Dental insurance can reduce out-of-pocket costs for basic procedures by covering co-insurance, deductibles and annual maximums. But patients still have to pay for some services upfront, including cleanings, evaluations and x-rays.
The Cost Estimator can help employees calculate their out-of-pocket cost for procedures by subtracting the network fee and their dental plan savings. It also takes into account downgrades, which can occur when insurance pays a lower fee for an item than what was actually performed.
The cheapest way to lower dental cost is to visit your dentist regularly for routine cleanings and exams. These services are typically covered at 100 percent by most dental insurance plans, with minimal or no deductible and co-pays, and don’t count toward the annual maximum.
Research has shown that regular dental care prevents more serious oral health problems down the road. These problems can result in hospital visits, higher medical costs, and reduced productivity at work.
To determine the effects of dental care on overall health costs, researchers studied 11,734 adults who were continuously enrolled in a health plan in Arkansas that included preventive dentistry coverage from 2014 to 2018. They compared the health-related cost savings of patients who visited their dentists to those who did not.
Those who visited their dentists annually had significantly lower dental and non-dental costs over the course of the study. Those with annual preventive care also had lower emergency room and urgent care visit costs than those who did not visit their dentists. This is a valuable finding for public payers, such as states, that are considering transitioning to block grants from fee-for-service models.
Dental insurance costs are a personal decision, with each person’s needs and family history playing a role in whether coverage is right for them. The lower monthly premium of an entry-level plan may work best for people who need minimal care or have healthy teeth, while those who require frequent visits or costly procedures should consider a higher-tier plan.
Most plans have a deductible and annual maximum, with the patient responsible for any expenses that exceed those limits. Typically, routine preventive care is covered at 100%, with bi-annual cleanings, exams and X-rays included. Some preventive treatments like sealants are considered basic by one insurer and major by another, so it’s important to know how each carrier categorizes procedures.
Many dental plans also come with copays, which are a set dollar amount that the patient pays upfront for a treatment. Generally, these fees are low for routine procedures, but can be high for more expensive ones such as root canals and crowns. Lastly, most dental plans limit the dentists to which they will pay for a procedure, referred to as a “network.” These dentists must agree to a discounted fee or risk losing their contract with the insurance company.
Many people find themselves without dental insurance when they retire, and are often shocked to learn that Medicare does not pay for extensive work. Forgoing dental coverage is less risky than going without health insurance, but budgeting for a big bill can be challenging.
If you do not have employer-based dental coverage, there are still options. Some dentists offer discounted services for self-pay patients. These can be as low as 10 to 15 percent, depending on the provider. Some dentists will also offer payment plans or allow you to pay for the service over time.
Some states and the federal marketplace/exchange offer stand-alone dental insurance that can be purchased in addition to other forms of health coverage. A plan of this type can be much cheaper than an employer-sponsored dental insurance option. However, it is important to understand that a point-of-service option may have higher claims costs than an insurer-sponsored or preferred provider network (PPO) plan. Additionally, some point-of-service options use a dental insurance carrier to provide administration services and reimburse for out-of-network care. These plans may have a trending increase each year to cover these costs.
Dental costs can be high, but it doesn’t have to be. Consumers can reduce costs by pursuing preventive care, buying dental insurance, negotiating prices, and considering dental tourism for large procedures.
Dentists pay high overhead due to malpractice risks, and their services are expensive because they use advanced, high-tech equipment that commands top dollar. Other costly items include dental implants, CEREC crowns, composite resin bonding and digital X-rays that require specialized sensors and software. These expenses are passed on to consumers as higher pricing.
Many employers offer dental coverage at much lower cost than health insurance. Individual and family dental policies can also be purchased at affordable rates. These plans often have annual deductibles and maximums, but routine treatments like checkups and cleanings are typically covered without additional charges.
Consider getting a Preferred Provider Organization (PPO) or dental discount plan that offers a network of dentists with agreed-upon fee structures. This type of dental insurance is less expensive than traditional plans and may cover more types of procedures. It may be more flexible too because you can visit any provider in or out of the network.
Many dental practices offer payment and financing plans that help make expensive procedures more affordable for uninsured patients. Healthcare financing companies such as Compassionate Finance and CareCredit also provide loans to qualifying patients.
Dental insurance is a great option to reduce financial barriers to dental care, but premium rates, deductibles and annual limits can add up quickly. It is important to compare plans before enrolling, and verify that your preferred dentists and specialists are in the insurer’s provider network.
Dental discount plans are another option for the uninsured and may include free exams and X-rays plus significant discounts on other dental services for a low monthly or annual fee. These plans often have no waiting periods and lower rates than insurance providers, but their networks tend to be smaller. Patients can also save money by requesting price quotes from multiple dental offices for the same procedure. For example, the cost of a dental filling can vary depending on the number of surfaces treated and the type of filling material. The price of an inlay or onlay, which are more complex restorations than a standard filling, can also vary.