You’ve been all smiles about your dental health. Then, one day it hits you – a painful toothache. Suddenly it hurts to sip a glass of water, and you can barely focus on anything but the pain. Unfortunately, you know it won’t get better on its own. You need a dentist – and wonder how much it will cost you.
The answer depends on if you have dental insurance and what your dental insurance covers. Some dental insurance plans may just cover preventive care, but others may cover services like crowns and oral surgery.
If you’re wondering, “Do I need dental insurance?” The answer is you can get by without it, but doing so comes with some risk. It’s usually worth it to have dental insurance. Depending on your personal needs, you may not need a plan with the most comprehensive coverage. But whether or not you have dental insurance, you shouldn’t ignore problems with your mouth, teeth and gums. Oral health concerns can get worse without treatment and may lead to other costly medical problems.
Below we explain how dental insurance works and how having insurance can save you money in the long run.
For starters, here’s what you should know about dental insurance
Some types of insurance (like car insurance) are there in case something bad happens. But dental insurance, like health insurance, is designed to keep the worst from happening.
Here’s how dental insurance works: you pay a monthly amount (premium) and your plan covers some of the cost of your care during the year. Plans can vary based on the insurance carrier and their plan options. But dental insurance usually covers 100% of preventive dental care, like checkups, screenings and cleanings. Other services can have different levels of coverage.
Here are terms you should know.
- Premium: The monthly payment to be enrolled in a dental insurance plan.
- Deductible: The dollar amount you’ll need to pay towards your dental care before your benefits begin for the year – for dental plans, this amount is usually between $25-$75. Preventive services are covered even before you reach your deductible.
- Coinsurance: The percent of the cost you pay for dental services after you’ve met your deductible. For example, your coinsurance for a root canal may be 20% or 50% of the cost.
- Annual maximum: The most your dental plan will pay for your dental care in a single year. After this point, you’re responsible for 100% of the dental expense.
Is dental insurance worth it? How dental insurance pays for itself
If you keep up on your preventive care appointments, dental insurance usually pays for itself. And, if you need additional dental care, you’ll definitely see the value of having a plan.
To understand what an investment in dental insurance looks like, let’s start by examining monthly premiums. If you pay $40 each month, that equals $480 per year.
With this investment, you usually get two checkups covered at 100% each year, although that may vary based on coverage. Dental providers can also negotiate checkup fees with insurers, decreasing overall cost. Without insurance, these two visits alone typically cost between $400 and $500 out of pocket. But the value of dental insurance usually doesn’t stop there – since most plans cover at least a portion of the cost of dental services like fillings and root canals.
Dental insurance can also make it less likely that you’ll need advanced dental care. Here’s why: given the cost of preventive care, you may skip it if you didn’t have dental insurance. But regular preventive checkups help keep your mouth, teeth and gums healthy, decreasing your risk of developing serious oral health problems that can be painful and expensive to treat. And since your oral health is tied to your overall health, a dentist may also be the first to identify other health conditions such as oral cancer or diabetes.
Dental care without insurance: The costs quickly add up
In a 2013 report by the American Dental Association on per-patient dental costs (the most recent study of its kind), adults spent an average of $685 per year on dental services. When you consider inflation, dental costs for the average adult is likely around $1,000 per year.
But let’s say you need more dental work during the year – a crown, root canal, or some other specialty service – your costs are likely to jump by $1000 or more, according to the same American Dental Association report. That’s a lot to pay out of your own pocket. But dental insurance can help cover a big chunk of the cost. For example, if you need one crown that normally costs $1,200, your dental plan’s negotiated fee with network dental clinics could be reduced to around $900. If your plan has a 50% coinsurance on crowns, you would pay $450, and the dental plan would pay $450. This means you could save $750 on that one crown.
Average cost of dental services without insurance
- Routine checkup: A preventive appointment that includes teeth cleaning by a dental hygienist and a dental exam can cost between $80 and $400. Insurance usually covers 100% of the cost, even before you meet your deductible.
- Fillings: Prices fluctuate depending on size, location and the type of filling material used. The average cost of a filling is $140 to $200, but in more severe cases, that cost can rise to around $500. Insurance may cover 50% to 80% of the cost.
- Tooth removal (extraction): A simple extraction usually costs between $75 and $300 per tooth. The price can go up to several thousand dollars if the procedure is complicated – like if your tooth is stuck (impacted) or broken, or if you’re having your wisdom tooth removed. Insurance may cover 50% to 80% of the cost.
- Crowns: A typical dental crown can cost between $1,100 and $1,500. This cost depends on variables such as crown type, treatment and any additional services required to do the procedure, like bone grafts or root canals. Insurance may cover 50% to 80% of the cost.
- Root canals: You can expect to pay between $700 and $2,100 for a single root canal, though factors such as location of the tooth, and the need for emergency care can affect (and increase) price. Insurance may cover 50% to 80% of the cost.
Do I need dental insurance through my employer? It’s usually a great choice
When you get dental insurance through your employer, the choices have been made for you in terms of premiums, coverage and network. If your employer offers a dental plan, it’s usually a great value for your money. Here are a few reasons why:
- Your employer will often pay part of the cost of the premium.
- Dental plans through employers are based on group rates, which means that your monthly premiums may be lower than what you can get on your own.
- Your employer has already worked with the insurance carrier to determine good coverage and perks.
- You’ll be able to pay for your premiums with pretax dollars, which saves you money.
Are individual dental plans worth it? There are options to fit your needs and budget
If you don’t have dental insurance through your employer, it makes sense to look into individual or family insurance plans. If you’re self-employed, retired or your employer doesn’t offer a dental plan, individual dental insurance can be purchased directly from a dental insurance carrier or marketplace. These plans help ensure that you and your family get the coverage you need.
With individual dental insurance, you can explore a variety of plans and networks to find what works best for you. This will help you get more specific about your health and financial needs. Maximums, premiums, coverage specifications and networks will vary based on your plan selection.
When enrolling in an individual dental plan, you’ll have the option to add a spouse and dependents. That makes it easy to provide coverage for the whole family. When seeking care, seeing an in-network dentist will help save money.
There are several items to consider when choosing a plan:
- The amount of dental care that you and your family need
- Whether or not there’s a nearby dentist within network
- What best fits your budget
Find individual or family dental insurance that’s worth it
If you don’t have dental insurance through your employer it’s a good idea to look into individual or family insurance plans.
Each person’s situation is unique, but overall, if you have dental insurance, you are more likely to go to the dentist – and that’s a good thing. Whether you’re getting treated for an emergency or using your regular preventive visits, caring for your teeth will help you maintain a healthier mouth. And in the long run, a healthier mouth saves you time, pain and money.