Dental insurance plans: Comparing coverage and costs
Dental care expenses frequently represent a substantial financial commitment, yet dental insurance plays a pivotal role in mitigating these costs. It is imperative to recognize the considerable divergence among dental insurance policies in terms of their extent of coverage and associated benefits. These policies present a range of options, spanning from preventive-oriented plans to encompassing coverage inclusive of major procedures like dentures and implants.
The different types of dental insurance plans and how they work
Given the nuanced relationship between dental health and overall well-being, dental insurance functions akin to its health insurance counterpart, providing financial support for essential care in exchange for a regular premium payment. Critical parallels between dental and health insurance encompass:
– Provider Networks: The majority of dental plans rely on a network of contracted dentists and specialists.
– Deductibles: Typically, individuals must fulfill a deductible threshold before the insurance coverage commences.
– Copays or Coinsurance: Patients commonly participate in the cost-sharing of treatments through copayments or coinsurance obligations.
Nevertheless, distinctions between dental and health insurance manifest in several aspects:
– Coverage Emphasis on Preventive Care: Numerous dental plans extend coverage to preventive measures such as routine checkups, cleanings, and x-rays at full or significant reimbursement rates.
– Lower Deductible Thresholds: Dental insurance often features lower deductible amounts in comparison to medical insurance, typically averaging $50 for individuals and $150 for families.
– Annual Maximum Benefit Limits: Dental plans frequently impose an annual ceiling on benefits, typically ranging from $1,000 to $2,000 per policyholder.
– Waiting Periods: Certain dental plans may necessitate waiting periods prior to extending coverage for non-preventive procedures.
The two most common types of plans are DPPOs and DHMOs
Dental Preferred Provider Organization (DPPO) plans, such as Guardian’s expansive network comprising over 120,000 dentists across 400,000 locations nationwide, offer substantial benefits. Remaining within this network presents distinct advantages including streamlined claim processing and significant discounts, effectively minimizing out-of-pocket expenses. For instance, while an out-of-network dentist may charge $100 for a filling, an in-network provider may offer the same service for $60-$70, even before meeting the deductible.
Assessing DPPO plans entails evaluating their coverage structure. A plan identified as 100/80/50 typically covers preventive care at 100%, basic procedures (e.g., fillings, extractions) at 80%, and major procedures like crowns, bridges, and root canals at 50%. Consequently, it offers more comprehensive benefits compared to plans with, for instance, an 80/60/40 coverage distribution.
Conversely, Dental Health Maintenance Organization (DHMO) plans often feature lower premiums but entail less flexibility. These plans involve a more restricted provider network, potentially requiring a change from one’s current dentist. While deductibles and maximums are typically absent, copayments are commonly necessary for most non-preventive procedures.
Indemnity and discount plans
In addition to the aforementioned dental plans, two other options exist: Indemnity plans and Discount plans.
Indemnity plans afford flexibility, permitting individuals to visit any dentist of their choice and subsequently reimbursing a portion of the incurred expenses, typically ranging between 50% and 80% of what the insurance deems as “reasonable and customary.” Notably, preventive care often receives full coverage under these plans. However, they frequently entail higher costs and are less prevalent in the market, necessitating more extensive paperwork as individuals are accountable for upfront payments to the dentist, followed by claim submission.
In contrast, Discount plans deviate from conventional insurance models, resembling more of a membership club structure. By paying an annual fee, individuals obtain a card granting access to discounted prices at participating dental providers. The extent of discounts varies depending on the nature of the procedure, yet under these plans, individuals typically bear out-of-pocket expenses during each dental visit. Given the diverse range of plans and discount structures available, providing a generalized estimate of dental care costs under a discount plan proves challenging.
What you can expect to pay for each type of plan
The average monthly premiums for each plan type are as follows:
– Dental Health Maintenance Organization (DHMO): $22.75
– Dental Preferred Provider Organization (DPPO): $62.75
– Indemnity: $81.50
Premium amounts are subject to various influences, including the plan type, the insurance provider, and the extent of coverage offered. Monthly costs typically vary from $12 to $50 per individual for DPPO and DHMO plans. DHMO plans generally fall towards the lower end of this spectrum, while comprehensive DPPO plans tend to occupy the higher end. Indemnity plan premiums are notably higher, often amounting to twice the cost of a DPPO plan.
Compare Dental Insurance Coverage And Costs From Our Partners
1. Ameritas
Ameritas, as featured on The Dental Insurance Guide’s website, offers coverage in 48 states, boasting an extensive network of 111,500 providers. Monthly plan premiums commence at $24.69.
