Dental insurance plans: Comparing coverage and costs
Dental care expenses can often be significant, but dental insurance serves to alleviate some of these financial burdens.
It’s important to note that dental insurance policies vary widely in their coverage and benefits, offering a spectrum of options from preventive-focused plans to comprehensive coverage that includes major procedures such as dentures and implants.
The different types of dental insurance plans and how they work
Given the intricate connection between dental health and overall well-being, dental insurance operates much like health insurance, offering financial assistance for necessary care in exchange for a monthly premium. Key similarities between dental and health insurance include:
– Network of Providers: Most dental plans utilize a network of participating dentists and specialists.
– Deductibles: Before the insurance plan covers treatment costs, individuals typically must meet a deductible.
– Copays or Coinsurance: Patients often share the cost of procedures through copays or coinsurance payments.
However, dental insurance differs from health insurance in several ways:
– Coverage for Preventive Care: Many dental plans cover preventive treatments like checkups, cleanings, and x-rays at 100% without additional charges.
– Lower Deductibles: Dental insurance plans generally have lower deductibles compared to medical plans, typically around $50 for individuals and $150 for families.
– Maximum Annual Coverage: Dental plans commonly impose a maximum annual benefit, typically ranging from $1,000 to $2,000 per member.
– Waiting Periods: Some dental plans may have waiting periods before covering non-preventive procedures.
The two most common types of plans are DPPOs and DHMOs
DPPO, or Dental Preferred Provider Organization, encompasses plans with extensive networks of dentists, such as Guardian’s network boasting over 120,000 providers across 400,000 locations nationwide. Staying in-network offers notable advantages: streamlined claim processing and substantial discounts, which effectively reduce out-of-pocket expenses. For instance, while an out-of-network dentist might charge $100 for a filling, an in-network provider may only charge $60-$70, even before meeting the deductible.
Comparing DPPO plans involves assessing their coverage formula. A plan designated as 100/80/50 typically covers preventive care at 100%, basic procedures (e.g., fillings, extractions) at 80%, and major procedures like crowns, bridges, and root canals at 50%. Consequently, it provides superior benefits compared to plans with, for example, an 80/60/40 coverage breakdown.
On the other hand, Dental HMOs (DHMOs) often feature lower premiums but less flexibility. These plans come with a more restricted provider network, potentially necessitating a switch from your current dentist. While there are no deductibles or maximums, copayments are typically required for most non-preventive procedures.
Indemnity and discount plans
There are two additional types of dental plans available: Indemnity plans offer flexibility, allowing you to visit any dentist, and reimburse a portion of your expenses, typically ranging between 50% and 80% of what the insurance deems as “reasonable and customary.” Preventive care is often fully covered under these plans. However, they usually come with higher costs and are less common, requiring more paperwork as you’re responsible for upfront payments to the dentist, followed by claim submission.
Discount plans, on the other hand, diverge from traditional insurance models, resembling more of a membership club. With an annual fee, you receive a card granting access to reduced prices at participating dentists. Discounts vary depending on the procedure, but under these plans, you pay out-of-pocket during each dental visit. Due to the diverse array of plans and discount structures available, it’s challenging to provide a general estimate of your dental care costs with a discount plan.
What you can expect to pay for each type of plan
The average monthly premiums for each plan type are as follows:
– DHMO: $22.75
– PPO: $62.75
– Indemnity: $81.50
Premium amounts are influenced by various factors, including the type of plan, the insurer, and the level of coverage. Monthly costs typically range from $12 to $50 per person for DPPO and DHMO plans. DHMO plans usually fall towards the lower end of this range, while comprehensive DPPO plans tend to be towards the higher end. Indemnity plan premiums are higher, often costing as much as twice the amount of a DPPO plan.
Compare Dental Insurance Coverage And Costs From Our Partners
1.Ameritas
The Dental Insurance Guide’s website offers coverage in 48 states, boasting a network of 111,500 providers. Monthly plan premiums commence at $24.69.
