Dental care is crucial to good health, but some people avoid visits due to concerns about cost. Learn more about how dental cost work and what options are available to make care more affordable.
Many medical plans include coverage for dental services, but not all do. In addition, dental insurance often comes with specific out-of-pocket costs like deductibles, copayments and annual maximums.
Dental insurance can reduce your out-of-pocket dental costs significantly. However, it’s important to know how different components affect your overall cost of treatment. These include premiums, deductibles, coinsurance and annual maximums.
A deductible is the amount you pay toward dental services before your insurance begins to cover them. Some plans have a yearly deductible while others have a lifetime maximum. In general, the lower the deductible, the higher the coverage.
Most dental plans have coinsurance, which is the percentage of the cost you are responsible for after the deductible. Preventive care typically does not require a copayment since most insurance companies want you to utilize your benefits for routine procedures that can prevent more costly treatments down the road.
Most plans have an annual maximum, which is the limit on how much your provider will pay for care in a year. Most PPO plans have a low annual maximum while more comprehensive plans may have a high one. Some plans also have a separate lifetime maximum for orthodontics, which can be quite expensive. Some insurance providers offer fee-for-service plans, which are more similar to traditional insurance and don’t have a provider network.
Considering the high cost of dental procedures, it’s important to understand how copays, deductibles, and annual maximums affect your overall out-of-pocket costs. Understanding these factors can help you choose the right dental insurance plan for your needs and budget.
Routine care includes two cleanings per year, fluoride treatments, and full mouth x-rays. These services are usually covered at 100% by most dental plans. However, it’s important to note that your yearly maximum might be reached before these services are covered again.
The average cost for a standard cleaning with a hygienist is $127. A filling can cost anywhere from $90-$250, depending on the type of material and whether it’s composite or tooth-colored. The average cost of a surgical extraction is $204.
Many insurance companies offer dental coverage options that allow you to pay a flat rate for preventive services and a percentage or percentage of the cost for major services, such as a root canal or crown. This can save you money, but it’s essential to carefully review the benefits and costs of each plan before selecting one.
Most dental insurance plans require patients to pay a deductible before the plan begins paying for treatment. Depending on the type of plan, the deductible may be for an individual or family.
Once the deductible has been met, coinsurance typically applies to treatment. Coinsurance is a percentage of the cost of a procedure that the patient is responsible for after meeting the deductible. Preventive care is usually not subject to copayment or coinsurance.
Many plans have annual maximums that limit the amount of money the insurance company will pay in a year or lifetime. This is a good reason to encourage your patients to schedule preventive visits twice a year, because this will help reduce the number of services that exceed the maximums.
Some dental insurance plans use tables or schedules of allowance to determine a fixed fee for certain treatments. These are often called “usual, customary and reasonable” (UCR) fees. The difference between these fees and the dentist’s actual charges is billed to the patient. Other types of dental insurance plans are not based on tables or schedules, but instead pay a fixed amount to contracted dentists in return for the privilege of treating their patients.
In most dental plans, a patient must pay the cost of treatment up front before the insurance company starts to cover costs. This is often in the form of a copayment or deductible, although some plans don’t have either. When researching dental insurance options, eHealth’s licensed insurance agents can help you understand the deductible, copay and annual maximum costs of each plan so that you can find a policy that fits your needs and budget.
The cost of dental copayments vary by the type of plan. For example, a DPPO (dental preferred provider organization) plan has a relatively large network and only covers a percentage of the cost of out-of-network procedures, while an indemnity plan allows patients to visit any dentist and is reimbursed by the insurance provider based on what the insurance considers to be “reasonable and customary.” Whether the dentist is in-network or out of network, a DPPO or DHMO plan will typically have lower copayments than an indemnity plan. This is because a copayment is a fixed dollar amount while the remainder of the cost of a procedure is covered at a percentage.
While most medical insurance plans require a minimum out of pocket cost, many dental insurance plans allow you to choose a yearly maximum amount that your plan will pay for each year. Depending on the plan, this annual maximum can be per-person or family. Once a person or family reaches their annual maximum, the plan will stop paying for any additional treatment until the next benefit period.
While some services like diagnostic and preventive procedures don’t count towards the annual maximum, others do. Depending on your plan, it may be best to speak with your dentist about the costs of your care so that you can come up with a treatment plan that will fit comfortably within your annual maximum.
With Delta Dental of Illinois’s To Go feature, groups and individuals have the ability to rollover any unused portion of their annual maximum from one year to the next. This allows patients to maximize their benefits and keep costs low. Contact your Delta Dental of Illinois representative for more information.