable to federal or state employee dental plans for dependents.
Children who are under 19 years of age may be eligible for CHIP. Income requirements vary by state but generally fall between 170% and 400% of the federal poverty level.
Children covered under CHIP should receive necessary dental care. This includes cleanings, exams, and X-rays. Additionally, fillings and crowns may also be covered if they have cavities or broken teeth.
Medicare Dental Coverage
Medicare is federal health insurance for people age 65 or older (or younger people with certain illnesses or disabilities). Medicare dental coverage is a bit limited in scope. Currently, it covers dental services that are part of another medical procedure.
For example, if your jaw is reconstructed after an accident, it would cover dental care as needed. It also covers oral examinations before a significant surgical procedure, such as a heart valve replacement or kidney transplant. However, if the exam uncovers dental decay or other issues, Medicare doesn’t cover the treatment.
People over age 65 may be eligible for Medicare. Younger people with specific disabilities might also be eligible. Finally, people with end-stage renal disease may be eligible for Medicare.
Medicare doesn’t cover routine dental care. It covers dental services when they’re connected to another covered medical procedure. It also covers extractions done before radiation treatment and exams before major surgery.
Dental and Dental Hygiene School Clinics
Dental and dental hygiene school clinics present a win-win for patients and providers. Patients can receive low-cost coverage that’s more affordable than a standard dentist, and providers in training can hone their skills and gain valuable experience. While dental students perform care in these settings, licensed dental procedures closely monitor every procedure to ensure nothing goes wrong.
Currently, over 1,400 dental programs are endorsed by the Commission on Dental Accreditation across the country, meaning you can likely find a dental school near you offering low-cost services.
Anyone can go to a dental and dental hygiene school clinic. Many schools allow you to make an appointment in advance.
Dental school clinics usually offer a wide array of services, including exams, cleaning, and X-rays. Many also offer fillings, root canals, and emergency services.
Local and State-based Health Centers
Local and state-based health centers are usually federally funded clinics that can offer low-cost services to the community. These centers use federal funding to provide free or low-cost care. Many centers use a sliding fee scale, so lower-income patients pay less.
In addition to offering vital healthcare services like adult medicine, pediatrics, women’s health, and behavioral health, many also provide dental care.
Nearly anyone can go to a local or state-based health center. Some may require you to live in the community where the health center is.
Many local dental care centers offer a robust variety of services, including exams, cleanings, fillings, crowns, and more.
Employer-sponsored Dental Coverage
In some cases, you may be eligible for employer-sponsored dental coverage through your workplace. Employers sometimes don’t have to offer this, but many provide dental benefits to full-time employees.
If you’re eligible for benefits, you can sign up for a dental insurance plan and have your premiums deducted right from your paycheck. Some companies may pitch in and cover part of or the entire premium for you, but it’s not required on their part. These dental plans usually offer coverage for preventive care, typically with a copay per visit.
Eligibility varies based on the employer. Typically, you have to be a full-time employee to be eligible for dental care benefits.
Many dental plans provide essential routine preventive maintenance and diagnostic care. Others may offer fillings, root canals, crowns, and more coverage. It varies depending on the plan.
Dental Lifeline Network
Dental Lifeline Network is an organization that provides dental care to adults over 65, people who are permanently disabled, or people who need medically necessary dental care. Patients must have no other way to pay for their treatment, so if you have dental insurance or Medicare, that is billed first.
Volunteer dental providers donate services, and currently, the network includes over 14,000 volunteer dentists. Because there is such high demand for treatment across the country, you can get services from the Dental Lifeline Network 1 time.
You may be eligible if you are over 65, permanently disabled, or need medically necessary dental care. You also can’t have other ways to pay for treatment.
The Dental Lifeline Network might cover restorative treatments like fillings, dentures, or bridges. Emergency and cosmetic dental services are not covered.
Private Dental Coverage
It’s possible to get private low-cost dental coverage if you know where to look. Signing up for a dental plan may sound expensive, but several options keep your monthly charges low while offering discounts on necessary services. Some stipulations may include finding in-network care or staying under a certain number of charges.
An indemnity plan is a type of dental insurance that pays a set percentage of the costs based on your procedure. Sometimes, indemnity plans pay a set dollar amount instead of a percentage. This is called a table or schedule of allowances plan.
You’d then be responsible for any remaining balance. One exception is if fees exceed what’s usual, customary, and reasonable. In that case, you might have to pay more. Usually, you can see whatever dentist you’d like with this plan, though you may get better savings if you stay within the network.
Dental Health Maintenance Organization (DHMO) or Capitation
A DHMO or capitation plan almost works like a prepaid plan. You pay a set amount each month to your insurance provider, and the provider pays the in-network dentist. From there, you choose a monthly stipend. This dentist then provides specific services at no or reduced cost. Dentists don’t bill you separately for each procedure, meaning you could theoretically get as much treatment as you want each month, as your monthly fee covers it.
Direct Reimbursement (DR)
Direct reimbursement is a good option if you’d prefer to choose your own dentist. It allows you to go to any dentist and receive treatment. You pay for the treatment upfront, then submit your receipts to the insurance company. You then get reimbursement for a percentage of your costs. Your reimbursement isn’t tied to the type of treatment but rather how much you spent overall.
Preferred Provider Organization (PPO)
A PPO is a type of indemnity insurance, but with a specific network of providers, you have to go to if you want lower bills. These providers have agreed to perform services at the rates set by the insurance company. You might be able to go to a provider outside of the network, but if their fees are higher than the plan’s allowable reimbursement, you could be on the hook to pay the remainder of the bill.
If you have a managed care dental plan but want to seek out-of-network care, a point-of-service plan can offer you some coverage. These plans reimburse you based on a lower table of allowances, meaning you get less money back than if you had used an in-network provider. POS plans can be good if you need to see another provider for a 1-time treatment. Otherwise, it’s better to stick to in-network care.
Exclusive Provider Organization (EPO)
An EPO restricts benefits to in-network dentists. To receive reimbursement for your dental treatment, you must go to a participating provider. If you don’t, the plan doesn’t pay for anything. These plans can be very limiting, especially if you don’t have a lot of dental providers in your area. You could also be stuck with a hefty bill if you’re traveling and need emergency dental care out of the network.
Discount or Referral Plan
Technically, a discount or referral plan isn’t insurance. It’s a network of dentists that have agreed to offer services at discounted rates. Every time you go to the dentist, you pay a set fee for each procedure. You don’t have to worry about reimbursement or insurance claims, as everything is prenegotiated between the dentist and the plan. This can help you know exactly what to expect every time you visit the dentist.