When it comes to insurance coverage for your teeth and gums, sometimes it’s difficult to know whether or not it’s really necessary. After all, the premium and deductible costs are relatively affordable, but so are dental cleanings. So what should you do? Is dental insurance worth it?
First off, a couple of fast facts about dental insurance in the U.S.:
- The federal government does not require you to have dental insurance.
- Dental coverage is an ACA essential health benefit for kids – that means insurers have to offer it but in most states, you’re not required to opt-in. Learn more about ACA dental coverage.
- There are generally three ways to get coverage: You can buy dental insurance from the public ACA Exchange when you enroll in your major medical plan, your employer can provide dental insurance or you can purchase a policy in the private market throughout the year.
Whether dental coverage is “essential” or not for you is a personal decision based on your oral health, anticipated dental care needs, and finances. In the remainder of this blog post, we’ll address some questions that may help you make that determination:
- How much is dental insurance?
- What does dental insurance typically cover?
- What are the costs associated with some common dental procedures?
- How do different types of dental plans impact what you pay?
How Much is Dental Insurance?
Your out-of-pocket costs for dental coverage will vary depending on where and how you get your coverage. For instance, if you are enrolled in an employer-sponsored group plan through your job, your employer will usually pay a portion of your premiums – lowering your overall costs.
Depending on the type of dental plan you have (we’ll discuss the different types in more detail later) there could be considerable differences in your out-of-pocket costs. When it comes to your oral healthcare costs and dental insurance, be sure to consider premiums, deductibles, co-insurance, and your policy’s annual maximum benefit limit.
Some of these may play a role in your overall costs, depending on the policy selected:
Dental insurance premiums: This is the amount you pay monthly or annually to maintain your policy. If you don’t have employer-sponsored coverage, dental insurance premiums may cost an average of around $25 a month (or $300 a year), however, premiums can range anywhere from $150 to $600 annually (2016). Your premium will be higher if you have more people on your policy.
Dental insurance deductibles: This is the amount you’re responsible to pay out-of-pocket before your dental benefits take effect. Most dental plans have a low deductible or none at all, with an average deductible of around $50.
Dental coinsurance: This is the amount you’re responsible for after your insurance company covers its share. After you’ve reached your deductible amount (and up to your maximum annual benefit limit) your insurance will pay a portion of covered services, usually 50 or 80%. You are responsible for the rest.
Dental copay: Similar to your medical policy’s copay, this is a fixed amount you may pay for a covered service after you’ve paid your deductible.
Maximum annual benefit limit: This is the maximum benefit amount your dental insurance will pay in one year — usually between $1,000 and $2,000. After reaching the maximum, you pay any additional costs for the remainder of the year out of pocket.
Learn more about how dental insurance works, including how the cost-sharing structure is different from major medical, so you have a better understanding of the real cost of dental coverage.
Get a quick quote to find out how much a dental policy could cost you.
Now that you understand the different costs and limits associated with most dental policies, let’s look at the cost of some common dental procedures.
How Much Can Dental Care Cost?
As you saw from the previous section, most types of dental insurance include some out-of-pocket costs. However, the American Dental Association (ADA) has estimated that people without dental coverage pay about $370 per year out-of-pocket just for annual exams, cleanings and X-rays.
Add in services such as a crown, or even a basic filling, and the bills can add up.
Average costs for typical dental services are:
- Cleanings: $75-$200
- Set of bitewing x-rays: $20-$100
- Silver dental filling: $50-$300
- Porcelain crown: $500-$1,500
- Basic (non-surgical) extraction: $75-$300
The average costs of root canals by tooth location are:
- Front tooth root canal: $300-$1,500
- Bicuspid root canal: $400-$1,800
- Molar root canal: $500-$2,000
What Does Dental Insurance Cover?
Now that we’ve seen some common dental procedures, let’s look at how dental insurance typically classifies and covers care.
