In the U.S., the question of how to afford dental care can often be just as scary (if not more so) than the treatment itself. Even with dental insurance, a large portion of the cost of care may still be left for the patient to pay. Any dentist working in the U.S. should be willing and able to have a frank and open discussion with their patients regarding treatment options and their relative costs.
While having this conversation with your dentist may seem scary and embarrassing, it is an important conversation to have. No dentist should ever shame you for your inability to pay for treatment or for you asking about more affordable options. A conversation about treatment priorities may also help you to space out dental work in a way that allows you to save and pay for treatment as you go.
Models of Practice in the USA
Ray Kimsey, a dentist from Coral Gables, has shared this handy overview of models of practice in the USA:
“It seems that in USA there are several models of practice:
- There are the HMO type practices where the fees are very low and so the dentists have very little time to do anything.
- There are the PPO practices where dentists have agreed to lower fees on varies insurance plans and each plan pays a different amount.
- There are fee for service plans where the dentist charges basically the same fee to everyone he sees with an occasional up or down charge.
As you might expect, the best dentists are fee for service and you can expect to be treated the best but at a higher price than if you go to the PPO dentist. You will see a dentist who is basically seeing one patient at a time and not running around between patients at all.”
If you are having difficulty paying for treatment, some of the options below may be helpful.
Table of contents
- Your Own Savings Account
- Dental Insurance (Dental Benefit Plans)
- Dental Schools
- CareCredit and Payment Plans
- Dental Discount Plans
- Call 211
- Medicaid Dental Coverage
- Low-cost Neighborhood Clinics, Public Health Services, and Other Community Resources
- Charitable or Religious Organizations
- Offering Services or Skills
- Borrowing Money from Relatives
Your Own Savings Account
You may want to open a savings account and draw out what you need to pay your dentist. Your dentist may even give you a percentage off (usually about 5%) for paying in full at the time of your appointment, if you ask them.
You can work out a treatment plan with your dentist which allows you to space out treatment over a considerable period of time, and pay as you go along. The same goes for some of the other options on this page.
Dental Insurance (Dental Benefit Plans)
Usually, dental benefit plans (dental insurance) are based on a contract between your employer (or your partner’s employer) and a dental insurance company. Coverage is limited, usually to around $1000-$2000 per year.
You can take one out yourself, but, depending on your situation, it may not be worth the cost. Also, most private plans require a waiting period before you can use them and may have restrictions for ‘pre-existing’ conditions. Before you buy you own (non-employer) plan, it’s best to take a hard look at the cost vs. potential savings:
No insurance company will allow an individual to buy a decent dental plan out-of-pocket. Why not? They are not in business to lose money. They will lose plenty if a patient needs say $1,000 worth of dental care for each of five years, but only pays $300 premium per year. And who would pay $300 a year and not go to the dentist? No one. That is why they sell to large corporations where the odds are 10% of the population has dentures and won’t go to the dentist, 20% are too scared to ever go to the dentist, 30% are too busy to really take serious advantage of it, another 10% will balk at paying a co-pay, often being 50% of the cost of a crown, and yes, 20% will exceed their premium.
There are 2 major types of dental insurance plans:
- Dental Health Maintenance Plans (DHMO)
- Preferred Provider Plans (PPO)
DHMO stands for Dental Health Maintenance Organization which is like an HMO, but for dental care. It is also sometimes referred to as a DMO or Dental HMO. With DHMO plans, contracted dentists are paid a fixed amount (usually on a monthly basis) per enrolled family or individual. The dentists, in turn, provide some types of treatment to the patient at no charge, while for other treatments, a co-payment is required.
Advantages of DHMO plans:
- lower out-of-pocket costs
- little or no insurance paperwork for patients
Disadvantages of DHMO plans:
- the list of dentists you can choose from may be small and may also be limited to dental chains.
- their payment structures tend to provide incentives to dentists that may conflict with quality of care (for example ignoring problems because of being paid regardless, or suggesting treatments which require co-payment, even though a more conservative treatment might be better)
The above is not to say that it’s impossible to find quality care if you are utilizing a DHMO, but you may need to search to find it.
PPO stands for Preferred Provider Organization. These are plans under which patients select a dentist from a list of providers who have agreed, by contract, to discount their fees. In PPOs that allow you to choose a non-participating dentist, you will likely pay higher deductibles and/or co-pays. If you are an established patient with a dentist who is not on the list of preferred preferred providers for your plan, it’s worth talking with the dental office to see if they would be willing to honor the contracted rates for you.
Be aware that some services may be either poorly covered or not covered at all by your insurance company, and every insurance plan has its own exceptions, limitations, maximums, and fee schedules. Let your dentist explain the pros and cons of your options, and try and base your decision on what’s best for you in the long run (as long as you can afford it), rather than on what’s covered by insurance. This may mean having to space treatment out a bit.
If you will be using insurance (regardless of the type) to help you pay for your treatment, it can be very helpful to ask your dentist to submit a pre-treatment bill to your insurance company so that you will know exactly what your out-of-pocket costs will be for the treatment. This can’t usually be done in emergency situations, but normally only takes 1-2 weeks to process.
If finances are tight, you may want to look into local dental schools. You will be treated by dental students, who perform the treatment closely supervised by their instructors. Expect to pay about 20% – 60% of what you’d pay for the same treatment by a private dentist. On average, it’s about a third to half the cost, but this varies quite a lot from state to state. Some dental schools have a sliding-scale fee program based on the patient’s income – ask for their fee schedule to find out more.
- Generally inexpensive.
