Dental Insurance: Coverage and cost

Oral health is essential to your overall well-being. The mouth is considered the gateway to the body and, as a consequence, poor oral health has been linked to chronic diseases like diabetes, heart disease and stroke. The cost of dental care can be high, but dental insurance aids in offsetting some of those expenses.

While the benefits and costs of dental insurance plans can vary significantly, there are coverage options for every budget. Keep reading to discover the types of dental insurance available, as well as the costs and benefits associated with coverage.

What Is Dental Insurance?

Dental insurance, which is separate from your primary health insurance, provides coverage to help protect you from the high costs of dental care. Dental insurance may be offered to you as an employment benefit, or you can buy a plan from a health insurance company. Approximately 64% of the U.S. population have dental insurance.

Most dental plans work similarly:

• You pay a monthly premium.
• A waiting period may be necessary before coverage can begin.
• You may need a primary dentist in the insurance provider’s network.
• There may be an out-of-pocket deductible amount paid before your plan covers a percentage of the out-of-pocket costs for care.
• Most plans have an annual maximum allowance.
• Your plan may require a copay with each visit.
• Most preventative care costs $0—this care includes an annual exam, cleaning, and x-rays. (Periodontal cleaning and Deep cleaning are covered under major not preventative)

What Does Dental Insurance Cover?

Most full coverage dental insurance plans use the 100/80/50 cost-sharing model.

• 100% of the costs of routine and preventative services, such as cleanings and check-ups every six months with annual x-rays, are paid by insurance.
• 80% of the costs of basic services, such as fillings, extractions, and root canals, are paid by insurance.
• 50% of the costs of major services, such as bridges, crowns, dentures, and implants, are paid by insurance.

Some plans also cover a portion of orthodontic appliances, such as braces and retainers. Choose the plan that offers the best coverage for you and your family’s current and future dental needs.

What Doesn’t Dental Insurance Cover?

Dental insurance doesn’t typically cover cosmetic dental services, or wear and tear, which are considered not medically necessary. These procedures include any dental procedure that is done for aesthetic reasons, such as teeth whitening or non-essential veneer placement, and they could leave you with a significant out-of-pocket expense.

Types of Dental Insurance Plans

There are many different types of dental insurance plans, each with different benefits and out-of-pocket costs. Some offer a large network of dentists for a higher monthly premium while others have a lower monthly premium but require more out-of-pocket expenses for certain procedures.

The three most common types of dental insurance plans include:

• Preferred provider organizations (PPOs).  The most common type of plan, a PPO uses a network of dental providers to provide care for an agreed-upon fee. Using an out-of-network dentist with this plan will cost more out of pocket.
• Dental health maintenance organizations (DHMOs). A DHMO pays the network of dental providers a set monthly fee regardless of whether you choose to receive dental care. Some services are covered 100% while others may require you to pay a small copayment.
• Discount or dental savings plans. These plans are sold to you by a company contracted with a group of dental providers agreeing to discount their dental fees. Most of these plans include cosmetic services, and you pay for treatment at the discounted rate determined by the plan.

Dental Insurance Costs

If your employer offers a dental insurance plan, it’s likely your most cost-effective option. Most employer-based dental insurance plans are deeply discounted depending on the size of the organization and the number of employees enrolled in the plan.

If you purchase private dental insurance, premiums vary by provider, plan type and coverage levels. While most pay between $40 and $120 a month for a basic dental plan, this amount can be more or less depending on your location, plan structure, and the insurance company plan that you choose. Typical implant coverage plans start at $70per month, up to $150 per month. The higher the Maximum yearly coverage ($5000) the more expensive the plan.

You also need to consider deductibles, co-pays, and annual maximum allowances in the total cost of dental insurance.

Should You Get Dental Insurance?

“Dental insurance is the third-ranked must-have benefit among employees, just after medical insurance and a 401(k),” says David Guarrera, M.D., vice president and chief dental officer at MetLife. “Employees are 10% more likely to say dental is a must-have than they were in 2018, and one in 10 employees say they have needed to undergo a major dental procedure in the past 12 months,” he adds.

Here are the average costs of dental services without dental insurance.

Preventive Services

• Basic cleaning and polish: $75-$200
• Panoramic dental x-rays: $100-$200

Basic Services

• Fillings: $50-$250 depending on the size of the cavity and the material used for the filling
• Tooth extraction: $75-800 depending on the size and location of the tooth and the difficulty of the procedure.

Major Services

• Bridge: $1,550-$2,500 depending on the size of the bridge, the materials used and the difficulty of placement
• Root canal: $600-$1,400 depending on the location of the tooth (front teeth are less expensive than those in the back)
• Crowns: $500-$2,000 depending on the material used.
• Dentures: $770-$2,200 depending on the type and the material used.
• Implants: $1,500-$2,000 per implant
• There are additional costs for the crown, the abutment (connects crown to implant), tooth and root extraction, bone grafting, office visits and pre/post-op care. These additional costs can range from $1500-$2800 bringing the total cost without dental insurance for a single implant to over $4,000.

Tamie Mongold

(951) 795-1943

ShopAgency65@gmail.com

Ameritas PPO http://ShopDental.xyz

Nationwide PPO  http://ShopDental.pro

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