There are pros and cons to purchasing a dental policy, either from your employer or as an individual from a private insurance carrier. In some cases, dental coverage will not save you money at all, even if you are needing dental care.Dental plans emphasize preventive care. Preventive care may seem optional if you have healthy teeth and good oral hygiene, but it saves money in the long run.
How much does dental insurance cost?
On average, Americans pay about $360 a year, or between $15 and $50 a month, for dental insurance. Most plans come with a maximum annual benefit or coverage limit. This limit usually falls between $1,000 and $2,000. Unlike medical insurance, which covers costs after your bills reach the amount of your deductible, dental insurance cuts off coverage after your bills reach the annual limit. You will pay additional costs out of pocket. Typically, only 2% to 4% of Americans annually will reach their maximum benefit annually.
What does a monthly dental premium cover?
A typical plan provides a level of coverage known as 100/80/50 coverage.
- Preventive care—the exams, cleanings, and X-rays you receive during an average dental checkup—are 100% covered. Preventive care is limited to services twice annually.
- Basic procedures like fillings, extractions, and periodontal work are 70% to 80% covered.
- Major procedures like crowns, root canals, dentures, bridges, or implants are 50% covered (or less). Most plans do not cover major procedures and thus you will be expected to pay out of pocket.
There are variations in individual plans. For example, a root canal could be considered either a basic or a major procedure, depending on the plan. Most plans allow you to purchase separate coverage for orthodontic care if it is not covered. Fewer plans will cover cosmetic care, like teeth whitening, which is usually an out-of-pocket expense.
Even if dental coverage does not save you money, it can be a good incentive to make those preventive-care appointments; you are more likely to go to the dentist if you’ve already paid for the insurance.
Dental insurance plans can you choose from?
The typical dental plan falls into one of three categories.
- Indemnity or fee-for-service plans
This plan allows you to pick a dental provider and your plan pays a percentage of the provider’s fee.
Pros: These plans let you choose from the widest variety of providers. The deductible may be lower than other plans. The annual maximum coverage limit may be higher.
Cons: The tend to be higher than other plans. You will be paying your share of service costs up front.
This plan is best if: You have a certain dental provider you want to see, or you anticipate needing major, costly procedures.
- PPO or Preferred Provider Organization plans
With a PPO, you pay lower fees to see certain in-network or “preferred” providers.
Pros: The insurance network pays more than they might with an indemnity plan or HMO plan. You are not required to see in-network providers, but you save money when you do.
Cons: You will pay more if you see a provider out of the network. PPO plans often come with a maximum amount they will reimburse in a calendar year. Some procedures may not be covered or have a waiting period before coverage starts.
This plan is best if: You don’t need major dental work right away but want to be prepared in case you need it in the future. You would like some flexibility in your choice of dental providers but do not want to pay high premiums.
- HMO or Health Maintenance Organization plans
With an HMO, you are required to see dental providers in the insurance network.
Pros: Preventive services—cleanings and X-rays—will be 100% covered, while basic procedures come with a co-pay. You may not have a deductible or maximum annual limit and premium payments will likely be lower.
Cons: Major or restorative procedures may come with less than 50% coverage or no coverage at all. You will not have a large choice of providers.
This plan is best if: You do not anticipate needing any major dental procedures in the near future. You have no provider preferences as long as basic dental work is covered financially. If you already have a dental provider you trust, see which plan their office recommends.
What if you are uninsured and you already know you need major dental work soon?
See what your dentist recommends but be prepared to have the procedure right away and pay out of pocket. Be honest about your financial situation and try to work out a payment plan. You will save more money than if you let the problem get worse while waiting for coverage to start.
If you plan to get insurance, your best bet is to purchase a policy before, not after, you need major work. Otherwise, you could be waiting months for coverage to begin a procedure.
Most plans will not immediately cover pre-existing conditions or reimburse for major procedures completed before you got insurance. When in doubt, ask what is covered and when.
Keep in mind there is always a possibility you may need a procedure you do not anticipate—and it may not be covered by your policy. The higher your premium, the more likely you are to have coverage for more extensive work. Your dentist will often tell you which procedures you are likely to need down the line.
In realty with or without insurance, you will be shelling out some money. It is a necessary evil. Remember those maximum annual limits? You can reach them quickly with even one major procedure. An average crown costs between $750 and $1,200.
A dental implant can start at $1,500, which is over the coverage limit for many plans. And while annual coverage caps remain about the same from year to year, the cost of dental services continues to rise.
What does dental care cost if you are uninsured?
The ADA Health Policy Institute’s 2019 Survey of Dental Fees (the latest publicly available data) compiled the average U.S. costs for some common procedures.
- Teeth cleaning: $96
- Complete series of X-rays: $124
- Silver dental filling: $125
- White dental filling: $189
- Porcelain crown: $1,219
- Average prices for root canals, compiled by FAIR Health, vary based on the tooth.
- Front tooth root canal: $785
- Bicuspid (a tooth with two cusps) root canal: $910
- Molar root canal: $1,192
What questions should you ask before picking a policy?
- Which dental procedures am I likely to need this year? How much would they cost out of pocket? How much would they cost with insurance?
- How much will I pay monthly and annually in premiums?
- How much will I pay for a regular cleaning without insurance? With insurance?
- What is the maximum annual payout for this insurance policy? Which procedures are covered?
- What dental insurance does my dentist accept? What plan does my dentist prefer?
How can you save money on dental care without insurance?
If you decide to skip dental insurance, you will still want to get your teeth cleaned once or twice a year. And you will want options if unexpected dental work comes up. Here is where you can look for care outside of the typical insurance marketplace.
- Visit a dental school
You will see students whose work is supervised by trained dentists. In exchange, you pay a low cost for appointments, even if you are uninsured. The ADA lists dental schools across the country.
- Visit a dental clinic
Some clinics offer a sliding scale fee based on income, and diagnostic exams may be free. Find a local branch of a national clinic like America’s Dentists Care Foundation or see what low-cost care options your state and local dental societies have to offer.
Dental school and clinic appointments are often in high demand. Be prepared to schedule far in advance or put your name on a waiting list. Even with walk-in clinics, it’s best to call ahead and find out their procedures before you go.
- Look into a discount dental plan
Discount dental plans or dental savings plans can give you the security of coverage without the cost. You will pay an annual fee and get a discount, anywhere from 10% to 60%, on average dental care prices. Unlike insurance plans, there are no annual caps or waiting periods.
Maybe paying a monthly premium or fee is not worth the cost to you for a few appointments, but you still want some cash on hand for dental work if the need arises. Set aside funds on a monthly basis for dental appointments and emergencies. Contribute at your own pace and take care of your teeth in the meantime.
So, is dental insurance worth it?
That depends on your dental health and the plan you choose. With more extensive procedures, having insurance can help cover the high cost, but chances are you will still be paying out of pocket for some of it. The best thing dental insurance can offer is a safety net in case you end up needing these extensive procedures.
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