2. Aflac
Aflac, available through HealthNetwork’s website, provides coverage across 48 states and Washington, D.C., with a vast network spanning 270,000 locations. Monthly premiums for plans start at $17.99.
3. Humana
Humana, also accessible via HealthNetwork’s website, extends coverage across 48 states and Washington, D.C., featuring an expansive network comprising 270,000 locations. Monthly premiums for their plans commence at $17.99.
How Much Does Dental Insurance Cost?
Forbes Advisor’s analysis indicates that the average monthly cost of a dental insurance policy providing comprehensive coverage is $47. In contrast, a plan focused on preventive care typically averages around $26 per month. The individual cost of dental insurance is subject to multiple factors, including the level of coverage provided, the annual maximum benefit, as well as out-of-pocket expenses such as deductibles and coinsurance.
Average Dental Insurance Costs by Plan
| Insurance company | Top-scoring plan in Forbes Advisor’s analysis | Monthly cost example |
|---|---|---|
|
Humana
|
Preventive Value
|
$21.99
|
|
Spirit Dental
|
Core Network
|
$43.37
|
|
UnitedHealthcare
|
Primary Plus Dental
|
$43.59
|
|
Cigna
|
Cigna Dental 1500
|
$49.00
|
|
Ameritas
|
PrimeStar Access
|
$49.98
|
|
Guardian Direct
|
Diamond
|
$58.40
|
|
Delta Dental
|
Delta Dental PPO Individual – Premium Plan
|
$64.92
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
$68.55
|
|
Anthem
|
Essential Choice PPO Platinum
|
$79.49
|
The monthly costs outlined pertain to a 30-year-old female resident of California and are provided for comparison purposes only; individual costs may vary. Humana’s Preventive Value plan emphasizes preventive care while excluding coverage for major services such as oral surgery and root canals.
Numerous employers incorporate dental insurance within their benefits packages, frequently offering group policies at discounted rates in comparison to individual plans. Through group plans, employers contribute to coverage expenses, thereby rendering dental insurance more accessible and affordable for employees.
Out-of-Pocket Dental Insurance Costs
Expect the subsequent out-of-pocket expenses associated with dental insurance:
1. Premiums
2. Deductibles
3. Coinsurance
4. Copayments
5. Costs incurred once reaching the plan’s annual maximum limit.
Premiums
This pertains to the customary fee necessary to uphold an active dental insurance policy.
In conjunction with premiums, dental insurance commonly involves deductibles, copayments, and coinsurance.
Dental Insurance Deductibles
A dental insurance deductible refers to the amount an individual is responsible for paying for dental services before the insurance provider begins coverage.
The specific deductible amount varies among dental insurance plans. For instance, our analysis of dental insurance deductibles indicates that certain plans may not have a deductible for in-network care, while others may impose an annual deductible of $50 for an individual. Moreover, some dental insurance plans may incorporate a lifetime deductible instead.
Examples of dental insurance deductibles include:
| Insurance company | Top-scoring plan in Forbes Advisor’s analysis | Annual deductible (unless noted as lifetime) |
|---|---|---|
|
Ameritas
|
PrimeStar Access
|
$50
|
|
Anthem
|
Essential Choice PPO Platinum
|
$50 per person, up to $150 per family
|
|
Cigna
|
Cigna Dental 1500
|
$50 individual, $150 family
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
Lifetime $100 in-network deductible or lifetime $200 out-of-network deductible
|
|
Guardian Direct
|
Diamond
|
In-network: $0 Out-of-network: $50
All Other Dental Services: $50 Teeth Whitening: $50
|
|
Humana
|
Preventive Value
|
Lifetime: $50 individual, $150 family
|
|
Spirit Dental
|
Core Network
|
$100 lifetime deductible
|
|
UnitedHealthcare
|
Primary Plus Dental
|
$50 for basic services
|
Coinsurance
Coinsurance denotes the proportion of dental care expenses divided between the individual and their dental insurance provider after the deductible is met.
For instance, one dental insurance company may cover 80% of basic care expenses and 50% of major care expenses. Conversely, another insurer may cover 50% of basic care expenses and exclude coverage for major care entirely.
In dental insurance, preventive care often involves no out-of-pocket expenses, while basic and major care typically entail coinsurance percentages.
