New Buyer’s Guide: What Does Dental Insurance Cover?
Are you one of the 74 million Americans who doesn’t have any form of dental coverage?
If so, you might wonder whether dental insurance is worth the extra $360 a year. After all, you only visit the dentist once (ideally twice) a year.
What does dental insurance cover, and is dental insurance worth it? Let’s dive in to see whether you should sign up for coverage.
What Does Dental Insurance Cover?
The average dental insurance plan in the United States uses a policy called “100/80/50.”
It is a tiered system that works like this:
Dental insurance covers 100 percent of your preventative care. Preventative care includes your cleanings, exams, and x-rays. It’s standard procedure stuff.
Your insurance also covers 80 percent of other necessary procedures. If you need a filling or extraction, you pay 20 percent of the cost.
The big stuff (dentures, root canals, implants, bridges, or crowns) come with 50 percent (or less) coverage.
That’s your 100/80/50.
Some plans vary by state and provider. For example, some insurance providers in individual states consider a root canal to be a necessary procedure and offer 70 to 80 percent coverage for it.
The philosophy behind the system is simple: insurers cover preventative care to prevent the costs of fillings, root canals, implants, and crowns. By subsidizing the cost of essential care, you should both save money over the long-term.
What About the Extras?
You likely noticed that the most expensive items have the least coverage. Orthodontic care is among those. It is rare to find a plan that covers orthodontics (braces, headgear, and related visits).
If you think you need orthodontic care for yourself or your children, you have the option to buy supplemental insurance.
Other extras that fall under cosmetic care are seldom covered. What falls under cosmetic dentistry? It’s often procedures like:
- Teeth whitening
- Implants (including bridges)
- Inlays and Onlays (indirect fillings)
The cost of cosmetic dentistry can be eye-watering. For example, implants can range from $1,600 to $8,200 per tooth without insurance depending on where you live, your dentists’ fees, the work you need, and how many teeth you need.
How Much Is Dental Insurance?
The cost of dental insurance depends on where you live and your preferred benefits and whether you get it as part of a group.
Dental insurance for a family can cost $680 for a family of four. A single person on a group plan may pay $366 per year (on average). In addition to your premiums, you may also pay co-pays and other fees.
The figures can make those on a tight budget consider skipping insurance altogether, particularly if you have healthy teeth. This particularly true when you learn that very few people max out their insurance coverage each year. Only 10 percent hit their yearly coverage maximum, which is usually around $1,500.
Is the Coverage Worth the Price? Weighing the Pros and Cons
Most dental insurance covers only the cheapest procedures in full and leaves you with a bill for more expensive items.
Is that kind of coverage worth the price? For many Americans, it is. Why? Because insurance offers peace of mind in the event of a dental emergency.
However, dental insurance can also make financial sense. Let’s consider the pros and cons of dental insurance.
Pros of Buying Dental Insurance
There are two significant advantages of dental insurance: one is health-based, and the other is financial.
The most significant health benefit of buying dental insurance is that it encourages you to go to the dentist twice a year.
Those semi-annual check-ups are critical for your oral health. Regular cleanings and exams identify problems in their infancy before they become an expensive procedure.
Going to the dentist regularly also benefits your general health, particularly as you get older. Your moth is full of bacteria. While most are harmless, others cause diseases, such as gum disease and tooth decay. Proper oral care limits those diseases by neutralizing harmful bacteria and protecting yourself.
As you get older, the harmful bacteria in your mouth can spread. It can enter your bloodstream and spread to your heart and cause endocarditis. It can also end up in your lungs and cause pneumonia. These diseases are dangerous, but they are also preventable with regular check-ups and stellar hygiene.
Then, there’s the financial aspect of dental care. Sixty percent of Americans avoid the dentist because of the cost. Paying monthly premiums offers a certain level of care, which rules out unnecessary expenses. This is particularly important if you or another member of your family has a health history that includes extensive dental work.
When you are more likely to max out your care, insurance can ensure you get the treatment you need when you need it.
Cons of Buying Dental Insurance
Dental insurance can be an expensive way of paying for routine cleanings, mainly if dentists in your area charge the national average ($80) or below. Two exams at the national average cost $160, but the average premium is an average of $300.
If you have healthy teeth and get regular cleanings, then dental insurance may not be worth it. However, remember that the cost of premiums reflects the cause of a catastrophe rather than routine costs like check-ups.
Dental insurance also makes less sense when few local dentists accept it. Many dental professionals accept cash only to avoid the high costs of negotiation with and billing insurance companies. If your dentist doesn’t take insurance, buying it makes less sense.
Learn More About Dental Insurance Today
What does dental insurance cover? In most cases, it covers all of your preventative care and part of more complicated procedures, like fillings, root canals, and crowns.
The purpose of dental insurance is to protect you from crippling bills associated with dental emergencies or diseases. Finding a plan that works for your health and your preferred dentist is the key to making the most of your coverage.
Are you ready to protect your oral health? Get in touch today to learn more about finding a dental insurance plan that fits your needs.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.