- Quality of treatment is generally excellent to superior, with the student getting checks at various points in the treatment.
- Patients appear to be generally happy with chairside manner.
- You can get free consultations with every dental specialty.
- Each appointment takes much longer because of the instructor checks, and because it takes practice to become fast at dentistry.
- There can be long waiting lists. Treatment may be very drawn out, over several years.
- At times, the students may stand in line waiting for an instructor.
- You can’t choose your dental student.
- You may be treated by more than one person.
- Your mouth may be looked at by a dozen different people.
To locate and get more info about dental schools near you, try Wikipedia’s List of Dental Schools in the United States by State. Or just use Google to find dental schools in your area.
CareCredit and Payment Plans
Care Credit specializes in loans for medical/dental care. If you can repay the entire cost of your treatment within a year, you do not have to pay any interest. Care Credit are very selective in who they give loans to, and you will need a good credit rating to be approved.
You still have to make a relatively small payment each month. If you do not pay the loan back in full in the 12th month, interest for the entire year is tacked on, and the interest is very hefty! So this option will only work if you can save up enough money within the year to repay in full, and if you can make the monthly payments.
Initially you must be referred by the treating dentist (in order to establish an account), but most dentists are glad to do that, because the company pays them immediately for the work.
The good thing about this option is that you can save money to pay for treatment over the course of a year, rather than having to pay upon completion of treatment.
If you are upfront with the dentist and tell them about your financial situation, you may discover that the dental office offers patients a payment plan through their office with little or no interest. It is always worth asking about this!
Dental Discount Plans
Due to the decline of traditional dental insurance over recent years, discount dental plans have become quite prevalent. Dental discount plans are also known as “referral plans”. You pay 100% of the rates negotiated by the dental plan company directly to your dentist – these discounted fees are about 10% to 60% lower than what a dentist normally charges, depending on the procedure and materials in question.
The dentist gets paid 10% to 60% less than they normally would, and the difference goes to the dental plan provider, for acting as a referral agent.
Some dentists participate simply because there is a lot of competition in their area and if they’re starting up a new office, they may feel forced to participate in dental discount plans to get new customers. Some dentists take discount plan patients hoping they will refer their next-door neighbors at full fee. In these cases, dental plans may work to your advantage.
Similar to DHMOs discussed above, dental discount plans are another situation in which the financial incentives for dentists don’t always align with quality care. This means you need to have your eyes wide open to ensure that quality of care is the dentist’s first priority.
Dental plans come with a membership card and a complete list of all dental procedures covered and what the discounted price will be. Unlike with dental insurance benefits, there are no claim forms, pre-existing condition checks, or paperwork hassles.
Many dentists are cynical about discount dental plans:
I know the USA dental market and your only safe space is the small office that doesn’t accept the cheap dental plans. – Ray Kimsey DDS, posted on our message boards
If you do decide you’d like a discount plan, you should choose it based on which plans the dentist of your choice accepts, NOT the other way round (don’t take out a discount plan and then see which dentists partner with that plan!). Some discount plans don’t even give you the list of participating dentists until you have signed up, so make sure you avoid these.
In the United States and Canada, you can call 211 to get information and referrals to relevant health, human, and social service organisations. Explain your situation and see what options may be available to you from local and national social service programs, governmental agencies and non-profit organizations 1.
Medicaid Dental Coverage
Medicaid-eligible people under the age of 21 are entitled to Medicaid Dental Coverage in all U.S. states. For people aged 21 and older, it varies from state to state. Most states provide at least emergency dental services for adults. You can call 211 to see what services are available in your state. If your children are covered under an Affordable Care Act plan, that plan is required to offer a dental plan for purchase for those children until they turn 19 years old 2.
Low-cost Neighborhood Clinics, Public Health Services, and Other Community Resources
Some communities have low-cost health clinics or similar organizations whose services also include dental care for people with limited resources. The Bureau of Primary Health Care, part of the Health Resources and Services Administration, has federally funded community health centers that provide dental care.
Charitable or Religious Organizations
You can check with your state dental board or call 211 to see if you are eligible for any programs in your area. Here are some examples:
- For victims of domestic violence there’s a scheme called “Give Back a Smile”.
- The Mission of Mercy also hold nationwide events where free dental care is provided. You can find a list of upcoming free dental clinics here.
- If you are elderly, disabled, or medically compromised, try the National Foundation of Dentistry for the Handicapped (NFDH) website, where you can find contact numbers and addresses for donated dental services in your area. More detailed information is available on our Special Needs and Dental Care page.
- Eldercare Locator is a service provided by the US Admin. on Aging. The site is designed to connect seniors with local resources (health, housing, care giving, SNAP, etc.). If you search by zip code it will show the local offices nearby.
- Remote Area Medical (RAM) Events: “I volunteered with RAM a couple years ago when they came to my city. My role was helping get people checked into the clinic. We only asked for general information. No ID was required, we gathered no insurance information and there were no restrictions. RAM events are open to anyone that shows up, including people from outside the county. For this reason they can get busy so they recommend showing up early.” (from our message board). You can find upcoming RAM events here.
Offering Services or Skills
Got a skill or service you can barter with? Tell or write to dentists in your area about what you can provide in return for dental treatment, or as a partial payment. Examples might include landscape design/gardening, website design, building/carpentry/plumbing, or anything else that would otherwise have a monetary value.
Borrowing Money from Relatives
There may be family members who are willing and able to lend you the money, or offer you a part time job.
You may also like:
How dental coverage works in different countries – from our message boards
Sources of Information