Kids Dental Insurance: The Ultimate Guide

Kids Dental Insurance
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Finding dental insurance for yourself is difficult enough, but you have to make sure your kids are covered too. After all, according to the Chicago Dental Society, tooth decay is the most chronic disease in children.

Making sure your kids get coverage for the routine dental care they need is a great step toward keeping them happy and healthy.

Things to know about kids dental insurance

The top benefit of dental insurance plans for kids is that they help you provide your kids with preventive care and manage costs. Parents should know a few other things about this kind of coverage before enrolling in dental plans for children.

Here are the top six tips.

Consider your options carefully

Finding the right dental insurance for kids requires planning and consideration. Parents may be interested in balancing the extent of coverage, network providers, deductibles, copays and premiums. Coverage varies among plans and carriers, making thorough research essential.

If you want the benefits of embedded or supplemental dental insurance to gain this coverage for your kids, examine your options to determine what each plan includes. Consider your kids’ ages, dental needs, and even family history to determine which coverage options can benefit them the most.

It can also be helpful to compare health insurance companies and their coverage.

Start early

Preventive care gives kids a healthy foundation for life. Regular dentist visits help catch potential issues before they become more severe problems that could be expensive to resolve. Giving your kids good dental care early in life sets them up for a lifetime of healthy teeth. Establishing a dental routine helps kids continue these healthy habits as they age.

As soon as baby teeth start arriving — around age 6 months old, according to the American Dental Association — it’s time to consider getting dental insurance for your child. These baby teeth can develop cavities, so it’s essential to properly care for teeth from the time they come in until your kids get their adult teeth.

The Centers for Disease Control and Prevention recommend taking babies to the dentist as early as their first birthday. Getting dental insurance for your kids before their first dentist visit covers the cost of these visits and provides additional services that benefit them.

Get coverage even without insurance

If you’re unsure whether purchasing dental insurance for your kids is the right option for you, you have other options for making their dental care more affordable. These insurance options may not offer the same level of coverage as other dental plans for kids and may have income eligibility requirements.

  • Medicaid and CHIP: Medicaid and the Children’s Health Insurance Program offer low-cost or free health insurance for kids up to 19. This coverage includes dental care services like checkups, sealants, fillings and X-rays. Parents can check their family’s eligibility to determine whether this coverage is an option.
  • Dental discount plans: Dental discount plans are a membership with an annual fee that allows members to access lower prices on dental services. A dental discount plan isn’t insurance, but it can significantly reduce the cost of visits for those who don’t have coverage.

Consider group health insurance

As mentioned earlier, the ACA requires all healthcare plans offered in the Marketplace to include pediatric dental services as part of the 10 essential health coverage categories. The regulation applies to individual markets and small-group insurance provided through employers with 50 or fewer employees.

Many parents access these dental services for their kids through a family plan their employer offers. If your employer offers insurance, learn about the pediatric dental services it covers by contacting your human resources department.

Even if parents don’t have access to an employer-sponsored plan, they can purchase a family insurance plan to gain this kind of coverage. All Covered California dental plans for California families include children’s dental insurance and cover:

  • 50% of major services
  • 20% of basic services
  • 50% of coinsurance on children’s orthodontics after meeting the deductible
  • X-rays, oral exams and tests
  • Periodic cleaning and other preventive costs like sealants

These costs count toward the health plan’s maximum out-of-pocket expenses. As an essential health benefit, dental coverage for kids is also subject to the same regulations as the plan’s medical deductible.

Look for adequate coverage

If purchasing supplemental coverage, parents should look carefully into the kinds of services each plan provides. California insurance for kids varies among health insurance companies, with some plans only covering cleanings. Parents should determine which plan offers the coverage they want for their children. A comprehensive dental plan for kids should include:

  • Periodic teeth cleanings
  • Dental X-rays and exams to prevent or find potential issues early
  • Recognition of any bite issues
  • Identification of the possible need for braces
  • Emergency dental services for accidents involving teeth or toothaches
  • Fluoride treatments for cavity prevention
  • Advice on proper brushing, flossing and nutrition

Choose between two types of coverage

Various insurance plans work differently. Parents of kids needing dental coverage should take the time to learn about their options. Dental insurance for kids comes in two basic types.

  • DMO: A dental maintenance organization is a type of dental coverage from a primary dental physician. These care providers coordinate dental care and can refer patients to specialists as needed. A DMO plan only covers providers from within your network except by referral.
  • PPO or PDN: A preferred provider organization or participating dental network plan offers patients more flexibility in seeing providers outside their network. With this plan, patients choose the dentist they want to provide their dental care, and their coverage goes with them.

When and why to get coverage

Babies usually start getting teeth around 6 months of age and cavities can develop as quickly as teeth appear, so consider getting dental insurance as early as possible. Your dentist will check to see if your child’s smile is off to a good start and provide useful information about dental disease prevention, nutrition, and dental development.

Children can also develop cavities by their first birthday. Childhood cavities can cause pain, difficulties eating and speaking, and infections that can damage permanent teeth developing underneath their gums. If these cavities are severe or extensive, very young children may need to be treated in a hospital while under general anesthesia. This can have an emotional and financial effect on parents.

