Insurance coverage

Coverage and Cost – Forbes Advisor

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The cost of dental care can be high, but dental insurance helps offset some of these expenses.

Dental insurance policies are not universal. Benefits and coverage vary from preventative-only plans to those that help with major care like dentures and implants.

What is dental insurance?

Dental insurance provides coverage to protect you financially against the high costs of dental care. The policies are separate from your primary health insurance, although some health insurers offer dental insurance plans.

Dental insurance may be offered to you as a benefit of employment, or you may purchase a plan from a dental insurance company.

How does dental insurance work?

Most dental plans work this way:

  • You pay a monthly premium.
  • You may experience waiting periods for some types of care, but preventative care (like cleanings) often doesn’t have a waiting period.
  • You may need a primary dentist in the insurer’s network.
  • There may be a deductible to pay before your plan covers a percentage of care costs.
  • Most plans have a maximum annual allowance.
  • Your plan may require a co-pay for dental visits.
  • Most preventative care is 100% covered by the dental plan, which includes an annual exam, cleaning and x-rays.

What does dental insurance cover?

Dental insurance policies generally cover preventative services, but the additional amount they cover varies by plan. Some policies cover a percentage of the cost of basic services, while others cover a portion of the cost of basic services and major services.

Routine and preventive services

  • Generally covered at 100% of costs
  • Cleanings and checks every six months
  • Annual x-rays

Basic services

  • Percentage coverage varies, but often 80% of costs
  • Toppings
  • Simple extractions

Main Services

  • Coverage percentage varies, but often 50% of costs
  • Root canals
  • Bridges
  • Crowns
  • Dentures
  • Implants

What does dental insurance not cover?

Dental insurance generally does not cover services such as:

  • Cosmetic dentistry that is not medically necessary
  • Bonding
  • Non-essential tackle placement

Dental insurance may not cover the services below. Be sure to read the fine print if you are interested in this dental work, as there may be lifetime maximum benefits or waiting periods for services even though 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 differ in whether you can get out-of-network care 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 fee. You can also get out-of-network care at a higher cost. These policies generally have higher premiums because they offer more flexibility.

Dental Health Maintenance Organizations (DHMO)

A DHMO offers lower cost coverage with a network of dental providers. Some services are 100% covered, while others may require you to pay a small co-payment. You must generally remain in the network of a DHMO to obtain reimbursement for care.

Paid plans

Paid 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 a PPO or DHMO.

Dental discount or savings plans

Discount dental plans are not actually dental insurance. They instead offer discounts on participating discounts and you pay for treatment at the discounted rate determined by the plan.

How much does dental insurance cost?

The average dental insurance policy with full coverage costs $47 per month, according to the Forbes Advisor analysis of dental insurance premiums. A preventative care plan costs an average of $26 per month.

Factors that affect the cost of individual dental insurance include a plan’s coverage and how much it charges for out-of-pocket expenses such as deductibles, coinsurance and annual maximums.

Here is the average monthly cost of the top rated plans from dental insurance companies analyzed by Forbes Advisor. Note that Humana’s Preventive Value Plan focuses on preventative care and does not include coverage for oral surgery, root canals, and other major services.

Average Dental Insurance Costs by Plan

Employers often offer dental insurance as part of their benefits package. These group policies are generally less expensive than purchasing a dental insurance policy yourself. The employer helps pay for coverage and provides more affordable dental insurance coverage by bundling coverage rather than one person getting an individual plan.

Reimbursable dental insurance costs

Here are different types of disbursements you can expect with dental insurance:

  • Premiums
  • Franchises
  • coinsurance
  • Co-payment
  • Annual maximum

Premiums

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 services before the dental insurance company starts paying 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 individual each year. There are other dental insurance plans that provide a lifetime deductible instead.

Examples of dental insurance deductibles

coinsurance

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 major care costs. Another company may pay 50% for basic care and not cover major care at all. In this case, you would be alone to pay for the major dental work.

Preventative care usually costs you nothing, but basic care and major care usually have coinsurance levels.

Examples of dental coinsurance

Participation in dental insurance

A dental insurance co-pay is a predetermined amount that you pay at the time of service. Copayments are usually a small amount, like $20 or $30, that you pay even after you exceed your deductible.

Preventative care is often co-payable since dental insurance companies want you to take care of your teeth to reduce the risk of more expensive care later.

Maximum annual dental insurance

Dental insurance plans generally have annual caps. These limits are the maximum a dental insurance company will pay for your dental care in a year or lifetime.

Examples of annual dental insurance maximums

Should you buy dental insurance?

Whether dental insurance is right for you depends on how much you pay for dental care and whether the cost of dental insurance would offset those costs.

Here are the average costs for dental services without dental insurance, according to Humana.

Preventive services

  • Basic cleaning and polishing: $75 to $200
  • Panoramic dental x-rays: $100 to $200

Basic services

  • Fillings: $50 to $250, depending on the size of the cavity and the material used for the filling
  • Tooth extraction: $75 to $800, depending on the size and location of the tooth and the difficulty of the procedure

Main Services

  • Root canal: $500 to $1,500, depending on the location of the tooth (front teeth are cheaper than back teeth)
  • Wreaths: $500 to $2,000, depending on material used.
  • Dentures: $600 to $8,000 for a full set, depending on type and material used.

There are additional charges for the crown, abutment (connects the crown to the implant), tooth and root extraction, office visits, and pre/post-operative care.

These costs could do a number on your wallet. But whether dental insurance is worth it depends on how much you want to spend on a dental plan and what level of coverage you want.

Methodology

To find the best dental insurance, we evaluated 30 stand-alone dental plans. Only the highest rated plans from each company are shown. Benefit details may vary by state, so see the plan brochure for details. Ratings are based on the following criteria:

  • Cost. We compared costs for a 30-year-old woman in California. When California was not available, we used Texas: 30% of the score.
  • Annual maximum insurance payout: 10% of score.
  • No waiting time for preventive care: 10% of score.
  • Base Healing Payout Level: 10% of score.
  • Waiting time for basic care: 10% of score.
  • Coverage of major care in the first year: 10% of the score.
  • Implant coverage: 10% of score.
  • Coverage for orthodontics: 10% of score.

Best Dental Insurance Companies of 2022