Illustrative examples of dental insurance coinsurance:
| Insurance company | Top-scoring plan | Coinsurance for preventive care | Coinsurance for basic care | Coinsurance for major care |
|---|---|---|---|---|
|
Ameritas
|
PrimeStar Access
|
Plan pays In-network Day 1 100%
Out-of-network 80%
After year 1 100%
Out-of-network 80%
|
Plan pays In-network Day 1 65%
Out-of-network: 45%
After year 1 80%
Out-of-network: 60%
|
Plan pays In-network Day 1 20%
Out-of-network: 10%
After year 1 50%
Out-of-network: 30%
|
|
Anthem
|
Essential Choice PPO Platinum
|
100%
|
In-network: 20%
Out-of-network: 20%
|
In-network: 50%
Out-of-network:50%
|
|
Cigna
|
Cigna Dental 1500
|
100%
|
80%
|
50%
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
100% for 2 exams per calendar year
4 cleanings per calendar year
|
Year 1: 10%
Year 2: 25%
Year 3: 40%
Year 5: 50%
|
Year 1: 10%
Year 2: 25%
Year 3: 40%
Year 5: 50%
|
|
Guardian Direct
|
Diamond
|
100%
|
80%
|
50%
|
|
Spirit Dental
|
Core Network
|
100% for 2 exams per year
3 cleanings per year
|
Year 1: 50%
Year 2: 65%
Year 3: 80%
|
Year 1; 25%
After Year 1: 50%
|
|
Delta Dental
|
Delta Dental PPO Individual – Premium Plan
|
100%
|
80%
|
50%
|
|
Humana
|
Preventive Value
|
100%
|
50%
|
Not covered
|
|
UnitedHealthcare
|
Primary Plus Dental
|
100%
|
Day 1 1: 50%
After Year 1: 65%
After Year 2: 80%
|
Not covered
|
Dental Insurance Copayment
A dental insurance copayment is a predetermined fee paid directly at the time of service. Copayments are typically modest, ranging from $20 to $30, and are applicable even after meeting your deductible.
In dental insurance, copayments are often waived for preventive care, aligning with insurers’ focus on promoting proactive dental hygiene to reduce the need for more expensive treatments in the future.
Dental Insurance Annual Maximum
Dental insurance plans commonly include annual maximums, indicating the highest amount that the insurance provider will reimburse for dental procedures within a specified year or over the course of a lifetime.
Illustrative examples of dental insurance annual maximums:
| Insurance company | Top-scoring plan | Annual maximum |
|---|---|---|
|
Ameritas
|
PrimeStar Access
|
Day 1: $1,000
After Year 1: $2,000
Covers a maximum amount per person per benefit period for basic and major services combined.
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
Year 1: $750
Year 2: $1,500
Year 3: $2,000
Year 4: $2,500
|
|
Guardian Direct
|
Diamond
|
$1,500 Dental Implants: Lifetime max $1,000
Orthodontia: Yearly max $500 Lifetime max $1,000
Teeth whitening: yearly max $500
|
|
Anthem
|
Essential Choice PPO Platinum
|
$2,000 with annual maximum carryover
|
|
Cigna
|
Cigna Dental 1500
|
$1,500
|
|
Delta Dental
|
Delta Dental PPO Individual – Premium Plan
|
$2,000
|
|
Humana
|
Preventive Value
|
Unlimited
|
|
Spirit Dental
|
Core Network
|
$1,200
|
|
UnitedHealthcare
|
Primary Plus Dental
|
$1,000
|
What Is Dental Insurance?
Dental insurance provides financial safeguarding against the significant costs commonly associated with dental care. While separate from primary health insurance, certain health insurers extend dental insurance plans in conjunction with their medical coverage.
Dental insurance may be included in your employment benefits package, or alternatively, you have the option to procure a plan directly from a dental insurance provider.
How Does Dental Insurance Work?
Typically, dental insurance functions within the following framework:
1. Monthly Premium: Policyholders pay a monthly premium to sustain coverage.
2. Waiting Periods: Certain types of care may be subject to waiting periods, although preventive services like cleanings often entail no waiting period.
3. Network Dentist: Policyholders may be required to select a primary dentist from the insurance provider’s network.
4. Deductible: An out-of-pocket deductible may be applicable, which must be met before the plan contributes toward the costs of care.
5. Annual Maximum: Most plans establish an annual maximum allowance for covered services.
6. Copayment: Plans may involve copayments for dental visits.
7. Preventive Care Coverage: The majority of plans offer 100% coverage for preventive care, encompassing annual exams, cleanings, and X-rays.
What Does Dental Insurance Cover?
Dental insurance policies frequently emphasize preventive services, although the level of coverage differs among plans. While certain policies may provide partial coverage for basic services, others offer coverage for both basic and major services, albeit with varying degrees of reimbursement.