Dental insurance typically covers a range of oral healthcare services, everything from preventive care (routine exams) and basic procedures (fillings) to major treatment (crowns). Usually, these levels of dental care are covered at different rates. A typical dental plan provides levels of coverage known as “100/80/50 coverage:”
- Preventive care, such as routine exams and X-rays are covered 100%.
- Basic procedures such as extractions, fillings, and sometimes root canals and periodontal treatment are covered at 80%.
- Major procedures such as crowns, bridges, inlays, dentures and sometimes implants and root canals are covered at 50%.
Orthodontics coverage can often be purchased as a rider. Cosmetic care (like tooth lightening) is usually not covered.
Types of dental plans
As we mentioned earlier, different types of dental plans can affect your out-of-pocket costs. Depending on the type of plan you choose, you’ll also have different levels of flexibility when it comes to choosing a provider. Consider whether cost or choice is more important when you decide which plan might be the best fit for you.
Dental plans generally fall into three categories:
- Indemnity or fee-for-service plans
- PPO or Preferred Provider Organization plans
- HMO or Health Maintenance Organization plans
Indemnity or fee-for-service plans let you pick a dental provider and your plan will pay a percentage of the fees. These plans come with the greatest choice, but also usually come with higher premiums and usually have a higher annual maximum.
With a PPO or Preferred Provider Organization plan – the most common type – you pay lower fees to see in-network or “preferred” providers. You can see “out of network” providers, but you’ll probably pay more. PPO plans often come with annual maximums and some procedures may not be covered or have a waiting period before coverage starts.
With an HMO or Health Maintenance Organization plan, you must see dental providers in the insurance network. Preventive services usually will be totally covered and basic procedures usually come with a copay. Major procedures may be covered at less than 50% or not at all. You may not have a deductible or annual benefit maximum, and premiums are usually lower.
- Dental discount or savings plan – In these plans, a group of dentists offers services at a discount and you generally pay the dentist directly.
- Dental school – If you have minimal dental needs, you may want to visit a dental school. The students’ work is overseen by trained dentists and you pay a lower rate for services.
- A walk-in dental clinic – These facilities may offer a sliding-scale fee system based on income. Diagnostic exams may be free.
Is Dental Insurance Worth It?
Whether or not dental insurance is worth it is a personal choice. The decision will ultimately come down to your current level of oral health, potential changes in your dental needs (whether you’ll need more or less care), how you prioritize dental care, and your budget.
Dental Care Costs
When you compare the cost of insurance and the cost of just the basic two cleanings a year, dental insurance may not look like a good value if you have healthy teeth and good oral hygiene habits.
On the other hand, dental insurance may encourage you to keep up with preventive-care appointments that could help you avoid more expensive problems and procedures in the future.
Some dental issues can affect your general health. Untreated gum disease, for instance, can lead to other health conditions, including heart disease, so if you think carrying a dental policy will help you be more proactive about seeking preventive care, it may be a good idea.
And if your dentist discovers a problem, your dental insurance policy could pay off with just one set of X-rays, a filling or an extraction!
Here are a few things to keep in mind when looking at dental insurance plans and trying to decide whether or not the coverage is worth the cost:
- With the exception of missing teeth, most policies cover pre-existing conditions.
- Make sure your preferred dentist is in the network of any policy you’re considering, or that you’re able to locate a provider near you.
- Be sure to understand how different dental care services are classified by your policy so you know what percentage of costs you’ll be responsible for.
- Be sure to validate what, if any, waiting periods are applicable to a policy you’re considering.
Compare dental insurance plans now.
Summary + Next Steps
Dental plan premiums and deductibles are relatively low, but so are the costs of a basic cleaning or exam. That said, the costs of basic and major dental procedures can be high – and unexpected, so a dental plan can help with costs up to your policy’s annual benefits limit.
When looking into whether dental insurance is worth it for you, consider:
- The cost of dental care and which services you’ll likely need and use
- What services dental insurance covers and at what percentage
- All of the costs associated with dental insurance (premium, deductible, etc.)