No Insurance at 26 - Finding Affordable Dental Care When Coming Off Your Parents' Insurance

April 23, 2019

11.20 - PM

According to the Centers for Medicare and Medicaid Services, nearly 30 percent of young adults in the United States were uninsured in 2010 when the Affordable Care Act established that individuals up to 26 years of age could join or remain as dependents on their parents’ insurance. The most recent statistics from the U.S. census indicate that number has dropped to about 25 percent, with one quarter of all uninsured Americans being aged 25 to 34. While the overall number of uninsured people is significantly lower now than it was in 2010, there are still millions of young Americans facing the need to find affordable dental care — many for the first time in their lives.

If that describes you or someone you care about, the following ten tips should help ease your mind and provide some direction for what you can do right now to help resolve this situation without destroying budgets.

We’ll begin by considering practical ways young adults who aren’t yet 26 can prepare for the inevitable change that will occur on their birthday. Then, we’ll look at what options are available for obtaining new insurance and exploring insurance alternatives. Finally, we’ll consider some practical tips everyone can put into practice to keep dental care as affordable as possible by maintaining excellent oral health.

Related Content: Dental Savings Options for Uninsured Employees

Practical ways to prepare

Prepare for affordable dental care

Modern dental care in the United States is constantly evolving and improving. Dentists today have access to tools and techniques that would blow the mind of their predecessors just 30 years ago. But, the other side of that story is this:

Dental care costs a lot.

A look through CostHelper’s dental health hub could ruin your appetite if you’re not familiar with the current retail cost of even routine dental services. But, do it anyway. If you’re almost 26, you need to know.

Under current regulations, short of a disability requiring the intervention of a court-appointed legal guardian, there’s no way to remain as a dependent on your parents’ insurance beyond your 26th birthday. So, if you still have time, preparation is the best first step.

Set up a realistic budget

Most young adults coming up on 26 are either still pursuing an advanced degree or just a year or two out of college. Even those who entered the workforce early are only a few years into their careers (if they’ve actually chosen a career at all yet). Understandably, very few of them are making a lot of money. In fact, a survey published by Business Insider indicated the median income of “independent Americans aged 18-35 ranged from $18,000 to $43,000 in 2015. Depending on where they lived, those figures put the average Millennial in the lower middle class at best.”

So, there are not a lot of disposable funds floating around and decisions need to be made. Unfortunately, paying for dental care is often overlooked or actively rejected, especially if they’re not experiencing any current oral health issues. But, that’s a mistake that can become more costly the longer it continues.

A smarter option is to consider it a necessary expense and include money for appropriate dental care as part of a realistic budget. This will require self-discipline to save money for the recommended semi-annual cleanings and exams, and potentially additional savings for treatments or restorations as needed.

Get in the know

It’s also vital for you to do your due diligence by researching what it takes to care for your oral health and what options are available to you for doing so, especially if this is the first time you’ve had to consider these subjects. Reading this article is an excellent first step, but don’t let it be the last!

Here are a few things you’ll want to look into as you start to learn:

  • What is the current status of your oral health?
    • Do you have any ongoing issues that need to be addressed? (Are you currently wearing braces, or do you know you have an untreated cavity?)
    • Have you had any dental work done in the past that will require checkups?
  • What has your dental care pattern been up until now?
    • Have you gone to the dentist every 6 months for as long as you can remember? Or, are you having a hard time putting your finger on when your last visit was?
  • Which dentist has your most recent dental records?
    • Are they still convenient for you to visit regularly?
    • Do you even want to keep going there? Do you have a good relationship with the dentist and their staff?
  • How has your oral health care been paid for in the past?
  • What dental care resources are available near me?
    • We’ll cover examples of these below, but the most important consideration is locating a dentist’s office that’s convenient to where you live or work, and where you feel comfortable.

Armed with the answers to those questions, you’re in the best position to start pursuing your own dental care journey.

Obtaining insurance through an employer

dental insurance

If you’re employed when your 26th birthday rolls around, your first and most obvious consideration should be looking into what your employer offers for dental insurance.

The Affordable Care Act (aka Obamacare) legislation mandates that the Marketplace offer plans with dental coverage for children. However, the law does not require dental coverage be included in comprehensive health plans for adults.

As a result, only about 1 percent of medical insurance plan options in the Marketplace include dental coverage for adults. This means enrollees who want dental insurance need to select a standalone dental option and pay a separate, additional premium. Following the priorities set by the insurance companies and the government, many employers don’t contribute much (if anything) toward these dental insurance options.

This may not be the case with your job, of course, so contact your HR office or go online and check out the options available to you. If you’re able to obtain quality dental insurance at an affordable price through your employer, that’s an excellent option to pursue. In most cases, these plans will cover preventive care — a semiannual professional cleaning and examination, and annual bitewing x-rays — at little or no cost beyond your premiums. More advanced procedures like root canals, extractions, fillings, or restorative work are usually partially covered with limitations.

