Elizabeth Risberg knows something about the cost of dental care, and not just because she works for a dental insurance provider. "I do a lot of public speaking," says the media relations manager. "I want my teeth to be perfect." Next month, she will get transparent Invisalign braces at a cost of nearly $6,000. Her dental insurance will cover $1,800, but no more—that's the plan's lifetime coverage cap on orthodontia.
Having planned ahead, she is using her flexible spending account—a special account set up through her employer that allows her to pay pretax dollars toward medical and dental costs—to help cover her portion.
Caring for your teeth can get pricey if a problem develops. The portion insurance companies will pay for orthodontic treatments like Risberg's, not to mention crowns and root canals, is often lower than the total cost.
Moreover, the number of people who have dental insurance pales in comparison with the number with health insurance. According to a surgeon general's report in 2000, about 108 million Americans lacked dental insurance. At the time, all but 44 million or so Americans had health insurance.
Still, experts say, dental care is generally a good bargain, even for those who pay out of pocket, since good oral health fosters overall health and wellness. "My big pitch for decreasing dental costs is to use preventive measures," says Anne Murray, a California dentist and a spokesperson for the Academy of General Dentistry. "Keep up on the recommended cleaning schedule (some people need more than two a year—just like some people need to work out more to stay in shape), and fix problems when they are small rather than put them off until they get to be bigger and more expensive."
If your employer doesn't offer dental benefits, consider purchasing an individual dental insurance policy. Like health insurance plans, typical dental plan options include traditional indemnity plans, preferred provider organizations, and health maintenance organizations. For those who need frequent dental care, says Jeff Album, director of public affairs for insurer Delta Dental, an HMO might be the best option because that type of plan offers "minimal out-of-pocket costs [and usually] no annual maximum" for preventive care. But HMO networks tend to be small, meaning members have to choose among a limited number of providers. Make sure any anticipated services—a certain type of filling, say, or cleanings by a favorite dentist—are covered before settling on any plan, says Diane Paletta, a spokesperson for the Academy of General Dentistry.
Those who can't obtain private insurance face a trickier battle. Some providers belong to discount programs and have agreed to charge those plans' members reduced fees. The website DentalPlans.com—which calls this approach an "attractive alternative to costly dental insurance " without the "hassle" of deductibles or claim forms—lists more than 30 such programs charging annual fees of $80 to $190 for individuals and families. Members get 10 to 60 percent off the cost of care at thousands of participating dental providers.
Medicare, Medicaid, or the State Children's Health Insurance Program may be an option, but coverage varies by state for the low-income programs Medicaid and SCHIP, and Medicare covers only dental services that are crucial to another covered treatment, such as jaw reconstruction following an accident. One alternative can be to go to a local dental school for reduced-cost treatment delivered by supervised dental students. Some so-called federally qualified health centers, which serve people regardless of insurance status, offer dental care and price it based on a patient's ability to pay. And some state and local health departments and the United Way offer information on free and low-cost dental care.
With or without insurance, paying for dental care can demand careful budgeting and resourceful payment strategies. Jocylen Ashton, 38, faced a large bill when she got braces to fix a gap and relieve crowding in her teeth. For previous dental work, "most of whatever I had done was covered by my dental insurance," says the San Jose, Calif., resident.
To pay her portion of the $3,000 bill for her braces, she turned to CareCredit, which offers a credit card accepted by more than 75,000 health providers. The company allows no-interest repayment for three to 18 months on balances of $300 or more, as long as minimum monthly payments are met; otherwise, interest charges accrue at a variable rate that's currently about 23 percent. Ashton will still have to pay the bill off, but she says it's well worth it for nicer teeth. "I saw it as a healthcare issue versus a cosmetic thing," she says. "It was something I could do for myself."