2. Aflac
HealthNetwork’s website provides coverage across 48 states and Washington, D.C., with a vast network spanning 270,000 locations. Monthly premiums for plans start at $17.99.
3. Humana
HealthNetwork’s website states that their coverage extends across 48 states and Washington, D.C., with an extensive network comprising 270,000 locations. Monthly premiums for their plans start at $17.99.
How Much Does Dental Insurance Cost?
Forbes Advisor’s analysis reveals that the average cost of a dental insurance policy with comprehensive coverage is $47 per month. Meanwhile, a preventive care plan typically averages around $26 per month. The cost of individual dental insurance is influenced by various factors including the extent of coverage, the annual maximum, as well as out-of-pocket expenses such as deductibles and coinsurance.
Average Dental Insurance Costs by Plan
| Insurance company | Top-scoring plan in Forbes Advisor’s analysis | Monthly cost example |
|---|---|---|
|
Humana
|
Preventive Value
|
$21.99
|
|
Spirit Dental
|
Core Network
|
$43.37
|
|
UnitedHealthcare
|
Primary Plus Dental
|
$43.59
|
|
Cigna
|
Cigna Dental 1500
|
$49.00
|
|
Ameritas
|
PrimeStar Access
|
$49.98
|
|
Guardian Direct
|
Diamond
|
$58.40
|
|
Delta Dental
|
Delta Dental PPO Individual – Premium Plan
|
$64.92
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
$68.55
|
|
Anthem
|
Essential Choice PPO Platinum
|
$79.49
|
The monthly costs provided are specific to a 30-year-old female residing in California and are presented for comparison purposes only; individual costs may vary. Humana’s Preventive Value plan prioritizes preventive care but excludes coverage for major services such as oral surgery and root canals.
Many employers include dental insurance as part of their benefits packages, often providing group policies at reduced rates compared to individual plans. Through group plans, employers contribute to coverage costs, resulting in more affordable dental insurance options for employees.
Out-of-Pocket Dental Insurance Costs
Anticipate the following out-of-pocket costs associated with dental insurance:
1. Premiums
2. Deductibles
3. Coinsurance
4. Copayments
5. Expenses incurred after reaching the plan’s annual maximum limit.
Premiums
This refers to the standard fee required to maintain an active dental insurance policy.
In addition to premiums, dental insurance typically encompasses deductibles, copayments, and coinsurance.
Dental Insurance Deductibles
A dental insurance deductible denotes the sum an individual pays for dental services before the insurance provider assumes coverage.
The precise deductible varies across dental insurance plans. For instance, our assessment of dental insurance deductibles reveals that some plans impose no deductible for in-network care, whereas others may levy $50 annually for an individual. Additionally, certain dental insurance plans feature a lifetime deductible instead.
Illustrative instances of dental insurance deductibles:
| Insurance company | Top-scoring plan in Forbes Advisor’s analysis | Annual deductible (unless noted as lifetime) |
|---|---|---|
|
Ameritas
|
PrimeStar Access
|
$50
|
|
Anthem
|
Essential Choice PPO Platinum
|
$50 per person, up to $150 per family
|
|
Cigna
|
Cigna Dental 1500
|
$50 individual, $150 family
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
Lifetime $100 in-network deductible or lifetime $200 out-of-network deductible
|
|
Guardian Direct
|
Diamond
|
In-network: $0 Out-of-network: $50
All Other Dental Services: $50 Teeth Whitening: $50
|
|
Humana
|
Preventive Value
|
Lifetime: $50 individual, $150 family
|
|
Spirit Dental
|
Core Network
|
$100 lifetime deductible
|
|
UnitedHealthcare
|
Primary Plus Dental
|
$50 for basic services
|
Coinsurance
Coinsurance refers to the percentage of dental care expenses shared between you and your dental insurance provider once you fulfill your deductible.
