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NY Dental Insurance Plans

Average Premium, Service Co-Pays, and Benefit Limits in New York

By Insurance Industry Expert & Author
Updated on

Interested in becoming a better dental insurance shopper? We’ve analyzed more than three dozen 2021 dental coverage alternatives in New York and have the data to help you make a better dental plan selection.

Before reviewing our findings on New York dental plans, it’s important to clarify a few terms that we will use:

  • DPPO Plan - A dental preferred provider organization is a dental insurance plan where an enrollee can use a dentist within the plan’s network and benefit from lower out-of-pocket costs or use an out-of-network dentist and pay more for care
  • DHMO Plan - A dental health maintenance organization normally has a narrow network of dentists and services received from out-of-network dentists won’t be paid for by the dental plan. Specialized dental care also requires a referral unlike PPO plans where no referral is necessary
  • Indemnity Plan - Indemnity dental plans typically reimburse an enrollee for only a share of the total cost of a covered dental service. Indemnity plans often do not restrict an enrollee to a network of dentists, thus providing more options for receiving dental care
  • Dental Discount Program - A dental discount program is not insurance. Instead, it is a program where membership is accessed through a monthly fee and the enrollee can receive discounted dental care from dentists belonging to the discount program

Premiums: High, Low, & Average

The monthly fee for dental coverage in our study ranged from $5.10 (MetLife's “TakeAlong Dental HMO-Managed Care 350 (Low)") to $68.72 (Nationwide Classic 2000 Indemnity). Benefits differed considerably among plans. For the plan year 2021, the average premium across plans was $38.03 for single-person coverage.

Maximum Benefits Per Year

The ceiling on a plan’s reimbursements for enrollee dental care is known as the plan’s “maximum annual benefit.” The DHMO plans included in this study did not have a maximum annual benefit limitation, nor did the discount program have a limit on annual consumer savings. DPPO plans and indemnity plans, on the other hand, did have such caps and they made up the majority of plan options available within this study. The lowest of the benefit caps was $500. However, some plans had a maximum benefit that increased over time. For example, Renaissance’s MAX Choice Plus had a maximum benefit of $1,000 in the first year of enrollment, $2,000 in the second, and $3,000 in the third and following years. The average first year maximum benefit for plans having this spending cap was $1,422. The highest maximum benefit was $3,000. Only one plan in the study had a $3,000 maximum benefit in the first year of enrollment. A second plan, the previously discussed MAX Choice Plus, had a $3,000 benefit starting in the third year of enrollment.

Deductibles did not vary among plans to the same degree as maximum benefits. Deductibles are the amount spent out-of-pocket by a dental plan enrollee before the plan begins sharing the cost of dental services. Some plans had no deductibles. This was the case for the three DHMOs included in the study, a DPPO plan, and a dental discount program. There were two other DPPO plans that had no deductible for diagnostic, basic care and major dental procedures, but did have a deductible that applied to orthodontia care. For the plans with deductibles, the highest deductible for an individual was $100 annually. Family deductibles were higher. Many plans had a deductible of $50 per family member. Some others had a deductible that applied to families regardless of size. The most common deductible for family coverage was $150 annually.

Major Services

Major dental services include care such as crowns and root canals. This can be very expensive care. For dental coverage of crowns where a flat fee was charged in 2021, the Dental Discount program had the highest cost ($701 for members of Careington's 500 Series Dental Savings Discount Card). DHMO plans’ crown copayments ranged from $245 to $430. Over 12 percent of dental coverage options did not include crowns among their dental benefits. Most dental plans charged enrollees a percentage of the total crown cost as a coinsurance fee. The most common coinsurance fee was 50 percent of the total crown cost.

Root canal procedures had similar cost-sharing trends as found among crowns. Some plans didn’t cover the care, others had flat fees between $110 and $399, and the rest had coinsurance fees. With respect to the coinsurance fees, the most frequent was a fee of 50 percent of the root canal cost.

DENTAL CARE RESOURCES FOR NEW YORKERS

New York State Dental Association (NYSDA)

The NYSDA represents 13,000 member dentists throughout New York State. This powerful partnership is enhanced by 13 local dental societies within the state of New York.

MouthHealthy: Oral Care Resources

The MouthHealthy.org website provides education (good oral health habits, top dental concerns, nutrition, etc.) categorized by age group and life stage (pregnancy, babies/children, teens, adults under the age of 40, adults ages 40 to 60, and adults over age 60.

Low-Cost New York Dental Care

The FreeDentalCare website lists free and low-cost dental services located in the state of New York. This site collects information on free dental clinics, sliding-scale clinics, low-cost clinics, and non-profit clinics. These resources may have limited capacity or eligibility criteria (e.g. income level).

New York State

Excelsior (Ever Upward)

  • Capitol: Albany
  • Nickname: The Empire State
  • State Bird: Eastern Bluebird
  • State Flower: Rose

Our best-selling plans in New York

Guardian Logo

Managed DentalGuard

Low monthly cost DHMO plan with no waiting periods, no deductible, no annual maximum.

Plan type: DHMO
Plan Maximum: None

Delta Dental Logo

Immediate Coverage Plan

Immediate coverage with no waiting periods for most services. Generous plan maximum.

Plan type: PPO
Plan Maximum: $3000

Guardian Logo

Advantage Gold

Rich benefits with maximums increase each for year the first 3 years.

Plan type: PPO
Plan Maximum: $1000 – $1500

See why our customers trust us to help them find the right dental plan

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