Dental Insurance Doesn't Always Cover Full Costs

Even with dental coverage, patients often face high out-of-pocket expenses for care.

Apr. 3, 2026 at 2:10pm

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A highly detailed, translucent X-ray image of a human molar tooth, revealing the intricate internal structures and highlighting the specialized nature of dental care.An X-ray view into the complex inner workings of a tooth, underscoring the specialized care required even with dental insurance coverage.Today in Nashville

Despite having dental insurance, many patients still face high out-of-pocket costs for dental care. Dental plans typically cover routine preventive care like cleanings and exams, but only pay a portion of additional procedures like fillings, root canals, and crowns. Dental plans also often have annual maximum payouts, leaving patients responsible for costs above that limit. Experts recommend being upfront with dentists about what you can afford and exploring options like payment plans, dental schools, or community health centers for more affordable care.

Why it matters

Dental care can be a significant expense, even for those with insurance. Understanding the limitations of dental plans and finding ways to manage costs is important, as unaffordable dental bills can lead people to delay or forgo needed care, which can lead to more serious and expensive problems down the line.

The details

Dental plans generally follow a '100/80/50' coverage model, paying 100% for preventive care, 80% for basic procedures, and 50% for major work. Plans also typically have annual maximum payouts, often between $1,000 and $2,000, leaving patients responsible for costs above that limit. Patients are encouraged to be upfront with dentists about their budgets and explore options like payment plans, dental schools, or community health centers for more affordable care. Maintaining regular dental visits and good oral hygiene habits can also help prevent more costly problems from developing.

  • Russell Anthony had a root canal last week that cost $500.
  • The week before, Anthony had a crown that cost several hundred dollars.
  • As of the report, Anthony has a broken tooth and needs to see the dentist soon.

The players

Russell Anthony

A 65-year-old retiree in Nashville, Tennessee who has dental insurance but still expects to pay around $2,000 for dental care this year.

Cara Anthony

The host of the HealthQ health series and Russell Anthony's niece.

Sarah Olim

A general dentist in Katy, Texas who encourages patients to visit the dentist regularly to catch problems early and keep costs down.

American Dental Association

Reported that 77% of adults in the U.S. had dental insurance in 2021.

KFF

A health information nonprofit that includes KFF Health News, which conducted a 2023 survey finding that 1 in 4 adults with dental insurance reported costs as a barrier to care.

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What they’re saying

“Trying to weigh the cost of when to go to get dental care and paying for it, versus the other needs that I have, is something that's very important.”

— Russell Anthony

“The best thing that you can do to mitigate the cost of going to the dentist is make sure that you are going regularly and trying to take care of things early.”

— Sarah Olim, General Dentist

What’s next

Patients should continue to monitor their dental health and be proactive about scheduling regular check-ups, even if they have dental insurance. They should also be upfront with their dentists about their budgets and explore options like payment plans, dental schools, or community health centers for more affordable care.

The takeaway

Dental insurance provides important coverage, but it does not fully protect patients from high out-of-pocket costs for dental care. Understanding the limitations of dental plans and finding ways to manage expenses is crucial, as unaffordable bills can lead people to delay or forgo needed treatment, potentially leading to more serious and costly problems down the line.