Americans aren’t going to the dentist, and it’s not just because we hate the drills. According to a 2016 Kaiser study, a third of Americans hadn’t seen a dentist in the previous year. Two out of five said they skip regular visits due to cost, according to a 2014 Harris poll for the American Dental Association.
The need is out there, but unfortunately many Americans can’t afford it. Prices for procedures vary widely depending on where you live, with a basic adult dental cleaning averaging just $95 in Des Moines, Iowa versus $205 in New York City, according to the Fair Health cost lookup site, which estimates prices based on your zipcode. Nationwide, a filling can cost anywhere from $145 to $205, while root canals range from $765 to $1075, according to a 2018 survey of 1,688 dentists conducted by the American Dental Association.
Even if you have dental insurance, you’re likely paying $168 to $384 annually in premiums, according to data from the National Association of Dental Plans, with the annual dollar amount the insurance company will shell out capped at $1000 to $2000 before you’re on your own.
It’s a grim financial landscape, but you shouldn’t have to choose between keeping your teeth and saving your bank account. What's more, oral health is closely tied to general wellness. “As long as you have more regular dental care, you end up with less dental disease and better oral health, which contributes to better overall health,” said Dr. David Preble, Senior Vice President of the Practice Institute at the American Dental Association.
To find out how to get dental care you can actually afford, I spoke to dentists, health advocates, and patients alike. Here’s what I learned:
Max out free care with insurance
If you work for a company that provides health insurance, chances are they offer dental coverage as well. But that doesn’t mean you can just go to any dentist and expect the bill to be covered. Before making an appointment, call the dentist office and ask if they participate in your dental network, then double check with your insurer.
Biannual cleanings are typically covered at no extra charge or with a small copay. If you need a more expensive procedure, however, you may bump up against your plan’s maximum, which means you’ll have to pay out of pocket for the rest. (If you have a health savings account or flexible spending account, however, you can pay the balance using pretax dollars.) To avoid any surprise bills, never agree to a procedure until you understand exactly how much you will be billed.
If you qualify for Medicaid, most states offer emergency services and basic diagnostic and preventative services like x-rays and cleanings. You can also usually get minor restorative procedures costing under $1,000 per person annually. But only 19 states offer more extensive, non-emergency services costing more than $1,000, according to July 2018 data from the Center for Health Care Strategies.
Help a dental student earn their degree
Another great option if you're not in a rush is to seek out a dental school. "Services are performed by dental students, under the supervision of practicing dentists, for a fraction of the cost of a typical cleaning and x-rays,” says Dr. Alexander George, a dentist in San Diego.
For example, New York City College of Technology, a City University of New York school that trains dental hygienists, offers cleanings for $20. The downside is, it takes a long time, with appointments lasting for approximately three hours. At New York University’s dental clinic, an initial appointment including an examination and treatment plan will cost approximately $120 and requires a similar time investment. To find a dental school offering discounted care in your area, just search on the name of a university near you, like the University of Pittsburgh, A.T. Still University in Mesa, Arizona, or the University of Minnesota in Minneapolis.
Laura Pisoni, a graduate student in religion who uses NYU’s Dental School clinic for crowns, says the extra time involved is worth it. Although she has dental insurance through her school, it’s not enough to cover the price of multiple crowns; the lowest quote she got from other dentists was $800 per crown, and that was after a $1,000 root canal. “I’m saving a few hundred dollars per crown,” she says. Appointments take 45 minutes to two hours, and she’s had to go four times. “There is a dental professor who oversees the work, but the student who is seeing me is extremely competent.”
Do the math on discount plans
Some dentists aim to lower costs for patients by offering membership plans that come with an annual fee ranging anywhere from $75 to $150 in exchange for discounts of 10 to 60 percent on cleanings, x-rays, root canals, crowns, fillings, and teeth whitening.
If you don’t have dental insurance or have maxed out your in-plan benefits, these plans can save you money. But before you sign up, do the math to make sure it’s the right choice for your specific dental needs. If you only go once or twice a year for a cleaning, the plans could actually wind up costing you more than paying out of pocket. For example, if you pay $100 up front and only get 10 percent off two annual cleanings worth $100 each, you’ll actually wind up paying $80 more than you would without the “discount.”
Talk to your dentist
If insurance won’t cover the cost of dental work, it’s wise to be upfront with your dentist about what you can afford and negotiate based on that. “If you max out [on insurance] my advice is to talk with the dental office and see if they are willing to do a payment plan,” said Dr. Zara Omar, a dentist in private practice in New York City. “Maybe the office is willing to barter services—you won’t know until you ask.”
You’re more likely to have success with this approach with a dentist you’ve already seen regularly: “For my own patients with whom I have a relationship, I will offer a discount or a payment plan or find some other accommodation,” said Dr. Beth Caunitz, a dentist in New York City. “I feel that this is part of the dentist-patient relationship.”
Get to know a non-profit
When all else fails, consider looking into government-funded or non-profit organizations offering free or low-cost dental care. This directory from NeedyMeds lists nearly 4,000 low-cost dental clinics across the country. Here are three other options worth checking out:
Community-based health care providers (known as federally qualified health centers) receive federal funding to provide low-cost primary care and dental care to underserved communities. You can use this directory to search by zip code.
Donated care, which you can find by contacting local dental societies, the local and state chapters of the American Dental Association, and Dental Lifeline Network, which provides donated services to seniors, disabled Americans, and others with complex medical needs.
Mission of Mercy, a non-profit organization operating in Arizona, Maryland, Pennsylvania, and Texas, that offers free fillings, x-rays, and extractions. The group’s mobile clinics serve “the folks who are falling through the cracks of the healthcare system,” Executive Director Linda Ryan said.
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