What You Should Be Paying At Your Dentist
Financial stress is a prevalent issue in the U.S. healthcare system and can pose a serious deterrent to patients looking to receive care. While dental care may be covered under a different insurance than your family physician or urgent care visit, it still contributes to the financial burden of healthcare. Part of the issue lies in patients’ lack of knowledge regarding insurance coverage, typical costs of procedures, payment plans, and out of pocket costs. The aim of this article is to clarify and disseminate this information, with the goal of providing patients with the tools to maintain their physical and financial health.
1. Costs of Common Dental Procedures
There are multiple factors that affect the cost of dental procedures. They can vary from practice to practice, between states and regions, and based on the specifics of the treatment provided. While there are a lot of nuances, the 2020 Survey of Dental Fees conducted by the American Dental Association (ADA) offers a reliable estimate for those looking to determine the cost of their dental treatment. This valuable resource includes every dental code, each of which corresponds to a specific procedure, but this can easily become overwhelming because there are hundreds of codes. Having such a large quantity of codes is necessary for dental offices to appropriately bill the patient and insurance companies for the precise treatments rendered. To ensure that these codes are current and representative of the procedures being conducted, the ADA reviews and updates the list of dental procedure codes each year.
For preventive dental treatment, adult patients can expect to be charged $98 for a routine biannual cleaning, $87 for a comprehensive exam (which is done biannually and required for new patients), $31 for a single X-ray (and $25 for each additional X-ray), and $123-143 for full mouth X-rays or a panoramic X-ray (which are required for new patients and are typically done every 3 years). It quickly becomes clear how these costs can add up on a yearly basis.
Aside from preventive treatment, basic dental services are often required. In fact, 90% of adults had at least one cavity in 2011-2016 according to the 2019 Oral Health Surveillance Report conducted by the CDC. A patient receiving a filling can expect to pay $175-344 per tooth depending on the size and location of the cavity. Extractions are also common and can cost $135-505 per tooth depending on its location and complexity.
2. How Dental Insurance Works
Chances are, if you’ve ever had to look for a new health service provider you’ve probably heard the term “in-network” before. Being “in-network”for a certain insurance plan means that the health care provider or facility has negotiated a discount with the insurance company providing that plan. Each dental office has its own prices for each procedure. In-network dental service providers submit the codes and associated costs to the insurance companies, who then tell the dental office what they are allowed to charge for each code, according to their negotiated contract.
In order to obtain dental insurance coverage, a person has to pay a monthly cost to the insurance company called a premium. A person’s dental coverage will vary depending on the company and plan they are insured under, but most plans typically cover 100% of the cost of preventive treatments, 80% of the cost of basic procedures, and 50% of the cost of major services. Whatever these plans do not cover will be charged to the patient as their copay.
Patients may also be charged a deductible, which is a fixed dollar amount that must be paid by the patient prior to utilization of insurance benefits for a covered procedure. Not all plans have a deductible and the specific out-of-pocket cost prior to coverage varies from plan to plan, but most plans cover preventive treatment with no deductible required.
Dental insurance plans also have an annual maximum, which is the total amount of money that the insurance company is willing to pay in coverage in a given yearly period. This maximum is usually $1,500 but can be anywhere between $1,000 and $2,000. Any services provided after the maximum is reached will be the patient’s responsibility to pay.
3. What You Can Expect to Pay Annually for Dental Care
According to the ADA Health Policy Institute (HPI), national dental expenditures have been increasing annually for the past two decades. This is exacerbating an already looming issue: the unaffordably high cost of healthcare in the United States. In fact, the CDC reported that financial barriers to dental care were reported the most out of all types of health care. These financial barriers vary in severity among different groups based on age, race, and income level.
Overall, the average annual cost of dental care is $978 per person with dental insurance and $1,007 without, according to Cigna, an insurance company. Traditional dental insurance premiums are $564 per year on average while preventive plans are $312 per year on average. With the preventive plan, patients will save at least $58 a year so long as they go in for their 6-month checkup and cleaning. Given the same stipulation, most people will save a little bit of money by having a traditional dental insurance plan as well. The exact amount you will spend will depend on if you have insurance, the specific procedures you need done, and where you have them done.
4. Financing Dental Care Outside of Insurance
While dental insurance tends to save people money, it doesn’t make sense for everyone. Most plans don’t cover cosmetic or orthodontic procedures and only cover a small portion of advanced surgical procedures like implants. For patients seeking these types of work, it may be more economical to forego dental insurance altogether and utilize other financing options instead.
Some offices may have flexible pricing and could be willing to negotiate the costs of procedures if asked. Some offices also allow patients to set up payment plans so they do not have to pay the entire lump sum of their procedures all at once.
There are companies that provide dental discount savings plans which allow you to receive a discounted rate for procedures with some dental providers in exchange for an annual fee paid to the company. These plans are not the same as insurance because they don’t provide any coverage for the procedures, they only work to negotiate the cost you pay out of pocket at the dental office, and you do not have to pay a copay or deductible. These plans typically cost $150 per year and may save a patient money if they cannot afford traditional dental insurance or if the scope of their dental care needs is below or above traditional insurance coverage. Those who need only preventive care or those who need more extensive services outside the coverage of their dental insurance plan (such as implants or cosmetic procedures) may save money with a dental discount plan.
Patients who have insurance through their employers can open a Flexible Spending Account (FSA), which is a tax-advantaged account where patients can set aside money for out-of-pocket medical expenses. These accounts max out at $3,200 per year per employer and the funds within the patient’s account must be used within the year. Similarly, patients with High Deductible Health Plans (HDHP) may contribute to a Health Savings Account (HSA). An HSA is nearly identical to an FSA except the funds do not need to be used within the year. Funds from these accounts can be used to pay copays for some dental procedures, including non-cosmetic crowns, braces, dentures, and implants.
5. Conclusion
In a healthcare system that leaves 4 in 10 adults in medical or dental debt, one of the most important things patients can do is take preventive measures to maintain their physical and financial health. These measures include daily brushing and flossing, attending biannual checkups and cleanings, and finding the most economical way to pay for preventive and restorative care. Each patient is different and their individual circumstances will determine their specific needs, but these preventive measures are universally crucial in inhibiting the proliferation of costly oral diseases. Financial barriers to treatment are a huge issue and the very first step in overcoming them is providing comprehensive information about the resources available to patients so they are able to make informed decisions regarding their health.
