Health insurance is one of the only ways that Americans are able to afford necessary health and wellness procedures. While health insurance is often offered through employment or other programs, it does not cover the cost of most dental procedures.
Dental insurance is a completely separate entity, and for that reason, even fewer Americans are able to access dental care as opposed to physical healthcare. Learn how much it costs to get individual dental insurance if it’s not covered by your employer, as well as how much you might expect to pay for procedures even if you do have coverage.
Dental insurance is insurance that covers a portion of dental expenses that you might encounter throughout a typical year. It’s similar to health insurance in that you pay a monthly premium, it’ll typically have a deductible, and your dental plan may have preferred providers.
But what do those terms even mean? Let’s break it down:
A monthly premium is the amount you pay your insurance company every single month. This is the out-of-pocket cost you’re responsible for paying in order to accrue all of the benefits of your plan. But this isn’t the only cost you’ll likely need to pay.
A deductible is the amount you pay for health care services before your insurance plan starts to pay. You’ll pay this before you get a service provided – not every month. Deductible prices can range depending on your plan.
For instance, if you have a plan with a $500 deductible, that means you are responsible for paying $500 out of pocket until you get enough provided services that hit this deductible minimum. Some people might not even hit their deductible in a given calendar year.
Deductibles are different from co-pays, which you might also owe at the time of service. These are fixed amounts that you might need to pay for a covered healthcare service after your deductible has been met. Copays vary, but they are usually somewhere around $20 for a primary care provider and upwards of $60 for specialist care. Not all services will require a co-pay.
Note that plans with a lower monthly premium typically come with higher deductibles if you ever need services completed. This is usually good for generally healthy people who do not anticipate any extensive dental work coming up soon. On the other hand, higher monthly premiums tend to mean you get to enjoy lower deductibles when you need care.
With some dental insurers, you may only be able to see preferred providers who are specialists or dentists within your insurance plan’s network (in-network providers). If you want to see an out-of-network dentist, you might either need to pay a higher deductible or completely pay for your service out of pocket.
Dental insurance also does not cover every single procedure you might want or need. In general, dental benefits will cover the cost of procedures that either prevent or treat an oral health disease.
Some preventative services or possibly qualifying dental services might include:
Dental insurance will not cover elective procedures that are usually only used for cosmetic purposes. This includes teeth whitening, dentures, and veneers. There are also other exceptions that will be outlined by your specific provider.
Outside of your deductible, premium, or co-pays, your dental insurance provider will probably cover the entire cost of covered services. Still, there’s yet again another caveat — if your dental insurance plan has an annual maximum (a maximum total amount that your insurance will pay each year), you won’t be able to be covered past this cap.
Many people are able to get dental insurance through their employers. Individuals with insurance coverage through work may not need to pay for health insurance premiums or benefits as these might be covered by the company instead. This is known as a health benefit.
If you do not get coverage through your employer, you can still get an insurance policy on your own through a provider. However, deductibles and dental insurance premiums will likely be higher than they would be if you were getting insured through your job.
From reading the information above, we know what you’re probably thinking – that seems like a lot of expenses that you’d think insurance would maybe cover. The cost of dental care, including insurance, is a lot more than people typically realize.
Like not all dental insurance companies are alike, not all plans are alike either.
Here are some common plan categories you’ll see:
Note that with most PPO plans (a Preferred Provider Organization), you typically will pay less if you go to an in-network dentist. You can still visit other healthcare providers, but the out-of-pocket expenses will likely be higher.
HMO plans (Health Maintenance Organizations) are typically cheaper every month, and it’s more likely that you’ll pay less for services. However, you don’t have the same flexibility in picking providers.
Dental indemnity plans have slightly different coverage options (but they can also be paired with HMOs. This plan covers a certain amount of each procedure.
Let’s break down the cost of each one of these factors that you’ll need to spend money on if you get dental insurance. As far as your monthly premiums go, most individual plans are somewhere around $20-$50 a month. These are chargers you’ll pay every single month, even if you don’t receive care — not even a mere checkup — just to remain insured.
Deductibles vary depending on how much you’re paying for your monthly premium. This will likely range somewhere between $100 and $500, with the higher deductible plans usually having a lower monthly premium.
Co-pays usually range somewhere between $20 to $60 for each service, though you won’t always need a copay for preferred providers (in-network dentists).
Let’s do some math here: If you think about the average cost of each month of your premium and add on your deductible, you’re looking at a yearly bill of around $300 to $1,000 a year to remain insured — and this doesn’t include the cost of any additional co-pays you might need.
The high cost of insurance puts many Americans in a tight spot. Many Americans cannot even afford the cost of dental insurance, but they also can’t afford the out-of-pocket costs for basic procedures. In fact, only about half of the country has had dental care coverage in the past year.
You don’t need to let cost be a barrier to your care. There are other options available to help you get the smile you’ve been waiting for.
If you’re not able to have access to dental insurance, you can still have access to care. And there are a few ways to do it.
All of those talented dentists out there had to start somewhere, and it was most likely one of the dental schools across the country. These clinics are located in almost every city to help up-and-coming dental students practice their craft before heading out into the employment world.
Dental students will conduct real procedures to get experience but can’t be paid for their work until they’re employed. So, if you get a procedure completed at one of these schools, you’ll probably only need to pay for the cost of materials, making it a very inexpensive option for routine treatments.
The downside is that dental students are not as experienced, but a professional is always in the room to monitor their work.
The dental field is constantly changing and evolving. Sometimes, researchers need to conduct studies to see how effective new products or major procedures might be before they release them into the public. These are called clinical trials, and they might give you an opportunity to get low-cost dental care.
Some clinical trials will compensate you for your time when you get involved. While clinical trials may require specific things regarding their candidates, it’s often worth trying to get involved if you want to get no-cost dental care while also contributing to dental research.
Dental insurance allows you to afford dental care, but there are still a lot of associated costs that many people might not realize. Dental insurance requires you to pay monthly premiums to stay insured, deductibles out of pocket, and possibly co-pays. This can add up to almost $1,000 every single year, even if you don’t actually get any procedures completed in the first place. While insurance can make it easier to afford necessary care, many people are still not able to access these benefits.
Sources:
What's a deductible? | UnitedHealthcare
What is a Periodontist? Definition & Types of Periodontics | Cleveland Clinic
