By Kev Coleman Insurance
Industry Expert & Author
In this article
Using data on plan features and out-of-pocket costs, this article will explore:
The advantages of dental coverage
How dental coverage can save you money
What are dental costs without insurance
How different types of plans address some of the limitations associated with dental coverage
A review of the numbers
A question often directed at dental insurance is "Is it worth it?" Unlike Affordable Care Act medical insurance as well as large group health plans, dental coverage typically has a cap on the plan’s spending for covered benefits and the coverage also lacks a limit on annual out-of-pocket costs. So what’s the point in having coverage?
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The Advantages of Dental Coverage
Assuming a person lacks dental insurance and cannot obtain such coverage through his or her job or a government program, dental benefits are normally obtained using one of the following alternatives:
Three of the above options (PPO, HMO, Discount Plan) are associated with networks of dentists who accept a negotiated rate for dental service. The advantage of negotiated rates is the promise of dental fees below market rates. Moreover, in the case HMOs and discount plans, the annual limits on service payments by the dental plan are absent.
HMO and PPO plans often have no copayments for annual dental check-ups.
How Dental Coverage Can Save Money
When debating the value of dental coverage, it is important to know what the average plan costs. In the case of dental plans, benefits are not standardized and, as a consequence, there is considerable variation among premiums. On the low side, you may find a discount dental plan for around $9 a month while on the high side you may find a more comprehensive dental plan (with a $3,000 annual limit on benefits spending) that costs around $70 a month.
As mentioned in the prior section, the discounted or negotiated rates on dental services provided by networked dental plans can save consumers money compared to paying full retail rates. Dental plans also save money for enrollees when they waive copayments for preventive care such as annual oral exams and teeth cleanings. HMO dental plans may also deliver some dental services with little-to-no copayment and have no annual cap on dental service spending by the HMO plan.
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What Are Dental Costs without Insurance
Without some form of coverage, a consumer should expect to pay full price for dental care. Below are a few examples of average dental fees in 2020 collected from the Rochester, MN, metro area by Advanced Practice Management, LLC.:
Amalgam filling (one side) - $162
Composite filling (one side) - $190
Surgical tooth extraction - $362
Root canal - $892
Ceramic crown - $1,344
Upper partial denture - $2,307
As the costs above illustrate, a few major dental procedures can quickly transform into considerable financial responsibilities for the patient. An amalgam filling, a root canal, and a crown in the same year adds up to $2,398.
A dental discount plan provides reduced price services from a network of participating dentists. Assuming the network is in the consumer’s region, he or she may save up to 20 percent of dental costs regardless of how frequently the dental services are used.
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How Different Types of Plans Address Some of the Limitations Associated with Dental Coverage
The below table provides a quick reference to the general characteristics associated with different categories of dental coverage. While there are exceptions to these rules, the table is a solid guide to the different plan categories.
Dental Discount Program
Dental Health Maintenance Organization (DHMO)
Dental Preferred Provider Organization (DPPO)
Is the coverage a form of insurance?
Does the coverage provide discounted or negotiated rates on dental services
Is there an annual limit on the costs covered by the plan
Enrollees are limited to in-network dentists
Waiting periods before more expensive dental services are covered
A person with excellent oral health and little need for dental care may be better off setting aside savings for dental care and forgoing coverage. If the person is lucky enough to live near a dental school, there may be access to lower cost care from a dentist in training. However, even with these steps a major (likely unexpected) dental need could quickly change the math supporting the decision to go without dental coverage.
For people with more regular dental needs or less than optimal oral health, dental coverage offers tools to save money on the procedures needed to maintain a healthy smile. Some options, such as dental HMOs and dental discount programs, can be exceedingly affordable.
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