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In an era where healthcare costs continue to rise, many Americans find themselves grappling with unexpectedly high dental bills, even when they have dental insurance coverage. This phenomenon leaves many wondering: why is dental work seem so expensive, despite having insurance? This article delves into the complex factors that contribute to the high cost of dental care and why insurance can fall short in covering the costs,
Understanding Dental Insurance Coverage
Many consumers mistakenly believe that dental insurance will cover all of their dental expenses. However, unlike medical insurance, which often has high annual maximums or no maximum at all, dental insurance plans typically have annual maximums ranging from $1,000 to $2,000. Once this limit is reached, the patient is responsible for 100% of any additional costs until the policy year rolls over.
Dental insurance plans typically follow a 100-80-50 structure, where preventive care is covered at 100%, basic procedures at 80%, and major services at 50%.
Preventive care
This typically includes routine check-ups, cleanings, and bitewing X-rays and is usually covered at 100% by most dental insurance plans. This coverage is designed to encourage regular dental visits and early detection of potential issues. Regular preventive care is the best way to save on dental care costs over the long run.
Basic dental care
Basic care usually includes fillings, simple extractions, and periodontal treatments, and is typically covered at a lower percentage than preventive, often around 80%. You pay the remaining percentage out of pocket.
Major dental work
This includes crowns, bridges and dentures and may (but not always!) cover orthodontics. Insurance typically paying only about half of the cost of these expensive procedures.
Cosmetic and Orthodontics
Cosmetic treatments – which usually includes dental implants- are often not paid for by dental insurance. Orthodontics (braces) may be covered, often with a single, one-time benefit of $1000-$1500.
Factors Contributing to High Dental Costs
Several factors contribute to the high cost of dental care, even for those with insurance:
Material and Laboratory Fees
Dental procedures often require high-quality materials and specialized laboratory work. For example, crowns, bridges, and implants use durable materials like porcelain, ceramic, or precious metals, which can be expensive. The cost of these materials, combined with the skilled laboratory work required to create custom dental appliances, contributes significantly to the overall cost of dental procedures.
Professional Expertise and Overhead
Dentists undergo extensive training and education, which is reflected in their fees. Additionally, dental practices have substantial overhead costs, including rent, equipment, staff salaries, and malpractice insurance. These expenses are factored into the cost of dental services.
Insurance Limitations
Dental insurance plans often have limitations that result in higher out-of-pocket expenses for patients. Deductibles, which can range from $25 to $100 per year, must be paid before insurance coverage kicks in. Copayments for dental services can range from $10 to $50 per visit. Additionally, many plans have waiting periods for certain procedures, which can delay necessary treatments and potentially lead to more expensive interventions down the line.
Market and Economic Influences
Dental costs can vary significantly based on location. For example, dental insurance rates in Alaska average $50 per month, while in West Virginia, the average is just $18 per month. These regional differences reflect variations in the cost of living, competition among dental practices, and local economic factors.
Impact on Out-of-Pocket Expenses
To illustrate how these factors translate into real-world costs, let’s consider a hypothetical example:
You need a crown, which your dentist estimates will cost $1,200. Your dental insurance plan covers 50% of major dental work. The plan has an annual maximum of $1,200, you’ve already used $500 for dental work this year.
Here’s how the costs break down:
- Total cost of crown: $1,200
- Insurance covers 50%: $600
- You pay: $600
With 50% coverage, it’s no surprise you’re paying $600 for a $1,200 procedure. But if you need additional dental work later in the year, you would have only $100 left in your annual maximum, after which you would be responsible for 100% of any further costs until your plan resets.
Also note that if you need a crown due to dental damage that occurred prior to your purchase of dental insurance, your insurance will likely not pay for the crown at all.
The Dental Insurance Paradox
The structure of dental insurance creates a paradox where it doesn’t effectively protect patients from financial risk. As Marko Vujicic, chief economist and vice president of the Health Policy Institute at the American Dental Association, pointed out in a VOX article, “When you look at the dental insurance model, it doesn’t protect the patient from financial risk. It’s the opposite. Once the benefit runs out, the $1,400 or whatever it is, all of that financial burden is on the patient. So it protects the insurer, they’re limited on their exposure.”
This limitation becomes particularly apparent when comparing dental insurance to medical insurance. If medical insurance operated similarly to dental insurance, patients might find themselves responsible for 50% of a heart bypass surgery cost, with coverage capped at $10,000 annually. Such a scenario would be considered unacceptable in modern healthcare, yet it’s the reality for many dental procedures.
The Rising Cost of Dental Care
The cost of dental care continues to rise, with industry revenue growing at a compound annual growth rate (CAGR) of 3.9% over the past five years, reaching an estimated $190.4 billion in 2025. This growth is driven by various factors, including technological advancements, increased demand for cosmetic dentistry, and rising overhead costs for dental practices.
Moreover, the dental industry is not immune to broader economic pressures. The COVID-19 pandemic, for instance, led to a significant decline in dental visits, followed by a surge in demand as patients sought to address pent-up dental needs. Such fluctuations can impact the pricing of dental services and the financial stability of dental practices.
The Role of Dental Savings Plans
Given the limitations of traditional dental insurance, consumers are turning to dental savings plans as an alternative or supplement to insurance coverage. These plans operate on a membership model, where individuals pay an annual fee to access discounted rates on dental services from participating providers.
Dental savings plans can offer several advantages:
- No annual maximums or waiting periods.
- Immediate savings on most dental procedures.
- No waiting periods (Dental insurance often doesn’t offer full coverage for 6-12 months after purchase.)
- Potential savings on procedures not typically covered by insurance, such as cosmetic dentistry and orthodontics.
When you compare dental savings plans to dental insurance, it’s obvious that they can provide a valuable way for consumers to reduce their out-of-pocket costs, especially for those who require extensive dental work or have reached their insurance plan’s annual maximum.
How to reduce the costs of dental care
The high cost of dental work, even with insurance, is a result of complex factors including material and laboratory fees, professional expertise, insurance limitations, and market influences. Traditional dental insurance, while beneficial for preventive care, often falls short in protecting patients from significant financial burdens for more extensive procedures.
To navigate this challenging landscape, consumers can:
- Thoroughly review their current dental benefits, understanding coverage limits, exclusions, and out-of-pocket costs.
- Prioritize preventive care to minimize the need for costly procedures in the future.
- Discuss treatment options and costs with their dentist, exploring alternatives when possible.
- Plan for dental expenses by setting aside funds in a health savings account (HSA) or flexible spending account (FSA) if eligible.
- Consider joining a dental savings plan to avoid annual limits, waiting periods and other restrictions associated with dental insurance.
How Do Dental Savings Plans Work?
Dental savings plans are an alternative to insurance where plan members pay an annual fee to save on virtually any procedure, at any participating dentist or specialist nationwide. Unlike insurance, many dental savings plans do include reduced rates for dental implants and other cosmetic dental procedures like overlays and whitening treatments. And while dental insurance often has deductibles and waiting periods for costly procedures, dental savings plans do not.
Dental savings plans are often offered by the same health care companies that provide dental insurance. This choice allows you to select the option that best meets your budget and healthcare needs.
Dental Savings Plan or Dental Insurance?
The is no one right answer to this question, it depends on individual needs and dental health status. Take a little time to explore the unique advantages of dental savings plans and dental insurance. Or use the calculator below to quickly see how much you can save with a dental savings plan.
No matter which you choose – a dental savings plan or dental insurance – taking a proactive approach to dental care can lead to significant savings and improved overall health in the long run.
*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan. All cost averages obtained from DentalPlans.com procedure search tool, and independent research.
