The cost of dental services without insurance can be significant. However, depending on your anticipated needs and the type of dental plan you choose, it’s important to determine which type of coverage is best for you. Here’s what you need to know about the price of dental coverage, including various dental insurance costs, the factors that influence them, and what paying them typically gets you.
Dental Insurance Costs
While there’s no way to know exactly what you’ll spend on dental insurance in a given year, there are ways to estimate it. For example, in 2020 total dental expenditures in the United States were $142.4 billion. The U.S. has a population of roughly 332 million according to the latest figures, so that works out to an average of about $428 per consumer. Another helpful data point is the latest study released by the American Dental Association, which found that if you had dental insurance in 2015, you could expect to spend roughly $453 to $520 including premiums and out-of-pocket costs. Adjusting for inflation, that works out to around $529 to $606 in 2021 dollars. Ultimately, your actual annual costs depend on several factors, such as your dental service needs, location, and policy type. Dental insurance costs come from five sources: premiums, deductibles, copays, coinsurance, and annual maximums. Here’s how each one works, as well as what you can expect to pay for them.
Premiums
Premiums are the monthly or annual payments you make to an insurance provider to maintain your coverage. Here are some 2022 samples from zip codes within the following counties that use the Affordable Care Act (ACA) marketplace:
Travis County, Texas: $8.93 to $63.07/monthHawaii County, Hawaii: $18.06 to $52.06/monthSaint Johns County, Florida: $7.95 to $44.24/month
Costs fluctuate within states due to coverage variations and between states because of differences in costs of living.
Deductibles
Deductibles are the amount you must contribute toward your services annually before your insurance helps with the rest. Here are the 2022 dental deductible ranges for the same areas listed above:
Travis County, Texas: $0 to $60Hawaii County, Hawaii: $0 to $75Saint Johns County, Florida: $0 to $150
Deductibles usually have an inverse relationship with premiums, meaning policies with higher deductibles have lower premiums and vice versa. Some dental plans have no deductible.
Copays
Copays are fees that you may have to pay out of pocket when you visit your dentist that correlate with the price of the service. For example, many policies offer preventive services with no copay, but a 20% to 50% copay on a root canal procedure. That means for root canals costing $1,500, you may be responsible for a copay of $300 to $750.
Coinsurance Costs
Coinsurance is the percentage of care that you must pay for after meeting your deductible. For example, the ACA dental policies with the lowest premiums in Texas, Texas Essential Health Benefit plans, cover 100% of preventive care after your deductible. However, they only pay for 50% of restorative care for adults and 50% of orthodontic care for children.
Annual Maximums
Annual maximums are the most that dental insurance policies will pay in benefits. Once your policy pays its annual maximum, you’re responsible for all dental costs for the rest of the year. For example, the Texas Essential Health Benefits plan has an annual maximum of $1,000.
How Dental Plan Type Impacts Cost
There are five primary types of dental insurance plans. Which one you choose also affects the cost of your dental insurance. Here’s what they are and how they impact costs.
Dental Preferred Provider Organization (DPPO): DPPOs give you a network of providers to choose from; going to a dentist out of the network will increase your costs. DPPOs typically have deductibles, and copays and coinsurance are common for everything beyond preventive care.Dental Health Maintenance Organization (DHMO): DHMOs give you a network and no coverage outside it. They usually have no deductible or annual maximum and charge fees for non-preventive services.Dental Indemnity: These tend to cost more because they don’t limit you to a network or a primary care dentist. You’ll typically pay coinsurance for services once you meet your deductible.Dental Exclusive Provider Organization (DEPO): These plans also usually have deductibles and coinsurance. You don’t need a primary dentist, but you must use a dentist within the plan’s network in order to be covered.Dental Point of Service (DPOS): These plans often have higher deductibles, premiums, and copays. You are able to see an out-of-network dentist, but costs will increase.
Keep in mind that these are generalizations. Always check the details of individual policies before choosing one.
Out-of-Pocket Dental Costs
Dental insurance policies have restrictions, and you may have to pay out of pocket for some procedures. The cheapest policies only cover preventive care, and even those are subject to limitations. For example, you may only get two free teeth cleanings per year. The next step up in policies also covers restorative care, such as fillings for cavities, tooth extractions, or root canals. They cost more but are still generally affordable compared to having to pay for these services without any insurance coverage. The most expensive and comprehensive plans also cover orthodontic services. These correct your teeth and bite alignment. Certain services are generally not covered by any dental insurance policies. Some examples include cosmetic procedures, such as teeth whitening, and conditions that existed before you enrolled in the policy.
Reducing Dental Care Costs
Dental insurance can save you money, but only if you choose the right policy. Accurately predicting your dental care needs is the key to keeping costs down. For example, say you have healthy teeth, and your only desired dental services in the coming year are two teeth cleanings. Your research tells you each one would cost you $100 with no insurance. To see if you can save money through dental insurance, you look for policies that offer two free teeth cleanings. You find one that only costs $8 in monthly premiums. That would make sense to buy since you’d pay $96 per year with the policy and $200 without it. However, if the cheapest policy available had a $20 premium, coverage wouldn’t be worthwhile. You’d pay $240 per year with insurance versus just $200 without it. Another way to keep your costs down is to stay on top of your dental health. Preventive care and good hygiene can minimize the likelihood that you’ll need more expensive restorative services in the future.
