Dental Insurance: Coverage And Cost – Forbes Advisor
The cost of dental care can be high, but dental insurance helps offset some of those expenses.
Dental insurance policies are not the same for everyone. benefits and coverage range from preventive-only plans to plans that help with major care like dentures and implants.
what is dental insurance?
dental insurance provides coverage to help protect you financially from the high costs of dental care. Policies are separate from your primary health insurance, although some health insurers offer dental insurance plans.
You may be offered dental insurance as an employment benefit, or you may purchase a plan from a dental insurance company.
how does dental insurance work?
Most dental plans work like this:
- you pay a monthly premium.
- You may face waiting periods for some types of care, but preventive care (like cleanings) often doesn’t have a waiting period.
- You may need a primary dentist in the insurance provider’s network.
- There may be an out-of-pocket deductible you must meet before your plan covers a percentage of your out-of-pocket costs for care.
- Most plans have a maximum annual allowance.
- Your plan may require a copay for dental visits.
- Most preventive care is covered 100% by the dental plan; this includes an annual exam, cleaning, and x-rays.
- generally covered at 100% of costs
- cleanings and revisions every six months
- annual x-rays
- coverage percentage varies, but often represents 80% of costs
- simple extractions
- coverage percentage varies, but often represents 50% of costs
- root canals
- false teeth
- cosmetic dentistry that is not medically necessary
- placement of non-essential veneers
- teeth whitening
- orthodontics (braces)
- annual maximum
- Basic cleaning and polishing: $75-$200
- panoramic dental x-rays: $100-$200
- Fillings: $50-$250, depending on the size of the cavity and the material used for the filling
- tooth extraction: $75-$800, depending on the size and location of the tooth and the difficulty of the procedure
- root canal: $500-$1,500, depending on tooth location (front teeth are less expensive than back teeth)
- crowns: $500-$2,000, depending on material used.
- dentures: $600-$8,000 for a full set, depending on type and material used.
- cost. We compared the costs for a 30-year-old woman in California. when california was not available, we used texas: 30% of the score.
- Maximum annual insurance payout: 10% of score.
- no waiting period for preventive care: 10% of score.
- Basic care payment level: 10% of the score.
- Basic care waiting period: 10% of the score.
- coverage of elderly care in the first year: 10% of the score.
- Coverage for implants: 10% of the score.
- orthodontic coverage: 10% of the score.
what does dental insurance cover?
Dental insurance policies typically cover preventive services, but the additional amount covered varies by plan. some policies cover a percentage of the cost of basic services, while others cover part of the cost of basic and main services.
preventive and routine services
what does dental insurance not cover?
Dental insurance generally does not cover services such as:
Dental insurance may not cover the services below. Be sure to read the fine print if you are interested in this dental work because there may be lifetime maximum benefits or waiting periods for services, even if they are covered:
If your policy provides coverage for one or more of these services, it may be at a lower percentage.
types of dental insurance plans
Dental insurance plans are differentiated by whether you can get care out of network and how much the plans pay for different types of care.
dental preferred provider organizations (dppo)
A dppo uses a network of dental providers to provide care for an agreed upon fee. You can also get care outside the network at a higher cost. these policies generally have higher premiums since they come with more flexibility.
dental health maintenance organizations (dhmo)
a dhmo offers lower cost coverage with a network of dental providers. some services are covered at 100%, while others may require you to pay a small copay. You generally must stay in a dhmo’s network to receive reimbursement for care.
Fee-for-service dental plans, also known as traditional or indemnity plans, do not have provider networks. you can see any dentist.
These plans pay a percentage for each service and you pay the rest. A fee-for-service plan doesn’t contract with dentists, which means they don’t have discounted rates like ppo or dhmo.
dental savings or discount plans
Discount dental plans are not actually dental insurance. instead, they offer discounts at participating discounts and you pay for treatment at the discounted rate determined by the plan.
how much does dental insurance cost?
The average full-coverage dental insurance policy costs $47 a month, according to Forbes Advisor’s analysis of dental insurance premiums. a preventive care plan costs an average of $26 a month.
Factors that influence the cost of individual dental insurance include a plan’s coverage and how much it charges for out-of-pocket costs, such as deductibles, coinsurance, and annual maximums.
This is the average monthly cost of the top rated plans from dental insurance companies reviewed by Forbes Advisor. Please note that the Humana Preventive Value Plan focuses on preventive care and does not include coverage for oral surgery, endodontics, and other major services.
average cost of dental insurance per plan
Employers often offer dental insurance as part of their benefits package. Those group policies are usually cheaper than getting a dental insurance policy yourself. Employer helps pay for coverage and offers more affordable dental insurance coverage by bundling coverage instead of an individual getting an individual plan.
out-of-pocket dental insurance costs
Here are different types of out-of-pocket costs you can expect with dental insurance:
This is the regular amount you pay to keep a dental insurance policy in force.
dental insurance deductibles
A dental insurance deductible is the amount you pay for dental care services before the dental insurance company begins to pay for the services.
The exact deductible varies by dental insurance plan. For example, our analysis of deductibles offered by dental insurance companies shows that some plans have no deductible for in-network care, while others may charge $50 per person each year. there are other dental insurance plans that have a lifetime deductible.
examples of dental insurance deductibles
coinsurance is the percentage of costs that you and your dental insurance company share for dental care after you exceed your deductible.
For example, a dental insurance company may pay 80% of basic care and 50% of primary care costs. another company may pay 50% of primary care and not cover primary care at all. in that case, you would be on your own to pay for important dental work.
Preventive care generally costs you nothing, but basic care and primary care generally have coinsurance levels.
dental insurance coinsurance examples
dental insurance copay
A dental insurance copay is a predetermined amount that you pay at the time of service. copays are usually a low amount like $20 or $30 that you pay even after you’ve exceeded your deductible.
Preventive care often comes with no copay, since dental insurance companies want you to take care of your teeth to reduce the chance of more expensive care in the future.
annual dental insurance maximum
Dental insurance plans generally have annual maximums. These limits are the most a dental insurance company will pay for your dental work in a year or lifetime.
examples of dental insurance annual maximums
should i get dental insurance?
Whether dental insurance makes sense for you depends on how much you pay for dental care and whether the cost of dental insurance would offset those costs.
These are the average costs of dental services without dental insurance, according to Humana.
There are additional costs for the crown, abutment (connects the crown to the implant), tooth and root extraction, office visits, and pre/post-op care.
Those costs could hit your wallet. But whether dental insurance is worth the expense depends on how much you want to spend on a dental plan and how much coverage you want.
To find the best dental insurance, we rated 30 stand-alone dental plans. only the plans with the highest score from each company are shown. benefit details may vary by state, so check your plan brochure for details. ratings are based on the following criteria: