The value of dental insurance varies depending on your unique circumstances and health care needs. While a dental health insurance policy could be a cost-saving, worthwhile investment for one person, it may be expensive and unnecessary for another. By examining the pros and cons of dental insurance, MoneyGeek can help you determine if this coverage is right for you.
What to Expect from Dental Insurance Expenses
Dental insurance costs can vary depending on several factors. These include the type of plan chosen, coverage options provided, geographical location and insurance provider. Typically, you can expect the following expenses to be associated with your dental insurance plan:
- Premiums: Monthly fees paid to maintain coverage.
- Deductibles: A predetermined amount that must be paid before coverage applies.
- Copayments: The fixed fee required for specific dental services (for example, $20 for each office visit).
- Co-Insurance: The percentage of the dental treatment cost you're responsible for after meeting your deductible. With dental insurance, it’s common for the co-insurance to vary depending on the stringency of the service.
- Out-of-Pocket Expenses After an Annual Maximum: If your plan has a predetermined ceiling of reimbursement and it is met, the remaining dental costs are your responsibility.
It's important to review your plan details carefully to understand how copayments and co-insurance apply to different treatments or services.
How Much Does Dental Insurance Cover?
Health insurance doesn't cover dental work unless the situation falls under certain circumstances. When it comes to dental insurance, the extent of covered dental services depends on the plan type, with full coverage dental plans reimbursing more costs than basic plans. In general, the following services are covered by dental insurance to some extent.
Dental insurance often covers preventive care, including routine check-ups, cleanings and X-rays. These services help maintain oral health and detect early signs of dental issues.
Basic Restorative Treatments
Dental insurance may cover basic restorative procedures such as fillings and simple extractions to repair and restore damaged teeth.
Major Restorative Procedures
Some dental insurance plans cover major restorative treatments like crowns, bridges, dentures and root canals, which tend to be fairly extensive and costly procedures.
Certain dental insurance plans offer coverage for orthodontic treatments, such as braces or clear aligners, to correct teeth misalignment and bite issues.
Dental insurance may cover oral surgical procedures, including tooth extractions (including wisdom teeth), dental implants and other oral surgical treatments.
Emergency Dental Care
Many dental insurance plans cover emergency dental services, such as treatment for dental trauma, severe toothaches or other urgent oral health needs.
What's Not Covered
Dental insurance plans commonly have exclusions or limitations on certain treatments or services. These may include cosmetic dentistry procedures (such as teeth whitening), orthodontic treatments for adults, certain pre-existing conditions and elective procedures. In addition, if your plan has a maximum out-of-pocket expense, which is the most you must pay out of pocket in a given year, it may only apply to the children on the policy. Because of this, it's imperative to read the details of any dental policy.
- Indemnity Dental Insurance: This type of insurance allows individuals to visit any dentist. It offers flexibility and typically involves a fee-for-service structure, where the insured pays upfront and is reimbursed by the insurance company based on the coverage terms.
- Dental Preferred Provider Organization (PPO): PPO plans have a network of dentists who have agreed to provide services at discounted rates to plan members. Insured individuals have the freedom to choose any dentist, but they can enjoy greater cost savings by using dentists within the network.
- Dental Health Maintenance Organization (HMO): HMO plans require individuals to select a primary care dentist from a network of providers. These plans typically have lower premiums but require individuals to obtain referrals from their primary dentist for specialist visits or treatments.
- Dental Exclusive Provider Organization (EPO): EPO plans consist of a network of dentists who have agreed to accept lower fees for patients with EPO dental plans. Comparable to a PPO, EPO plans offer reduced premium costs while ensuring access to a wide range of dental providers.
- Dental Discount Plans: While not technically a form of dental insurance, discount plans offer reduced rates on dental services for a monthly or annual fee. Members receive discounted rates when visiting participating dentists within the plan's network.
Pros and Cons of Dental Insurance
Recognizing the advantages and disadvantages of dental insurance is an important part of deciding if this health care coverage is right for you. By considering these factors, you can determine if dental insurance is needed for your oral health and viable for your current financial circumstances.
Benefits of Dental Insurance
Dental insurance offers several benefits that can help individuals manage their oral health and alleviate financial burdens, including:
- Financial Protection: Dental insurance provides a safety net by covering a portion of dental expenses. For example, a routine dental check-up can cost around $100-$200 without insurance, but with insurance, the out-of-pocket cost can be significantly reduced to around $20-$50, or in many cases, no cost at all.
- Preventive Care Coverage: Many dental insurance plans emphasize preventive care, covering routine check-ups, cleanings and X-rays. These services are crucial for maintaining oral health and preventing serious dental issues. With preventive care coverage, individuals can access these services at reduced or no additional cost.
- Savings on Major Treatments: Dental insurance can provide substantial savings on major treatments, such as fillings, root canals, crowns and orthodontic procedures (if covered). For instance, the average cost of a root canal treatment without insurance is $900-$1,500 per tooth. With dental insurance, individuals may only need to pay a portion of that cost, resulting in significant savings.
According to the National Association of Dental Plans, individuals with dental insurance are also more likely to visit the dentist regularly and have better oral health outcomes than those without insurance.
It's important to note that the specific financial benefits and coverage can vary depending on the insurance plan, deductibles, copayments and annual maximums, and there are situations where paying for dental insurance doesn’t make sense.
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Drawbacks of Dental Insurance
While dental insurance provides certain benefits, it also has drawbacks that individuals should consider before deciding to purchase it, including:
- Premiums and Deductibles: While much less expensive than health insurance, dental insurance often comes with monthly premiums and annual deductibles that may be unnecessarily expensive for those who only need limited dental care. Dental insurance may not be a financially worthwhile investment if you only need the standard two cleanings a year and have good oral health.
- Limited Coverage for Certain Procedures: Dental insurance may have limitations on coverage for certain procedures, such as cosmetic dentistry or orthodontic treatments. For example, orthodontic treatment for adults may have limited or no coverage in many dental insurance plans, leaving individuals responsible for the full cost, which can range from $3,000 to $10,000.
- Exclusions, Waiting Periods and Pre-Existing Conditions: Dental insurance plans may impose exclusions, waiting periods and pre-existing condition clauses. Some plans may not cover pre-existing conditions, meaning individuals with existing dental issues may not receive coverage for necessary treatments immediately. Waiting periods can range from a few months to a year before certain procedures are covered, which can cause delays in accessing needed dental care.
It's important to carefully review the terms, coverage limitations and costs associated with dental insurance plans to assess if the benefits align with individual dental needs and financial circumstances. Alternative options, such as dental discount plans or self-funded savings accounts, may be more cost-effective for some individuals who only need limited dental care.
How Much Does Dental Insurance Cost?
On average, individual dental insurance plans can range from $15 to $50 per month, while family plans may cost between $30 and $150 per month. For example, a basic individual plan with preventive care coverage may cost around $25 per month, while a comprehensive family plan with orthodontic coverage could range from $70 to $150 per month. However, if your plan has an annual maximum, which often caps reimbursements at $1,000-1,500, you may end up paying high costs out of pocket if a dental disaster occurs and your annual max is met.
Other costs to consider are copays, which are often around $20-50 per office visit, and your share of co-insurances, which is the percent of costs you are expected to pay for specific services.
Dental insurance costs can vary depending on the provider and specific plan type. The table below presents average dental insurance costs for HMO, EPO, PPO, POS and Indemnity plans to help you estimate how much you might pay for coverage.
Average Costs of Dental Insurance by Plan Type
Choosing a Dental Plan
Choosing dental insurance involves understanding your unique situation and carefully weighing your options; the following steps can help you decide which provider is best for you.
Assess Your Dental Needs
Evaluate your dental health and anticipate any upcoming treatments or procedures you may require. Consider factors such as routine check-ups, preventive care and potential major treatments. Understanding your needs will guide you in selecting the appropriate coverage.
Research Available Plans
Explore the dental insurance plans available to you, such as through your employer or the health insurance marketplace. Compare each plan's coverage options, benefits, limitations and costs.
Verify In-Network Dentists
Check the list of in-network dentists and specialists associated with each plan. Ensure that there are dentists conveniently located near you offering quality care. A broad network of providers gives you more options and potentially reduces out-of-pocket costs.
Review Coverage Details
Carefully review the coverage details of each plan. Pay attention to coverage for preventive care, basic procedures, major treatments and orthodontics, as well as any exclusions or limitations. Assess whether the coverage aligns with your specific dental needs and potential costs.
Consider Cost vs. Benefits
Analyze the overall expenses of each plan, including premiums, deductibles, copayments and potential out-of-pocket expenses. Compare these costs with the estimated value of the coverage provided. Ensure the benefits outweigh the costs and align with your budget and health care needs.
Selecting dental insurance is a personal choice based on individual needs and financial considerations. Researching, evaluating and comparing different options can help you choose a dental insurance plan that safeguards your oral health and aligns with your budget.
Considering Dental Insurance FAQs
For some, dental insurance is a money-saving, crucial component of their health care; for others, the costs outweigh the benefits. MoneyGeek answered some of the most frequently asked questions about dental insurance plans to help you decide if it's right for you.
About Brenna Kelly, Licensed Health Insurance Agent
- National Association of Dental Plans. "Understanding Dental Benefits." Accessed June 29, 2023.