For example, one dental insurance company might cover 80% of basic care expenses and 50% of major care costs. Conversely, another insurer might cover 50% of basic care expenses and exclude coverage for major care entirely.
Under dental insurance, preventive care typically incurs no out-of-pocket expenses, while basic and major care typically involve coinsurance percentages.
Examples of dental insurance coinsurance:
| Insurance company | Top-scoring plan | Coinsurance for preventive care | Coinsurance for basic care | Coinsurance for major care |
|---|---|---|---|---|
|
Ameritas
|
PrimeStar Access
|
Plan pays In-network Day 1 100%
Out-of-network 80%
After year 1 100%
Out-of-network 80%
|
Plan pays In-network Day 1 65%
Out-of-network: 45%
After year 1 80%
Out-of-network: 60%
|
Plan pays In-network Day 1 20%
Out-of-network: 10%
After year 1 50%
Out-of-network: 30%
|
|
Anthem
|
Essential Choice PPO Platinum
|
100%
|
In-network: 20%
Out-of-network: 20%
|
In-network: 50%
Out-of-network:50%
|
|
Cigna
|
Cigna Dental 1500
|
100%
|
80%
|
50%
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
100% for 2 exams per calendar year
4 cleanings per calendar year
|
Year 1: 10%
Year 2: 25%
Year 3: 40%
Year 5: 50%
|
Year 1: 10%
Year 2: 25%
Year 3: 40%
Year 5: 50%
|
|
Guardian Direct
|
Diamond
|
100%
|
80%
|
50%
|
|
Spirit Dental
|
Core Network
|
100% for 2 exams per year
3 cleanings per year
|
Year 1: 50%
Year 2: 65%
Year 3: 80%
|
Year 1; 25%
After Year 1: 50%
|
|
Delta Dental
|
Delta Dental PPO Individual – Premium Plan
|
100%
|
80%
|
50%
|
|
Humana
|
Preventive Value
|
100%
|
50%
|
Not covered
|
|
UnitedHealthcare
|
Primary Plus Dental
|
100%
|
Day 1 1: 50%
After Year 1: 65%
After Year 2: 80%
|
Not covered
|
Dental Insurance Copayment
A dental insurance copayment is a prearranged fee that you pay directly at the time of receiving a service. Copayments typically remain modest, such as $20 or $30, and are applicable even after surpassing your deductible.
In dental insurance, preventive care often does not require a copayment, reflecting insurers’ emphasis on encouraging proactive dental hygiene to minimize the likelihood of requiring costlier treatments in the future.
Dental Insurance Annual Maximum
Dental insurance plans typically feature annual maximums, representing the maximum amount that the insurance company will cover for your dental procedures within a given year or over a lifetime.
Examples of dental insurance annual maximums:
| Insurance company | Top-scoring plan | Annual maximum |
|---|---|---|
|
Ameritas
|
PrimeStar Access
|
Day 1: $1,000
After Year 1: $2,000
Covers a maximum amount per person per benefit period for basic and major services combined.
|
|
Denali Dental
|
Ridge Plan 750/1500/2000/2500
|
Year 1: $750
Year 2: $1,500
Year 3: $2,000
Year 4: $2,500
|
|
Guardian Direct
|
Diamond
|
$1,500 Dental Implants: Lifetime max $1,000
Orthodontia: Yearly max $500 Lifetime max $1,000
Teeth whitening: yearly max $500
|
|
Anthem
|
Essential Choice PPO Platinum
|
$2,000 with annual maximum carryover
|
|
Cigna
|
Cigna Dental 1500
|
$1,500
|
|
Delta Dental
|
Delta Dental PPO Individual – Premium Plan
|
$2,000
|
|
Humana
|
Preventive Value
|
Unlimited
|
|
Spirit Dental
|
Core Network
|
$1,200
|
|
UnitedHealthcare
|
Primary Plus Dental
|
$1,000
|
What Is Dental Insurance?
Dental insurance offers financial protection against the often substantial expenses associated with dental care. While distinct from primary health insurance, some health insurers offer dental insurance plans alongside their medical coverage.