Routine and Preventive Services
Typically, the following services are fully covered:
– Routine cleanings and biannual check-ups
– Annual X-rays
Basic Services
The coverage percentage may vary, but it commonly encompasses approximately 80% of the expenses for:
– Fillings
– Simple extractions
Major Services
The coverage percentage is subject to variation, but it frequently encompasses approximately 50% of the expenses for:
– Root canals
– Bridges
– Crowns
– Dentures
– Implants
What Doesn’t Dental Insurance Cover?
Typically, dental insurance excludes coverage for the following services:
– Cosmetic dentistry considered non-medically necessary
– Bonding
– Non-essential veneer placement
Moreover, dental insurance may not encompass the following services. It’s imperative to meticulously review your policy particulars, as limitations such as lifetime maximum benefits or waiting periods may apply even if coverage is provided:
– Teeth whitening
– Orthodontic treatments (e.g., braces)
If your policy does extend coverage for any of these services, the reimbursement percentage may be reduced.
Types of Dental Insurance Plans
Dental insurance plans exhibit variance regarding their provisions for out-of-network care and the scope of coverage allocated to different types of dental procedures.
Dental Preferred Provider Organizations (DPPO)
A Dental Preferred Provider Organization (DPPO) employs a network of dental providers who deliver services at predetermined rates. While out-of-network care is accessible, it generally entails higher expenses. These policies commonly feature elevated premiums owing to their enhanced flexibility.
Dental Health Maintenance Organizations (DHMO)
A Dental Health Maintenance Organization (DHMO) furnishes economical coverage via a network of dental providers. While some services are fully covered, others may require a nominal copayment. Adherence to the DHMO’s network is generally mandated to qualify for reimbursement for care.
Fee-for-Service Plans
Traditional or indemnity dental plans, often termed fee-for-service plans, do not confine you to provider networks, allowing you the flexibility to consult any dentist of your preference.
In these plans, the insurance covers a percentage of the cost for each service, with the remainder falling under your responsibility. Unlike PPOs or DHMOs, fee-for-service plans do not negotiate discounted fees with dentists, as they lack contractual agreements with them.
Discount or Dental Savings Plans
Discount dental plans diverge from traditional dental insurance policies, offering discounted rates for dental services at participating providers. Within these plans, individuals are accountable for covering the treatment costs at the discounted rate established by the plan.
Should You Get Dental Insurance?
The value of dental insurance fluctuates depending on individual circumstances, chiefly influenced by one’s dental care expenses and whether the cost of insurance surpasses these expenses. Presented below are the average costs of dental services without insurance, as provided by Humana.
Preventive Services
Professional dental cleaning and polishing generally range from $75 to $200, while panoramic dental X-rays may cost between $100 to $200.
Basic Services
The cost of fillings may range from $50 to $250, depending on factors such as the size of the cavity and the material used for the filling. Tooth extractions typically range from $75 to $800, considering variables such as the tooth’s size and location, as well as the complexity of the extraction procedure.
Major Services
The cost of a root canal typically ranges from $500 to $1,500, with the specific amount influenced by factors such as the tooth’s location, where front teeth are generally less expensive to treat compared to those situated in the back. Crowns, which vary based on the material used, typically range from $500 to $2,000. Dentures, on the other hand, can cost between $600 to $8,000 for a full set, depending on factors such as the type and material utilized.
In addition to these primary expenses, there are supplementary costs associated with procedures such as crown placement, abutment installation (which connects the crown to the implant), as well as tooth and root extraction, along with expenses for office visits and pre/post-operative care.
While these costs can indeed add up, the decision on whether dental insurance is worthwhile hinges on individual preferences regarding coverage and budget allocation for a dental plan.
How to go about buying a dental plan
Commence by assessing the type of dental plan that best fits your specific needs. If you anticipate recurring or extensive dental issues and prioritize the flexibility to visit any licensed dentist, an indemnity plan may be suitable. Conversely, if you prefer a comprehensive option with a broad network of providers, a premium DPPO plan could be ideal. These plans often feature lower in-network costs, with the possibility that your current dentist is already part of the network. For individuals with budget constraints, a DHMO with its restricted network might be a practical choice. However, if preventive care is your primary concern and you value dentist selection, a DPPO plan may offer a balanced and cost-effective solution.
Whenever possible, securing dental coverage through your employer is advantageous. Group rates are typically more affordable as they are negotiated for multiple employees, and group plans often provide broader coverage, with the employer often contributing to the costs, thus enhancing its overall value. If employer-sponsored coverage isn’t available, explore the option of obtaining a group plan through professional associations or membership groups.
Individual dental insurance remains a viable and accessible option, with many providers, such as Guardian, offering convenient online tools for comparison, obtaining quotes, and purchasing plans.