As part of your research into dental insurance options, it’s important to understand how the plans work. It’s never as simple as “sign up and everything’s covered.” Rather, insurance plans will include some or all of the following details to carefully compare:

  • Premiums - The price you pay to obtain insurance coverage. If you’re getting coverage through your employer, this usually comes out of your paycheck as a pre-tax withholding, so your annual premium is split up into many small payments and spread throughout the year.
  • Waiting periods - An amount of time after you join the plan before services can be covered. This isn’t a part of all plans, and when it is included, it’s usually between 30 and 90 days.
  • Deductibles - The amount you need to pay out-of-pocket (OOP) for covered services before the insurance starts covering the cost. Generally, the higher the deductible, the lower the premium cost of the plan. Oftentimes, preventive services do not count toward the deductible, so you won’t need to pay out-of-pocket for them even if you haven’t yet reached your deductible for the year.
  • Copays - The amount you are responsible to pay the dentist’s office at the time of service. In most cases, these are minimal fees like $10 or $20 for office visits. They count toward your OOP maximum, but may not count toward your deductible.
  • Coinsurance - The amount you are responsible to pay toward covered services once the plan starts paying its share. Again, this will normally apply only to advanced services, not preventive. It is usually expressed as a percentage. For example, “coinsurance of 20 percent” means that, after you have reached your annual deductible, the plan will cover 80 percent of the cost of covered services (minus any applicable copay) and you will be responsible for the remaining 20 percent of the bill.
  • OOP maximums - A cap on the amount of money you will be required to pay out-of-pocket for dental services while covered, after which included services are covered completely by the plan. This running total usually includes everything you pay in copays, toward your deductible, and coinsurance throughout the coverage period.
  • Maximum payouts - A cap on the amount of money the plan will pay toward covered services. Most dental plans include a fairly low maximum benefit, such as $1,500.
  • Coverage limitations - A list of dental care services the plan will not cover. Plans vary, but these limitations often include things like oral surgery, cosmetic restorations, and some or all orthodontia.

So, although your employer may offer one or more options for dental insurance, it’s best to thoughtfully compare the full actual cost of the plan in terms of how you can realistically expect to use it.

A quick way to get a general idea of the value of a given dental insurance plan is to do the following math:

Total Premiums + Deductible = Guaranteed OOP

Copay x expected number of visits = Total Copay

Guaranteed OOP + Total Copay = Minimum Cost of the Plan

If you have ongoing dental issues that you know you’ll need addressed during the coverage period, add the following calculation for each expected service:

Average cost of needed service x Coinsurance = Additional OOP

Finally, put it all together:

Minimum Cost of the Plan + (Additional OOP) = Total Cost of the Plan

That Total Cost of the Plan is what you’re probably going to actually pay during the year of coverage. Now, keep that figure in your back pocket as we discuss some other alternatives to dental insurance because, in many circumstances, you could end up paying less overall by choosing not to join an insurance plan for your oral health care.

Viable alternatives to dental insurance

dental insurance alternatives

Carrying the above math just a little further, you’ll want to evaluate the options below based on what you can reasonably expect your OOP cost to be. Is the total amount you’re going to pay for adequate insurance coverage, plus the amount you’re responsible for to take advantage of that coverage, less or more than you would pay by using an alternative?

Some individuals will find that the combined premiums, deductibles, and copays involved in some dental insurance plans end up costing more over the coverage period than what it would have cost to simply pay out-of-pocket for the same services, or to take advantage of a dental discount program. This depends, to a large extent, on the retail cost of dental care in your area and the availability of alternative options, so let’s look into those now.

Low- and no-cost clinics

Dental clinics are available in most population centers, although they’re not always the easiest thing to find and take advantage of. They are generally staffed by local dental professionals who are volunteering their time (or receiving a drastically reduced rate) to serve individuals in the community who otherwise may not receive the dental care they need. In some cases, patients must meet certain requirements to be eligible to use the clinics. In other cases, they operate on a sliding fee schedule that is based on your income or other factors.

If you’re not already aware of one or more clinics in your area, check out our list of local resources for affordable dental care. You should be able to use those links to locate what’s available near you.

While visiting a free or low-cost dental clinic provides the benefit of professional care at very low cost, it’s important to consider the tradeoff:  most of these offices are inundated with patients. As a result, they may have waiting lists that extend months. That could mean postponing care you need. Also, since they depend on volunteer help from dental professionals who likely have full time jobs, they may have odd or less structured office hours than you’re used to. So, you may end up needing to settle for a highly inconvenient appointment.

If you qualify to visit a low-cost clinic and are willing to work around minor inconveniences, you can expect quality service at a highly competitive price.

Negotiating fees with private dental offices

If you’re comfortable doing so, you can consider approaching your chosen dentist’s office and trying to negotiate discounted fees for the services they offer.

