Learn How AARP Dental Plans Work Today

What AARP Dental Plans Cover and How They Work

AARP offers dental insurance plans through partner companies, primarily through Delta Dental and other carriers. These plans function differently than regular health insurance. When you enroll in an AARP dental plan, you pay a monthly premium, and in return, the plan covers a portion of your dental care costs. The plan pays its share, and you pay your share, based on the plan's structure.

Most AARP dental plans fall into one of two categories: preferred provider organization (PPO) plans or dental health maintenance organization (DHMO) plans. PPO plans give you more flexibility to visit any dentist, though you'll pay less if you use dentists in the plan's network. DHMO plans typically require you to choose a primary dentist and use network providers, but they often have lower monthly premiums and simpler out-of-pocket costs.

Coverage typically includes preventive services like cleanings, exams, and X-rays. Many plans cover these at 100 percent after you meet any deductible, or sometimes with no deductible for preventive care. Basic services like fillings and extractions are usually covered at a higher percentage than major services. Major services such as crowns, bridges, and root canals are often covered at 50 percent of the cost.

The plans operate through a network of dentists who have agreed to accept the plan's payment rates. When you visit a network dentist, the billing becomes simpler because the dentist knows the plan's payment structure. If you visit a dentist outside the network, you may pay more out of pocket, and the plan may reimburse you at a lower rate.

Practical takeaway: Before enrolling, review what specific services the plan covers and at what percentage. Check whether preventive care requires a deductible and understand the difference between network and out-of-network costs. Request a copy of the plan's coverage schedule from the insurance company.

Understanding Costs: Premiums, Deductibles, and Copays

AARP dental plans involve several types of costs that work together. Your monthly premium is what you pay regardless of whether you use dental services. As of 2024, AARP dental plan premiums for individuals typically range from $15 to $30 per month, though some plans cost more depending on coverage level and your location. This premium goes to the insurance company regardless of dental visits.

The deductible is the amount you must pay out of pocket before the insurance plan begins to pay its share. Not all plans have deductibles, and deductibles may vary by service type. For example, a plan might have no deductible for preventive services but a $75 deductible for basic and major services combined. Some plans have separate deductibles for different service categories. After you've paid your deductible for the year, the plan starts sharing costs with you.

Copays or coinsurance represent your share of the cost after the deductible is met. With copay plans, you pay a flat fee per service (for example, $20 per cleaning). With coinsurance, you pay a percentage of the cost. A plan might cover preventive care at 100 percent, basic services at 80 percent, and major services at 50 percent. This means if a crown costs $1,200, you'd pay $600 and the plan would pay $600.

Many AARP plans include an annual maximum benefit, which is the highest amount the plan will pay in a calendar year. Common annual maximums range from $1,000 to $2,000. Once the plan reaches its maximum payment for the year, you pay 100 percent of any remaining dental costs. This is important to know if you plan major dental work.

Example: If you're enrolled in a plan with a $1,200 annual maximum and you've already received $1,100 in plan payments for the year, the plan will only pay $100 toward any remaining dental services that year. You would pay the rest.

Practical takeaway: Calculate your potential annual dental costs by estimating how often you visit the dentist and what services you typically need. Add the monthly premiums for the year, plus typical deductibles, plus your percentage of common procedures. Compare this to what you might pay without insurance.

Network Dentists Versus Out-of-Network Dentists

AARP dental plans maintain networks of dentists who have contracted with the insurance company to provide services at negotiated rates. Using a network dentist offers several financial advantages. Network dentists have agreed to accept the plan's fee schedule, which means they won't bill you for the difference between their usual charge and what the plan pays. The network dentist sends the claim directly to the insurance company and bills you only for your share.

When you receive dental care from a network dentist, the financial arrangement is clearer. For example, if the plan's fee schedule says a cleaning is worth $120 and the plan covers preventive care at 100 percent, you pay nothing. A network dentist won't charge you extra even if they normally charge $150 for a cleaning to non-insurance patients.

Out-of-network dentists have not contracted with the plan. These dentists can charge whatever they want, and the insurance plan typically reimburses you based on a fee schedule or usual, reasonable, and customary (UCR) charges. The difference between what the dentist charges and what the plan reimburses becomes your financial responsibility. This can result in significantly higher out-of-pocket costs.

Example: Suppose an out-of-network dentist charges $200 for a cleaning, but the plan's UCR rate for a cleaning is $120. If the plan covers preventive care at 100 percent, it will reimburse up to $120. You would pay the remaining $80 out of pocket, plus any applicable deductible.

To find network dentists, you can call the insurance company's customer service line or visit their website, which usually includes a searchable dentist directory. When you find a dentist you like, call their office before your appointment to confirm they participate in your specific plan.

Practical takeaway: Before scheduling dental work, verify the dentist is in your plan's network. Ask the dentist's office what they expect you to pay for specific services. Request an estimate in writing before any major work begins.

How to Review Your Coverage and Compare Plan Options

AARP dental plans come in different tiers and levels of coverage. The basic differences between plans involve how much they cover preventive, basic, and major services. A limited plan might cover preventive care at 100 percent and basic services at 80 percent but exclude major services like crowns. A comprehensive plan might cover all three categories. Some plans also cover orthodontics for both children and adults.

When comparing AARP dental plans available in your area, request the Summary of Benefits and Coverage document for each plan. This document shows what services are covered, the percentage the plan pays, deductibles, annual maximums, and any waiting periods. Most insurance companies provide this document free of charge and often make it available online.

Compare plans by looking at several factors together rather than choosing based on premium alone. A plan with a lower monthly premium might have a higher deductible, lower coverage percentages, or a lower annual maximum. The lowest-cost plan isn't always the best value. Calculate the total annual cost for a plan based on your expected dental needs, including premiums, deductibles, and your out-of-pocket percentage for the services you typically use.

Some plans include waiting periods, which are time periods you must wait before certain services are covered. Preventive care typically has no waiting period, but basic services might have a 6-month waiting period, and major services might have a 12-month waiting period. This means if you enroll in September, you might not be able to use major services until September of the following year. Waiting periods can significantly affect when you can receive needed care.

Location affects plan availability and pricing. Dental plan options and premiums vary by state and sometimes by county. Check what plans AARP offers where you live, as plans available in one state may not be available in another.

Practical takeaway: Request information from at least two different plans and create a side-by-side comparison listing the premium, deductible, coverage percentages for preventive/basic/major services, annual maximum, waiting periods, and the network dentist availability in your area. Calculate what you'd pay out of pocket in a typical year under