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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. In order to choose the right plan for your circumstances, this article will teach you the basics regarding:
With this information, you can move beyond comparing prices to comparing value.
A review of 38 dental plans in the Lone Star State found a considerable range of prices. The average premium in 2022 was $40.83 for a 33 year-old sample applicant, 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 state average as did the one dental discount program in the study (Careington 500 Series Dental Savings). Among PPO and indemnity dental plans, 16 out of 33 had premiums below the study average.
Two-thirds (68 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 plans covered root canals and crowns paid for 32 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, with a $192.50 average cost for the patient. The sole dental discount program, Careington 500 Series Dental Savings, had its root canal charge begin at $320.
Teeth extractions had higher coverage from PPO and indemnity plans than was the case for root canals and crowns, with insurer payments averaging 45 percent of cost. Insurer payments toward fillings were even higher, at a 63 percent of the procedure cost. HMO dental plans copayments for fillings ranged from $25 to $60.
45 percent of all plans in the study examined had some level of coverage for dental implants. Most of the plans with implant coverage paid for 50 percent of the procedure (assuming the deductible was satisfied). Four of the plans with implant coverage only provided for 20 percent of the treatment cost and one plan only covered 10 percent. 65 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 38 plans under consideration, with 37 percent having no waiting period delays for traditional dental coverage (orthodontics excluded).
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 $2,014, up from $1,590 in 2022. The NCD Nationwide 5000 Plan had a limit over two times higher than the average at $5,000, and the NCD Complete by MetLife, at $10,000, had a maximum benefit roughly five times the market average. 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. A deductible is the money you pay your dentist before an insurance plan begins to share in covered dental treatment costs. If your policy has a $100 deductible then you pay the first $100 of dental care expenses you receive during that plan year. After that, the insurance companies some of the cost and the remainder is typically covered by the copays or coinsurance fees you pay.
In Texas, deductibles varied, but within a relatively narrow range. The smallest deductible observed among the plans studied was $0. In fact, 21 percent of the plans examined had no deductible ($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 $49.34 a year. Family deductibles were higher and often depended on the number of family members enrolled in the plan.
Teeth whitening is a form of cosmetic dentistry and most plans do not cover cosmetic dental services. However, a review of 38 Texas plans found that 21 percent had some form of coverage for teeth whitening. Many industry experts believe that teeth whitening coverage with become more common in the future.
There are many businesses offering dental benefits for Texas residents. The 35 plans reviewed as part of this study came from the following nine insurance companies:
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 insurance 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
The following chart provides additional details on the coverage trend in our Texas dental plan study. You can use this information when evaluating the breadth of coverage provided in a dental plan you are considering. The chart helps you recognize when a plan’s attribute (e.g. premium, maximum benefit, etc.) are above or below the averages for the state.
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.
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