You may receive dental insurance as part of your employment benefits package, or you can opt to purchase a plan directly from a dental insurance provider.
How Does Dental Insurance Work?
Typically, dental insurance operates under the following framework:
1. Monthly Premium: You pay a monthly premium to maintain coverage.
2. Waiting Periods: Some types of care may have waiting periods, although preventive services like cleanings often have no waiting period.
3. Network Dentist: You may be required to choose a primary dentist from the insurance provider’s network.
4. Deductible: There might be an out-of-pocket deductible that must be met before the plan covers a portion of the costs for care.
5. Annual Maximum: Most plans have an annual maximum allowance for covered services.
6. Copayment: Your plan may involve copayments for dentist visits.
7. Preventive Care Coverage: Most plans cover preventive care at 100%, including annual exams, cleanings, and X-rays.
What Does Dental Insurance Cover?
Dental insurance policies commonly prioritize preventive services, yet the extent of coverage varies across plans. While some policies may cover a portion of basic services, others extend coverage to both basic and major services, albeit to different degrees.
Routine and Preventive Services
Typically, these services are fully covered:
– Routine cleanings and biannual check-ups
– Annual X-rays
Basic Services
The coverage percentage can vary, but it often covers around 80% of the costs for:
– Fillings
– Simple extractions
Major Services
The coverage percentage can vary, but it often covers around 50% of the costs for:
– Root canals
– Bridges
– Crowns
– Dentures
– Implants
What Doesn’t Dental Insurance Cover?
Typically, dental insurance excludes coverage for the following services:
– Cosmetic dentistry that’s deemed non-medically necessary
– Bonding
– Non-essential veneer placement
Additionally, dental insurance might not cover the following services. It’s essential to review your policy details carefully, as there could be limitations such as lifetime maximum benefits or waiting periods even if coverage is included:
– Teeth whitening
– Orthodontic treatments (such as braces)
If your policy does provide coverage for any of these services, the coverage percentage may be lower.
Types of Dental Insurance Plans
Dental insurance plans vary in terms of their allowance for out-of-network care and the extent of coverage provided for various types of dental procedures.
Dental Preferred Provider Organizations (DPPO)
A DPPO (Dental Preferred Provider Organization) utilizes a network of dental providers who offer services at predetermined rates. While out-of-network care is available, it typically comes with higher costs. These policies often have higher premiums due to their increased flexibility.
Dental Health Maintenance Organizations (DHMO)
A DHMO (Dental Health Maintenance Organization) provides cost-effective coverage through a network of dental providers. While certain services are covered entirely, others may necessitate a modest copayment. Typically, adherence to the DHMO’s network is required to receive reimbursement for care.
Fee-for-Service Plans
Traditional or indemnity dental plans, also referred to as fee-for-service plans, do not operate within provider networks, affording you the flexibility to visit any dentist of your choosing.
Under these plans, a percentage of the cost for each service is covered by the insurance, while you are responsible for the remaining portion. Unlike PPOs or DHMOs, fee-for-service plans do not negotiate discounted fees with dentists, as they do not engage in contractual agreements with them.
Discount or Dental Savings Plans
Discount dental plans do not function as traditional dental insurance policies. Rather, they provide discounted rates for dental services at participating providers. Under these plans, you are responsible for paying for the treatment at the discounted rate established by the plan.
Should You Get Dental Insurance?
The value of dental insurance varies based on individual circumstances, primarily determined by one’s dental care expenses and whether the cost of insurance outweighs these expenses. Below are the average costs of dental services without insurance, as provided by Humana.
Preventive Services
Professional dental cleaning and polishing typically range between $75 to $200, while panoramic dental X-rays may cost between $100 to $200.
Basic Services
The cost of fillings can vary between $50 to $250, contingent upon factors such as the size of the cavity and the material utilized for the filling. For tooth extractions, prices typically range from $75 to $800, considering variables like the tooth’s size and location, as well as the complexity of the extraction procedure.