By age 5, more than 20% of children have had cavities and almost 10% have untreated decay. Poor dental health in childhood is likely to carry into adulthood. Fortunately, most childhood dental disease is preventable through good oral hygiene, proper nutrition and regular dental visits.

Dental insurance makes care more affordable and children with dental insurance are twice as likely to receive dental services than those without it. And a healthy smile is even important for learning, as students with poor oral health usually have lower grades and are absent more often than those students with good oral health.

Do you need dental insurance for a newborn?

You don’t need dental insurance for your newborn since it will be a while before they need to see a dentist – at least six months to a year. Still, it can be a good idea to look into dental insurance while your child is still a newborn, so you’re covered before the baby’s first appointment.

Before that time, you can help keep your newborn’s mouth healthy by cleaning their gums with a damp washcloth after feeding.

When do babies need dental insurance?

It’s recommended that your baby sees a dentist by their first birthday or within six months of getting their first tooth (whichever comes earlier). Babies usually start teething when they’re about 6 months old – but a baby’s first tooth can show up earlier or later.

Your baby’s first dental visit will mostly be about getting them used to the dentist and teaching you how to care for the baby’s teeth. Your baby’s second dental visit will likely be when they’re two years old. After that, your child should start seeing a dentist every six months, like older children and adults.

When to add your child to dental insurance

It’s a good idea to have dental insurance for your child (pediatric dental) by the time your child goes to the dentist for the first time – which is usually when your baby is about 1 year old.

Routine dental visits help to make sure your child’s teeth are coming in as expected and that they look healthy. These preventive visits are usually covered at 100% by most pediatric dental insurance plans.

Dental insurance may be even more valuable as your child gets older if you have dental plan coverage that helps with the cost of fillings for cavities and other dental services.

How do dental insurance needs change as your child gets older?

As kids get older, coverage for preventive care can be especially important in managing dental costs. Once your child is two years old, they should have a checkup and cleaning every six months. When they turn 4 years old, they will begin to need additional preventive services like X-rays (the first set is usually taken when they’re 4 to 6 years old) and sealants to protect against cavities (usually when they’re 7 to 9 years old).

There’s also a chance that you could save money on dental care if your child has coverage for basic dental treatments like fillings. While regular dental checkups and proper teeth brushing help prevent cavities, they still happen. According to the National Institute of Dental and Craniofacial Research, about 25% of children between 2 and 5 years old have cavities in their baby teeth. 17% of kids between 6 and 11 years old also have them in permanent teeth.

What to look for in coverage

Coverage varies among plans. As you compare plans, make sure you review what is and isn’t covered. Consider your children’s ages and their needs over the next year. Look for plans that cover all or most of the cost of preventive care (exams, cleanings, X-rays) and basic care (fillings, tooth extractions).

Most plans cover fluoride treatments and dental sealants for cavity prevention in children but check to make sure that they are included.

Add the total potential costs, including deductibles, out-of-pocket limits and co-insurance or co-payments (i.e.; the percentage or share you pay for a procedure), and make sure your dental insurer has a large network of dentists, including pediatric dentists and specialists.

To take full advantage of in-network savings, see if your preferred dentist is in-network.

How to get kids dental insurance

  • Employer coverage: If you or your spouse have a dental plan through your employer, you may be able to get a family plan during open enrollment. Also, having a baby is a qualifying life event, so you can add your newborn to your benefits within a period determined by your plan.
  • Individual and family coverage: You can purchase a plan to fit your family’s needs from companies.
  • Medicaid or the Children’s Health Insurance Program (CHIP): These state-funded plans are available to low-income families.

Do my kids need dental insurance?

Children need routine dental care, and some form of dental insurance coverage can make that dental care more affordable.

According to the National Center for Chronic Disease Prevention and Health Promotion, of kids 6-11, 17% have cavities. Of children 12+, 57% have cavities with 17% of those cavities going untreated.

Untreated cavities can lead to things like tooth loss and speech problems. All of these issues are preventable with proper dental care and hygiene – both of which can be made affordable with insurance.

If you get insurance through work, you may receive coverage through your health insurance or dental plan. Check with your benefits department if you have questions about your benefits.

Not only does getting your kids the care they need create a healthy start, but it will also help create good habits around dental hygiene for years to come.

What if your child doesn’t have dental insurance?

Having dental coverage for your kids is great for peace of mind, knowing it’ll help pay for needed care. Dental insurance for your child generally pays for itself since your yearly premiums are less than the cost of the two dental checkups your child should get each year. It is especially worth it when your child needs X-rays, sealants or fillings for cavities.

However, even if your kid doesn’t have dental insurance, seeing a dentist can still be affordable. The cost will vary by dentist, but it can be between $50 -$200 per visit for a routine exam and cleaning. But if you don’t have pediatric dental coverage, don’t shy away from the dentist. Many people find that regular dentist appointments for kids are affordable when they budget for them.

Some dentist offices also offer discounts and payment plans for people without dental insurance.


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