Dental care costs vary, depending on where you live and what procedures you need. You can save money by signing up for dental insurance and taking advantage of preventive care. However, dental insurance can also be costly, with deductibles, copays and waiting periods.
Dental plans typically cover 80% of routine dental care and 50% of basic services like fillings. They do not typically cover cosmetic procedures like teeth whitening.
Preventive care is important for oral health, and it can also reduce overall healthcare costs. According to a study conducted by Cigna, clients who routinely visit their dentists save an average of 4.4% in total medical costs per year over five years. This includes reduced hospital admissions, emergency room visits and urgent care visits.
The authors analyzed Medicaid claims data from six states to determine how adherence with preventive dental services impacts downstream utilization and associated expenditures. The analysis was conducted using a multiyear longitudinal utilization framework that identifies patterns of adherence over time.
This approach to the evaluation of dental adherence allows for comparisons between states and across socioeconomic groups. In addition, it isolates healthcare costs from non-elective activities, eliminating patient biases and tendencies.
Many dental insurance plans come with a deductible, which is the amount you pay for expenses before your plan starts to cover them. In addition, some plans have an annual maximum, which is the most the plan will pay for coverage within a year.
A coinsurance plan pays a percentage of the dentist’s fee after you meet your deductible. For example, if a procedure costs $100, your insurance company will pay 80% of that. You will pay the remaining 20%.
Other dental insurance types include Preferred Provider Organization (PPO) and Dental Health Maintenance Organization (DHMO). PPO plans allow you to visit any licensed dentist, but may charge a higher copayment. DHMOs usually have a smaller network and offer lower premiums than PPOs. Some also require referrals for specialist care.
There are a number of factors that affect dental cost. Some of them include deductibles and annual maximums. A deductible is the amount you pay for a procedure before your insurance kicks in. Many plans also have copays, which are set dollar amounts that you must pay before the plan begins to cover expenses.
Most dental plans have a yearly maximum, which is the amount that the insurance company will pay for covered services in a year or lifetime. These caps are important to keep in mind when budgeting for dental costs. Generally, the more extensive the work, the higher the out-of-pocket costs will be. Preventive care often doesn’t have a deductible, and most insurance companies will credit your individual or family deductible after you have paid it.
Annual maximums limit the total amount that a dental insurance plan will pay for a specific treatment during a benefit period, which is usually a year. This is different from other types of health insurance plans, which typically do not have a maximum benefit.
Dental cost can quickly add up, and a high annual maximum allows individuals to get the treatment they need without worrying about exceeding their coverage limits. This can help reduce their stress and improve overall oral health.
Having a high annual maximum is especially important for people who require expensive treatments like root canals or crowns. These procedures can be quite costly and require substantial time to heal. However, by purchasing a dental insurance with a higher maximum, you can minimize your out-of-pocket costs and avoid accumulating debt.
Preferred provider organization (PPO) plans
Preferred provider organization (PPO) plans are based on a network of dental providers and offer discounts to patients that reduce the out-of-pocket cost of procedures. A PPO plan has a negotiated fee schedule and a set yearly insurance maximum. It is also possible for a dental provider to offer an indemnity plan, which does not have a preferred provider list.
The MAC or Schedule of Allowances fee structure determines the amount that an insurance company will pay for a covered service. This fee is often different from the actual fees charged by a dentist. The difference is billed to the patient as an insurance adjustment. Dental insurers use this fee structure to control costs and encourage their employees to visit in-network dentists. Dental practitioners who negotiate MAC fees can have significant revenue gains, but they must be careful to report full fees on insurance claims.
Medicare Advantage plans
The cost of dental coverage varies significantly depending on the plan you choose. Some Medicare Advantage plans offer standalone dental insurance for a premium that is comparable to the cost of traditional medical coverage. These plans typically provide more comprehensive coverage for routine and prophylactic procedures. However, they may exclude some advanced services, such as crowns and root canals. You should consult the plan’s Evidence of Coverage to see how much each service is covered.
Most Medicare Advantage plans have annual dollar caps on the amount they will pay toward more extensive dental care. However, many beneficiaries experience high out-of-pocket costs for these services. Out-of-pocket spending on dental services is skewed and highly concentrated among individuals who receive the most expensive services. AARP and senior advocacy groups can help you find additional insurance or discount options for dental and other professional services.
Dental care is expensive and often out of reach for low-income people. Fillings, root canals and other extensive work can cost thousands of dollars. Those without insurance are on their own to pay for these services. They can either choose not to go to the dentist or turn to Medicaid for help.
Although federal Medicaid law requires most states to provide dental coverage, a lot of states have limited or no coverage. Some cover only emergency procedures, while others impose caps on annual per-person spending for basic services.
Thanks to tireless efforts by oral health advocates, some states have expanded their Medicaid dental benefits. CareQuest Institute has developed a tool to make it easier for people to advocate for better coverage. It also tracks progress in expanding dental coverage across the country.