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Maintaining good oral health is critical to maintaining your overall health. Seeing your dentist regularly is a key part of maintaining good oral health. In fact, dentists can catch small issues before they become major, and expensive, issues¹. People with dental insurance are more likely to visit the dentist regularly promoting better oral health².
There are a variety of factors that impact the cost of dental insurance. Depending on where you live, your oral health, and budgetary needs can all impact the cost of your monthly premium as well as your deductible and copayments.
If you immediately tense up when you think about monthly insurance premium costs that’s normal considering how high most medical premium costs typically are. The average cost of medical insurance premiums for one person is around $450 a month, and it can cost over $1100 per month to insure a whole family³. However, the average dental insurance premium is usually between $15 and $50⁴ a month.
If you’ve been on the fence about whether or not to get dental insurance for your entire family, you should consider that the cost for a procedure like filling a cavity can cost between $50 and $250 per procedure depending on the material used⁵. With children just learning to care for their teeth these costs can add up fast and dental insurance can typically lower your overall costs.
Dental insurance will also likely help cover your children’s dental expenses if they have an emergency, like if they have a tooth injured or knocked out playing sports or in a schoolyard accident. More than 40% of households in the U.S. would likely have trouble coming up with $400 in an emergency⁶. Emergency procedures, like tooth extractions or root canals, can cost between $200 and $1200 without insurance⁷. Depending on your insurance plan, your child’s emergency dental expenses may be covered.
When you are choosing a dental insurance plan, it is important to consider all of your options. Dental insurance plans are typically offered at different levels. Each level will typically have different options, coverage amounts, deductibles, and copays.
Dental insurance plans typically cover a wide variety of services. Depending on your budget and needs, you can choose a plan based on the coverage that it provides or based on the monthly cost. Throughout the dental insurance industry, there are three basic classifications of services: preventive, basic, and major.
Preventive treatment - typically are treatments designed to help keep your teeth healthy, including, regular cleanings, fluoride treatments, and other preventive treatments.
Basic treatments - are routine services like tooth extractions, fillings, and root canals. They are necessary procedures that can also help prevent more significant and harder to treat problems down the road.
Major treatments -- typically include treatments like implants, bridges, and emergency care that can involve multiple treatments to fix a problem.
Dental insurance plans provide varying coverage for these three types of services so you can pick a plan that covers the treatments that are the most important to you and has a monthly premium cost that fits your budget.
Another factor that impacts dental insurance costs is the maximum coverage amount on the plan that you choose. Some dental insurance plans have a maximum benefit amount that will be paid per year. If the cost of your services goes beyond that maximum cost, you are typically responsible for paying any overages. Plans with lower maximums typically have lower premiums and vice versa.
Choosing a top-tier dental insurance plan means that you will typically pay a higher monthly premium, but you will likely pay less out of pocket for many dental care and procedures. For example, subject to exclusions and limitations, a Guardian Direct® top-tier plan covers 100% of the cost of cleanings and x-rays and 70% of the cost of filings. But a less expensive Guardian Direct® mid-tier plan covers up to 80% of cleanings and X-rays and up to 50% of filings.
A dental insurance deductible is the amount you’ll have to pay out of pocket before your benefits kick in. You are responsible for paying for the costs of dental care in full up to the cost of the deductible. Once you have met that amount, your insurance will kick in and start covering costs. Your dental insurance will typically cover a percentage of treatment after your deductible has been met, not the entire cost.
Picking a dental insurance plan with a high deductible will typically help lower your monthly premium costs but likely makes you responsible for paying more out of pocket. Choosing a dental insurance plan with a high deductible can be a way to help you keep the cost of monthly premiums low.
The amount that you pay out-of-pocket for a dental visit is called a copay. The amount of your copay is typically based on the type of plan that you have and the services performed.
Paying for dental work without insurance coverage is typically higher than it would cost with coverage. Without insurance, you will be responsible for the full cost of all dental procedures, including routine cleanings and x-ray imaging. If you have insurance, you are typically responsible for a portion of most procedures, and routine cleanings and care are typically provided without additional cost.
Routine dental procedures can add up quickly without insurance, for example:
Basic cleanings can cost over $125⁸.
Cavities with fillings can cost between $50-$150⁹ each, depending on size and location, among other factors.