This is a viable option in many cases because, although they are healthcare providers first and foremost, most dentists own a small business, or are in partnership with a small number of other dentists to operate the office they work in. As such, they do need to compete with other offices in the area, and gaining or maintaining customers is vital to their success.

Whether you’re hoping to arrange a permanent discount in exchange for starting as a new patient, or wanting to reduce the cost of an advanced procedure they’ve recommended, all you can do is ask. Be aware, though, that they also need to be concerned with the cost of operating a dental practice, along with constant changes to the insurance landscape. For that reason, dental professionals may not always be willing to negotiate their fees on a case-by-case basis.

Dental discount programs

On the other hand, many dentists are willing to accept significantly discounted fees if they can be assured enough patients will be coming in for services to offset the lower amount each patient pays. That’s where dental discount programs have proven to be a highly beneficial option for those without dental insurance.

The basic premise of a dental discount program is this:

You pay a low monthly membership fee to join the plan. In exchange, you get access to a list of providers who have agreed to slash their normal retail fees by as much as half for members of the plan. You make an appointment and visit the office as you normally would, the discount is automatically applied to your bill, and you simply pay the remaining balance directly to the provider.

The dentist benefits because they’re potentially able to serve many patients that otherwise may not have been able to afford their services, and they’re being paid directly rather than needing to file innumerable insurance claims and wait weeks or even months for payment.

The patients benefit because they’re receiving the same high quality services at a greatly reduced cost without having to jump through hoops or settle for inconvenient appointments. Since the monthly or yearly membership fees for these programs can be as low as $10 per month, they can often be the best financial decision for individuals without dental insurance. In fact, depending on the services obtained and the details of the plan, a dental discount program can even cost less overall than paying for dental insurance coverage.

To join the Dental Solutions discount program, click here.

Preventive habits that promote excellent oral health

oral health self care

The final key to keeping dental care affordable when you come off your parents’ insurance is to make sure you need as little professional help as possible maintaining your oral health. That means focusing on preventive care at home by establishing strong habits.

No one is labeling anyone, but college kids do stereotypically have a bad reputation for prioritizing the wrong things when it comes to their personal habits. Understandably, there are a number of factors working against you, which helps explain why college students make oral care mistakes pretty regularly:

  1. Your schedule is full.
  2. Your wallet is empty.
  3. You feel physically invincible.

Of course, none of those statements are completely true.

  1. With some prioritizing and slight adjustments to your schedule, you can find some extra time to take care of your teeth. (Honestly, it only takes a few minutes a day, plus an hour or so every six months to take care of the basics.)
  2. Your funds are likely limited, but that’s what this entire article has been about. Again, with some slight adjustments and, perhaps, a needed change in priorities, you can afford to maintain your oral health.
  3. Take a deep breath and sit down… You are not invincible.

To take care of your oral health as best you can at home requires a simple two-pronged approach:

  1. Nutrition
  2. Self-care

Eat and drink with your oral health in mind

As you’ve no doubt heard a thousand times, you are what you eat. The more scientists learn about nutrition, the more clear it becomes that eating healthy isn’t just something overweight people need to be concerned with. The impact nutrition has on your oral health is a perfect example. It’s not just a matter of avoiding soda and sticky candy (although that’s certainly important), there are also a number of vital micronutrients that your teeth need to stay strong, healthy, and resistant to damage or decay.

Here’s a list of 19 foods that are great for your teeth

Alcoholic beverages can also have a strong negative impact on your oral health. But, you don’t need to swear off of all booze all the time. You just need to understand what its effects are, and what you can do to mitigate the risk.

Here’s a list of the best and worst alcoholic drinks for your oral health

Even the way you chew can either help or hurt the health of your teeth and gums. A lot of these impacts come from the way your mouth’s chemistry changes as you eat. So, give your nutrition some thought and, if you need to, consider making some small adjustments over time to establish better eating habits that can help maintain your oral health.

Self-care habits for excellent oral health

Finally, we’ll spend just a moment telling you what you probably already know: you need to brush and floss your teeth everyday if you want to keep them. And, if you want to avoid spending far too much on dental care in the near future. We won’t belabor the point, but it’s important to understand how vital these simple habits are and how to do them correctly.

Take our interactive quiz to see if you’re making any of the most common mistakes while maintaining your oral health

  1. Brush your teeth for at least two minutes, at least twice a day.
  2. Floss your teeth at least once a day, or whenever necessary to remove food particles.
  3. Rinse with an antibacterial mouthwash at least once a day.
  4. Stay well hydrated, especially immediately after eating.

If you’re keeping up with these very basic, but vital, self care habits you’re far less likely to run into the unexpected dental issues that cost the most to resolve. Combined with regular visits to your dentist for cleanings and examinations, you should be able to maintain excellent oral health for life.

Keep Your New Dental Costs Under Control


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