Which Dental Plans Cover the Three Most Costly Dental Procedures?
By Avery Smith
Insurance Industry Expert & Author Updated on
Treatment Types Reviewed
While many dental treatments (such as fillings and annual teeth cleanings) are very affordable, the expenses for dental care can reach several thousand dollars in some cases. In this report, DentalInsurance.com examined three of the most expensive procedures and reviewed coverage trends and the conditions under which the coverage was offered. Those conditions included waiting periods, lifetime limits on procedure spending, and separate deductibles. Dental benefits are not standardized so the services covered by one plan may not be covered by another.
The three dental treatments examined by this study were braces (i.e. orthodontic care), crowns, and dental implants. The selection of this trio was due to:
Each treatment can exceed $1,000 in expense
Information on their respective insurance coverage is readily available within dental plan records
With respect to treatment costs, it should be noted that prices vary among dentists for crowns, braces, and implants, and the condition of teeth, gums, and bone may affect the final cost for each procedure.
The average cost for adult braces is approximately $6,000 according to the American Dental Association's 2020 Annual Survey of Dental Fees. Braces were the least common insurance benefit among the three procedures examined, with only 28 percent of DentalInsurance.com plan options sampled from each state offering some degree of coverage. Among the plans that did include orthodontic benefits, most restricted this coverage to children and dependents. Only 20 percent of plans with orthodontic benefits extended these benefits to adult insurance enrollees. Waiting periods delaying the availability of orthodontic coverage were frequently encountered. When a waiting period was present, the delay was typically 12 months of continuous plan enrollment before the orthodontic benefits became available. These waiting periods, however, were limited to the PPO and indemnity dental plans (which combined were 90 percent of the options examined). The plans that were an HMO or dental discount program had no waiting periods.
Some plans had a separate deductible that only applied to orthodontic care. Others had a cap on lifetime spending by the insurance company on the enrollee’s orthodontic care. These lifetime maximums, when present, were often $1,000 with some as high as $1,500. The plans that were an HMO or dental discount program lacked lifetime maximums just as they had lacked waiting periods.
The average premium for dental plans offering orthodontic coverage was $40.84 for an applicant born on January 1, 1990. Examples of dental plans with orthodontic coverage include:
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A crown is an artificial tooth attached to the remainder of a patient’s original tooth. Depending on the type of material used to manufacture the crown (gold, porcelain, zirconia, etc.), it may cost as much as $2,500 or as little as $500. Among the options reviewed in this study, 91 percent had crown coverage. 42 percent of plans with crown benefits had progressive coverage that increased insurance cost contributions the longer a person was enrolled in the plan. For example, a particular dental plan may start by paying 20 percent of crown costs in the first year of plan membership. In the second year, the insurer cost contribution may rise to 30 percent. By the third year and after, the plan may cover half of crown costs. In some instances, a plan with crown coverage may not begin the benefit until the second year of continuous plan membership. For the plans that had a stable cost coverage regardless of how long a consumer was enrolled, the insurer contribution was often 50 percent of the crown cost (in the case of PPOs and indemnity plans). HMO plans, in contrast, charged a fixed copayment for the treatment (e.g. $523).
The average premium for dental plans including crown benefits was $46.17 for an applicant born on January 1, 1990. Examples of dental plans that cover crowns include:
Dental implants are instruments (e.g. metal posts) surgically inserted into the jaw (or skull in the case of upper teeth) and on it crowns (or a bridge) is attached. The combined cost of preparation and then implementation of a single post and crown can range from $3,000 to $4,500 according to Forbes. About half (53 percent) of DentalInsurance.com’s plans nationwide had coverage for implants. The out-of-pocket cost among several HMOs covering implants was $1,500 for single tooth. Other HMOs offered a discount of 15 percent to 25 percent on the price of the procedure. The one dental discount card in the study offered a 20 percent discount at participating dentists.
The coverage of implants by PPOs was similar to what was observed for crowns. Depending on the plan, there may be a waiting period and/or a lifetime cap of treatment spending. Some PPO plans began with low cost coverage (20 percent) in the first year of plan membership and increased insurer expense contribution in the second and third years. 12-month waiting periods delaying implant benefit availability were commonly observed as well. Some plans restricted implant coverage to one tooth for every five years of enrollment. Others had a restriction that no more than one implant will be covered for the same tooth position within a 10-year period.
The average premium for plans including dental implant benefits was $47.82 for an applicant born on January 1, 1990. Examples of dental plans with orthodontic coverage include:
The dental plans examined in this study were an aggregation of all DentalInsurance.com’s plan options available for one zip code from each of the 50 states plus the District of Columbia. This produced 1,446 options in total, with most dental plans having been duplicated across multiple states. The insurance companies providing the plans were:
Delta Dental of Kentucky
Delta Dental of Tennessee
Empire BlueCross BlueShield
California Dental Network
Dental Health Services
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