Root canals can cost over $950¹⁰ out of pocket and often may require a crown as well.
Crowns can run over $1000¹¹ depending on tooth location and the material that the crown is made of, among other factors.
All of these procedures are typically covered in part by dental insurance. Some procedures, like routine cleanings, can even be completely covered depending on your plan typically subject to annual maximum and other limitations.
Another consideration is that when you go to a dentist without having insurance coverage you also are typically charged a higher rate for all procedures¹². The reason for this is that insurance carriers are typically able to negotiate favorable rates when they partner with your provider.
With most dental plans a big factor in the cost of dental insurance is whether you get treatment from a dentist that is in-network or out-of-network. You will often pay lower rates if you see an in-network dentist instead of an out-of-network dentist. Dental insurance company’s networks are composed of dentists who have agreed to provide services to subscribed clients at reduced rates negotiated by the insurance company. If you choose to see a dentist that isn’t in the insurer’s network, you will usually have to pay a higher portion of the treatment cost out of pocket.
The size of the dental network typically depends on the insurer and what type of insurance plan you have. It’s important to understand the differences in types of dental insurance before you pick a plan to make sure you’re picking the plan that will give you the most options.
Most dental insurance companies provide easy access to lists of dentists in your area who are members of their network. You can usually find these on company websites or in written materials sent to you annually from the insurance company.
When you are shopping for dental insurance, it may be the monthly premium cost that makes you choose one plan over another. The average cost of dental insurance is about $360 per year, depending on your dental insurance plan and the state you live in¹³.
The monthly premium cost is typically based on the plan coverage, however other factors influence the cost of dental insurance each month, like where you live and what the cost of procedures in those areas are. Have you wondered why you need to input your zip code to get a dental insurance quote? It’s because if you live in a large city where the cost of living, and the cost of dental care, is typically high, then your premium will likely be higher than it would be if you lived in a rural area or smaller city.
Another consideration when deciding whether to purchase dental insurance or not is the cost of deep cleaning. If it has been a while since you have seen a dentist, you may need to have a more extensive cleaning done. Deep cleaning includes scaling and root planing and is more in-depth than normal cleaning. While routine cleanings may only cost around $100, depending on your state, and other factors, a full mouth deep cleaning can cost more than $1,000¹⁴. Deep cleanings are typically covered by dental insurance.
Plans with Guardian Direct include a large network of dental professionals which allows you to have flexibility in choosing a dentist that you trust. Choosing an in-network dentist is also a way to save money, in-network dentists have lower rates that have been negotiated by Guardian Direct.
Before making any choices regarding your dental health or insurance needs it is important to have all of the information that you need. This is why Guardian Direct has a vast library of resources designed specifically to help you make the best choices for yourself and your family.
Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.
https://www.dentalhealth.org/blog/the-importance-of-regular-dental-visits (2019) Accessed 3/25/2021
https://www.cdc.gov/nchs/products/databriefs/db336.htm#:~:text=Routine%20dental%20care%20can%20promote,coverage%20(3%2C4). (2019) Accessed June 2021
https://www.ehealthinsurance.com/resources/individual-and-family/how-much-does-individual-health-insurance-cost 2020 Accessed June 2021
https://www.moneyunder30.com/is-dental-insurance-worth-it 2020 accessed June 2021
https://www.mykoolsmiles.com/content/cavity-filling-cost-without-insurance/ accessed June 2021
https://www.cbsnews.com/news/nearly-40-of-americans-cant-cover-a-surprise-400-expense/ 2019 accessed June 2021
https://www.tempesmiledesign.com/patient-information/blog/2019/5/29/how-much-do-emergency-dental-services-cost/ 2019 accessed June 2021
https://health.costhelper.com/teeth-cleaning.html Accessed June 2021
https://health.costhelper.com/cavity-filling.html Accessed June 2021
https://health.costhelper.com/root-canal.html Accessed June 2021
https://health.costhelper.com/dental-crown.html Accessed June 2021
https://www.investopedia.com/articles/pf/07/dental-insurance.asp (May 2021) Accessed June 2021
https://www.moneyunder30.com/is-dental-insurance-worth-it (2020) Accessed June 2021
https://www.dentaleconomics.com/practice/article/16385079/the-dental-economics-annual-fee-survey (2018) Accessed June 2021
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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.10/23)
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