How to pay for your dental work

Dentistry can be expensive, especially when you need to have major work done. Yet only about 50 percent of Americans have private dental insurance to defray the cost, according to a September 2013 report by the Government Accountability Office. An additional 13 percent have coverage through Medicaid or the State Children's Health Insurance Program. An estimated 76 million Americans have no dental insurance.

For those with insurance, the amount covered has barely budged over the past several decades. According to the GAO study, the median maximum benefit was $1,500 in 2008 (the last year for which figures are available), about what it has been for the past 30 years. (The Patient Protection and Affordable Care Act eliminated the annual limit for people younger than 19 in most plans, but it still applies to everyone else.)

As with most medical coverage, there are co-pays and deductibles and your share goes up for more expensive procedures. For example, the AARP's Delta Dental B plan covers 80 percent of the cost of regular exams but only 50 percent of the cost of crowns, root canals, or oral surgery. Your insurer will cover only what it deems the "usual, customary, and reasonable," or UCR, charge, which might be much less than your dentist's fee.

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Consider the options available on your state's health insurance marketplace. Or investigate your Advantage plans if you're enrolled in Medicare.

Most preferred-provider-­organization plans have a large network of providers and cover 100 percent of expenses for preventive care, cleanings, checkups, protective sealants, and X-rays. Major services such as crowns and bridges are usually covered at 50 percent. A DHMO (dental health maintenance organization) usually has a smaller network of dentists, but members often pay less out of pocket for services.

Compare limits, monthly charges, co-pays, and deductibles of the plans that interest you. Find out whether your employer offers optional coverage; if so, compare its terms with plans you can buy on your own. If you're a veteran, check your coverage eligibility at the Veterans Affairs website. The exact coverage of dental services varies ­depending on your status—for example, whether you have a service-connected disability.

Before you buy any plan, add up what you usually pay for dental care annually. You might find that your out-of-pocket costs are less than it would cost you to pay for a plan.

Explore your options. If the bills are big, ask your dentist whether alternate treatments would work. Then call your insurance company to check coverage.

Do some haggling. If you don't have insurance or your policy won't pay for a particular procedure, ask for a discount. Start by looking at the "fair" prices in your area for your procedure at FAIR Health and Healthcare Bluebook. If your dentist charges more, negotiate. You can also ask about paying over several months.

Time your treatments. If you need an expensive procedure, ask your dentist whether you can space out the treatments so that you can apply the cost against two annual limits instead of one by starting near the end of one year and finishing in January.

Check out medical expense accounts. Ask whether your employer offers tax-­advantaged accounts to help save and pay for dental expenses not covered by its insurance, such as a health flexible-spending account (FSA) or a health reimbursement ­account (HRA). IRS Publication 969 has more details on the plans.

Try dental-school clinics. Almost every dental school offers affordable care by dental students and overseen by experienced teachers. You can expect to pay as little as a third of what a traditional dentist would charge. A list of schools is on the site of the American Dental Association.

–Mandy Walker (@MandyWalker on Twitter)