If you typically need dental coverage on a routine schedule, you should consider purchasing dental insurance. Nevertheless, if you do not visit the dentist frequently or require extensive dental care, a dental insurance plan may not be necessary for you. This article will teach you about various dental procedures, their benefits, and how much they cost with and without a major medical health insurance plan.

You might need a dental insurance plan

Dental insurance coverage is not essential for everyone, but it can save you hundreds of dollars on major dental procedures in some cases. You may benefit from a dental insurance plan if you meet the following criteria:

i) You visit the dentist’s office for routine checkups or cleanings.

ii) You often need supplementary services such as fillings when you go to the dentist’s clinic.

iii) You have a large family with children who visit the dentist regularly.

iv) You cannot pay the expenses of major dental procedures out of your pocket.

However, if you seek dental coverage infrequently and do not require any additional dental care services, dental insurance may not be necessary. It is always an excellent idea to compare the prices of dental insurance plans purchased with and without health insurance. 

The benefits and drawbacks of dental insurance

Deciding whether to obtain dental insurance coverage can be overwhelming, so Dr. Thomas McCarthy, DDS of “Sporting Smiles,” has helped us identify the main benefits and drawbacks of purchasing a dental policy.

Dental Insurance: Pros and Cons

Pros Cons
Dental insurance is ideal for the person that goes in for regular checkups and cleanings.  Many policies have waiting periods for specific procedures before you can access care.
Dental insurance is an excellent option if you have a large family with several children. Deductibles and copays have increased on most policies in the recent past, and the policy will typically have a yearly cap.
Dental insurance can protect you from medical debt if you cannot pay for services at the time of care. Sometimes it’s cheaper to pay out of pocket than use your major medical insurance.

What exactly is Dental Insurance?

A dental insurance plan works differently than traditional medical insurance. Dental insurance is also referred to as “dental benefits” because it covers some procedures completely while only covering a portion of the cost of others. Dental benefits include some expenses but do not reimburse you for all costs incurred. 

Many health insurance companies have dropped dental coverage from their medical coverage plans because it is not deemed necessary for wellbeing. Therefore, these policies must be purchased separately from major medical health insurance plans.

Dental insurance plans have copayments and annual maximums to consider. Typically, PPO programs use a 100/80/50 coinsurance structure. 

You are responsible for paying the portion of the treatment costs that your insurance plan does not cover. Here’s how it works: 

  • Dental insurance cover 100% of preventative care, including dental exams, cleanings, and X-rays;
  • It covers 80% of routine procedures, such as fillings;
  • It covers 50% of major dental procedures, including bridges, crowns, and dentures.

Furthermore, dental insurance rarely covers expensive treatments that are considered elective, e.g., teeth whitening and braces for cosmetic reasons. There is also an annual threshold amount that your dental plan will cover, typically between $1,000 and $2,000. You are responsible for covering any additional dental care expenses once you reach this limit, but 95 percent of Americans never reach it.

Dental Insurance Plan Costs

A dental plan typically costs between $15 and $50 per month, for a total annual cost of $360. This is sometimes less than the cost of dental care without insurance, but other times it is roughly equal to the cost of dental care without insurance. If you do not require any complicated procedures, two annual teeth whitening and one set of x-rays can cost you around $485. 

Below, we summarize the prices of some dental treatments if you are paying without health insurance. Please keep in mind that these costs will vary depending on your location, the type of dentist you visit, and the complexity of the care required.

Estimated dental care costs without health insurance

Description Average cost without insurance
Comprehensive dental examination for a new or returning patient $130
X-rays – Full mouth $187
Routine cleansing for adult $139
White Filling for Back tooth- 1 surface $250
White Filling for Back tooth- 2 surfaces   $315
White Filling for Back tooth- 3 surfaces $385
Non-surgical tooth extraction $295
Extraction or pulling of a tooth that necessitates bone removal $465
Restorative crown $1634

Considerations for group insurance plans

Some employers may provide dental insurance to their employees and their dependents. However, just because your employer offers dental insurance, does not mean it is a good deal.

A great program would provide coverage for your entire family with a sizeable annual maximum for a low monthly premium (say, $20 per month). A mediocre plan would cost more on a month-to-month basis (for example, $50 per month) with a low annual maximum. If your employer offers a costly program with a low annual maximum, purchasing individual dental insurance or paying for services out of pocket may be more cost-effective.

Nonetheless, if you cannot afford to pay the entire cost of care, purchasing a group dental plan may be your best option.

How to Save Money on Dental Care

Dental care can be prohibitively expensive without health insurance, as the cost of a one-time cleaning can be over $100. Fortunately, there are options for finding a low-cost dental care program.

  • First, many dental training centers accept Medicaid coverage or charge a lower fee than private clinics. The students are still trained and are capable of providing safe and effective care.
  • Second, many federally qualified community health centers offer dental care in addition to other health services. You can call ahead to see if regional centers provide dental care before scheduling an appointment.
  • Finally, if you have a high-deductible plan, you can open a Health Savings Account (HSA). Having an HSA account entitles you to use pre-tax dollars to pay for eligible vision and dental expenses for yourself, your spouse, and eligible dependents such as children, siblings, and parents. 

Frequently Asked Questions (FAQs) about dental insurance

Your personal dental care needs will determine whether or not you should purchase a dental insurance plan. Each plan is unique and may cover different services, so when shopping around, be sure to read the program benefits information carefully. Below, we answer some important questions about dental insurance with insight from Doctor Katrina Zhao, Principal Dentist and Managing Director at Midas Dental. 

What should I consider before purchasing a dental plan? 

The most crucial factor to consider before purchasing a dental plan is whether or not it will save you money. Even though dental insurance plans will cover 100% of preventative care, the annual cost of dental insurance may be significantly greater than paying out of pocket. 

Furthermore, if you need complex orthodontic procedures, you will be required to pay 50% or more out of pocket. A dental plan may not be a good investment if it has a low annual maximum. Here are some additional questions to ask when looking for a dental insurance plan.

  • What dental treatments might you need this year? How much would they cost if you paid for them out of pocket rather than through insurance?
  • How much will regular cleaning cost me without insurance versus with insurance?
  • What is the maximum annual payout for this insurance plan? What types of procedures are covered?
  • How much will my monthly and annual premiums be?

Who should consider purchasing dental insurance?

There are several reasons why you should consider purchasing a dental insurance plan. It can be an effective way to protect yourself from the cost of future procedures that would otherwise cost you thousands of dollars.

In addition, dental protection is imperative for patients with children who require dentures or oral surgery, in which case you may want to consider a dental insurance plan that includes orthodontia. Some states mandate all licensed dental insurers to provide coverage for children’s dentures, but only if the dentures are necessary to improve the child’s ability to chew food properly. These treatments often have a high initial cost for which you may need coverage. 

It’s important to note that your personal needs will vary depending on your health status, financial situation, and the amount of coverage you want. You should consult with an insurance broker or company before deciding what type of plan works best for you. 

What types of dental insurance plans are available?

Like health coverage plans, dental insurance plans are classified as either indemnity or managed care programs (Dental PPO policies fit into this latter category). In other words, the primary distinctions are in the selection of dental care providers, out-of-pocket costs, and bill payment methods.

Typically, indemnity plans provide a wider range of dental care suppliers than managed-care plans. Indemnity plans pay their portion of the cost for covered medical services only after they receive a bill (which means that you may need to pay upfront and then get reimbursement from your health insurance company).

Managed-care plans typically coordinate the dental provider networks. 

Dentists participating in a plan’s network agree to provide services to patients at pre-negotiated rates and will submit the claim to your dental insurance company on your behalf. In general, a managed-care dental plan will have fewer paperwork requirements and lower out-of-pocket costs, whereas an indemnity plan will offer a more extensive network of providers.

How does dental insurance coverage work?

Dental insurance works in the same way as medical insurance does. For a specific monthly fee (or “premium”), you obtain approval for certain dental benefits, which usually include routine checkups, cleanings, x-rays, and other services necessary to promote general dental health. Some plans provide more coverage than others, while others require you to make a significant financial contribution when services are rendered. Some programs may also provide coverage for certain dental implants, oral surgery, and other dental procedures.

What is the cost of dental insurance?

Most dental insurance policies can cost up to $55 per month, but the price of dental coverage will vary depending on your age, policy type, number of dentist visits, and overall health. Typically, your program will have higher premiums if you want more coverage. 

How much does it cost to visit a dentist without health insurance?

Visiting the dentist without insurance can be expensive, depending on the type of treatment required. A dental exam costs approximately $130, whereas a restorative crown can cost nearly $1,700. Some dentists may offer discounted prices to those who don’t have health insurance coverage. The cost of dental procedures varies considerably based on your location, but some individuals end up paying hundreds or thousands of dollars out of pocket. 

Final Thoughts

Cutting corners on dental care can lead to even higher costs in the long run. Preventive dental care is crucial for long-term health. If you anticipate needing expensive dental care in the future, you should think about getting a dental benefit plan. Check out Insurance Shopping and explore your options for dental insurance coverage.