With approximately 29 million residents and 15,000 dentists, Texas supports a robust dental insurance marketplace with a ratio of about 1,900 residents for every one dentist located in the state. However, in order to choose the right plan for your circumstances, this article will educate you on:
A review of nearly three dozen dental plans in the state of Texas found considerable range of prices. The average premium in 2022 was $37.74 for an individual enrollee, but the lowest monthly premium was $7.03 for the MetLife TakeAlong Dental HMO-Managed Care 350 (Low). Every HMO dental insurance plan premium in the study fell below the average as did the one dental discount program in the study (Careington 500 Series Dental Savings). Among types of dental plans, 21 out of 35 had premiums below the study average.
Two-out-of-three (66 percent) of the 35 plans covered routine dental cleanings without charging any copayment or other out-of-pocket fee. During the first year of enrollment, most of the that plans covered root canals and crowns paid for 41 percent of the treatment cost. Several of the dental plans increased this coverage percentage for customers who stayed in the plan for two and three years in a row. For HMO plans whose out-of-pocket costs were flat-fee copayments, the price for a root canal ranged from $110 to $260. The sole dental discount program, Careington 500 Series Dental Savings, charged $320 for a root canal.
Teeth extractions had higher coverage, averaging 56 percent of cost, and fillings were even higher at a 61 percent of cost average. HMO dental plans copayments for fillings ranged from $25 to $60.
40 percent of plans examined had some level of coverage for dental implants. Most of the plans with crown coverage paid for 50 percent of the crown cost. 4 of the plans with implant coverage only provided for 20 percent of the costs. 71 percent of dental plans that included implant coverage required the customer to be enrolled in the plan for at least a year before crown coverage was available. A delay in benefit access is known as a "waiting period." Waiting periods were common (especially for more expensive dental care) among the 35 plans under consideration, with 34 percent having no waiting period delays for the coverage they offered.
All the PPO dental plans and indemnity dental plans had restrictions on how much money the insurance company would pay annually toward dental treatment. The average amount among these plans was $1,590 for 2022. The NCD Nationwide 5000 Plan had a limit three times higher than the average at $5,000. Both the HMO plans and dental discount program in the study had no annual limits regarding insurer payments or customer savings.
These differences in insurer payment limits warrants some brief comments regarding different types of dental plans. A HMO is a dental health maintenance organization where care is covered when provided by in-network dentists and care outside the network is not covered. An indemnity plan, in contrast, does not limit the enrollee to specific dentists. However, an indemnity plan has a reimbursement scheme for dental services that may be lower than what a dentist charges. Within a HMO, the enrollee has fixed copayments (or, more rarely, coinsurance fees) that have been agreed upon by the dentists within the plan's network. Another form dental coverage is the dental preferred provider organization (PPO), the most common model of dental network, where in-network dentists have lower copays and cost-sharing than dentists who are out-of-network. In contrast, a HMO dental plan will normally not cover out-of-network dental care and their networks are typically smaller than is the case for PPO networks.
Out-of-pocket costs come in many forms: deductibles, flat fee copayments, and coinsurance fees where the patient pays for a percentage of the dental service. In Texas, deductibles varied, but within a relatively narrow range. The smallest deductible observed among the plans studied was $0. In fact, 20 percent of the plans examined had no deductible charge ($0). The highest annual deductible for an individual was $100, though a single plan had a one-time individual deductible of $150. The average deductible for a single enrollee was $63 a year. Family deductibles were higher and often depended on the number of family members enrolled in the plan.
There are many companies offering dental benefits for Texas residents. The 35 plans reviewed as part of this study came from the following nine businesses:
Now that you're more educated consumer regarding the Texas dental insurance market, you're in a better position to judge the value of your dental insurance options in the Lone Star State. To review dental insurance prices in your region of Texas, you can visit our dental insurance quote page. You can also review below the most popular Texas dental plans sold on DentalInsurance.com.
Rich benefits with maximums increase each for year the first 3 years
Plan type: PPO
Plan Maximum: $1000 – $1500
Immediate coverage with no waiting periods for most services. Generous plan maximum.
Plan type: PPO
Plan Maximum: $3000
100% preventive coverage on day one. $2000 plan maximum. No waiting periods.
Plan type: PPO
Plan Maximum: $2000
Chartered in 1871, the TDA is the third largest state dental association in the United States. Currently, it has more than 9,000 members and is comprised of 26 dental societies grouped into 4 divisions across the state.
Helpful information regarding dental health, assistance for teaching children about proper oral health, dental emergencies, and one-minute videos on a variety of dental topics.
The Texas Dental Association sponsors the TDA Smiles Foundation, a program that expands access to dental health services to underserved communities in the state. The TDA Smiles Foundation accomplishes its work through several organizations including the Texas Mission of Mercy providing charitable dental care through dental clinic events across Texas, the Fluoride Fest and the Cavity Free Corral delivering oral health information to families, and SMART Smiles, which provides preventive dental services to elementary school aged children and low-income children.