Dental Insurance Explained
Insurance can be not only overwhelming and confusing, but also misleading – especially when it comes to dental insurance. Dental insurance does not cover care the same way that medical insurance does. Dental insurance is a set amount of benefits given to you (typically by your employer) as a benefit. Most employees pay a set fee or premium every month for this benefit. Individuals who do not get dental insurance as a benefit through their employe can pay a premium to a private insurance company to receive dental insurance benefits.
Monthly Premiums
The premium is the amount that you and/or your employer pay monthly for insurance. The premium amount may vary between different insurance companies and different insurance plans. The premium for a dental plan can be anywhere from $25 - $50 per month for an individual up to $50 - $150 per month for a family
Copays
For most services covered under dental insurance plans, the insurance company does not pay the full amount for treatment provided. The copay is the amount that the insurance does not pay for a dental treatment or service that you are responsible for paying. Copays are in addition to the monthly premium
Deductibles
Many dental insurance plans have a deductible. The deductible is the amount of money you must pay before your insurance benefits begin to take effect.
Annual maximums
The annual maximum is the total amount that your insurance company will pay in a year. The average yearly maximum is $1,500
How much does dental care cost?
How much you may pay for a visit to the dentist depends on what type of dental care you receive
Preventive dental care costs
A routine cleaning with an exam and x-rays can range from $180 - $250
Basic/restorative dental care costs
A composite dental filling can cost from $150 - $350. A ceramic dental crown costs around $1,200. Many dental insurance plans cover up to 80% of the cost of basic restorative dental procedures up to your annual maximum.
Major dental care costs
Root canals can cost from $900 to $1,500. Bridges may cost $3,600 and up depending on the number of teeth involved. Implants may run $4,200 per tooth or more.
Many dental plants can cover up to 50% of the cost of these major services up to your annual maximum.
Do you need dental insurance?
Let’s go through a couple of examples for better understanding.
Example one:
Your premium is $80 per month, or $480 per year. You have great oral health and require no extensive dentistry, just your preventive visits every six months. Those two visits cost $360. Your insurance pays 90% of that $360 – equal to $324, which makes your copay the remainder of $36. Since you paid $480 in premiums, you actually paid $516 for the two preventive visits. If you didn’t have insurance and paid for those visits out of pocket, you would have saved $156.
Example two:
Your premium is $40 per month, or $480 per year. You have a tooth that needs a crown that costs $1,500 and two medium sized fillings that cost $350 each, totaling $700. You have your two preventive visits a year at $360 each. Your insurance will pay for 50% of the crown ($750), pays 80% of the two fillings ($560), and the two preventive appointments at $324 each. Altogether, the insurance should pay $1,634, but your yearly maximum is $1,500 – so on top of your premium of $480 per year and your copay, your out of pocket for the above services is $1,540. Your insurance company essentially paid $1,020 while you paid $1,540.
DENTAL INSURANCE IS A LIMITED BENEFIT.
How can you lower your dental costs?
One of the best ways to cut down on dentist bills is to keep up with your dental hygiene. Brushing and flossing every day and using floured toothpaste could help you prevent cavities and gum disease. It’s also important to attend your regular dental exams and cleanings at the dentist. Preventive care could help you avoid larger out-of-pocket costs.
Insurance does have a small benefit if you need extensive care. However, if you do not require extensive dental care every year – you may want to consider not having to pay for premiums and ultimately, overpaying for your care by paying out-of-pocket for your routine six-month visits.
Most patients do not realize that dental insurance companies give the patient a yearly allowable amount that they pay a part of.
