A guide to dental coverage for infants and children
Posted on February 18, 2021 in Children’s Oral Health
When a child is born, getting medical coverage is a priority. But it’s also important to have dental coverage, too. This guide to dental coverage for children helps provide everything you need to know.
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,1 so consider getting dental coverage 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.
Unfortunately, children can 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.2 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.3 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 coverage are twice as likely to receive dental services than those without it.4 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.5
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-coverage or co-payments (i.e.; the percentage or share you pay for a procedure), and make sure your dental benefits provider 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.
Future needs to consider
Your children’s permanent teeth will begin to come in around age 6. Coverage for dental sealants is vital at this time because permanent back teeth (molars and premolars) should be sealed right away.
Around age 7 your dentist may suggest your child visit an orthodontist to assess future needs. If your child is likely to need braces, you may want a plan that partially pays for major dental work and orthodontics.6
How to get coverage
- 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 Delta Dental of Illinois here.
- Medicaid or the Children’s Health Insurance Program (CHIP): These state-funded plans are available to low-income families.7
Additional resources
Looking for more information? Learn more about dental coverage.
What dental benefits do and don’t do
How to choose a dental plan
1https://www.mouthhealthy.org/en/az-topics/b/baby-bottle-tooth-decay
2Impact of early childhood caries on quality of life: Child and parent perspectives. Singh N, Dubey N, Rathore M, Pandey P J Oral Biol Craniofac Res. 2020 Apr-Jun;10(2):83-86.
3https://www.cdc.gov/nchs/products/databriefs/db307.htm#fig1
4https://jada.ada.org/article/S0002-8177(16)30904-7/fulltext
5https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html
6https://blog.getinsured.com/answers/health-insurance-basics/cc-pediatric-dental/
7https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/