Major Services
The cost of a root canal typically falls within the range of $500 to $1,500, with the specific amount influenced by the tooth’s location, where front teeth are generally less expensive to treat compared to those situated in the back. Crowns, which vary based on the material used, typically range from $500 to $2,000. Dentures, on the other hand, can cost between $600 to $8,000 for a full set, depending on factors such as the type and material utilized.
In addition to these primary expenses, there are supplementary costs associated with procedures such as crown placement, abutment installation (which connects the crown to the implant), as well as tooth and root extraction, along with expenses for office visits and pre/post-operative care.
While these costs can indeed add up, the decision on whether dental insurance is worthwhile hinges on individual preferences regarding coverage and budget allocation for a dental plan.
How to go about buying a dental plan
Begin by evaluating the type of dental plan that aligns best with your specific needs. If you anticipate recurring or extensive dental issues and value the flexibility to visit any licensed dentist, an indemnity plan may suit you well. Alternatively, if you prefer a comprehensive option with a wide network of providers, a premium DPPO plan could be ideal. This type of plan often features lower in-network costs, and your current dentist may already be part of the network. For those on a tighter budget, a DHMO with its restricted network might be a practical choice. However, if preventive care is your primary concern and you prioritize dentist selection, a DPPO plan may present a balanced and cost-effective solution.
Whenever feasible, securing dental coverage through your employer is advantageous. Group rates are typically lower since they are negotiated for multiple employees, and group plans often offer broader coverage, with the employer often contributing to the costs, enhancing its overall value. If employer-sponsored coverage isn’t available, explore the possibility of obtaining a group plan through professional associations or membership groups.
Individual dental insurance remains a viable and accessible option, with many providers, such as Guardian, offering convenient online tools for comparison, obtaining quotes, and purchasing plans.
Frequently asked questions about dental insurance costs
Is it worth getting dental insurance?
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Assuming you go to the dentist at least twice a year for preventive care, you may be able to save money or at least break even with the right dental insurance. And in years when you require additional care, you will likely come out ahead (see the scenarios above for examples).
Does dental insurance cover teledentistry?
Given regular biannual dental visits for preventive care, having suitable dental insurance could lead to potential savings or at least a balanced financial outcome. Moreover, during years necessitating extra dental procedures, the benefits of having insurance are likely to outweigh the costs, as illustrated in the scenarios outlined above.
Who has the best dental insurance?
Selecting the optimal dental insurance entails considering various factors such as plans, features, and provider networks offered by different insurance companies. There isn’t a one-size-fits-all answer, as the best dental insurance for you depends on your preferences. It should allow you to visit a preferred dentist, provide coverage for necessary treatments, and align with your financial constraints.
What is a full coverage dental plan?
Although there isn’t a universally standardized definition to differentiate between a basic dental plan and a full-coverage plan, typically, basic dental plans encompass preventive care and basic procedures such as fillings and extractions. In contrast, full-coverage plans extend to major procedures like root canals, crowns, and occasionally, orthodontic treatments.
Methodology
To identify the optimal dental insurance plans, we evaluated 30 standalone dental policies, showcasing only the highest-rated plans from each provider. It’s important to note that benefit specifics may vary by state, so it’s advisable to review the plan brochure for precise details. Our ratings were determined based on the following criteria:
1. Cost: We analyzed costs applicable to a 30-year-old female residing in California. In cases where California data was unavailable, we utilized Texas as an alternative benchmark: 30% of the overall score.
2. Annual maximum insurance payout: 10% of the overall score.
3. Absence of waiting period for preventive care: 10% of the overall score.
4. Level of coverage for basic care: 10% of the overall score.
5. Waiting period for basic care: 10% of the overall score.
6. Inclusion of major care coverage in the first year: 10% of the overall score.
7. Coverage for dental implants: 10% of the overall score.
8. Coverage for orthodontic treatments: 10% of the overall score.
