Coinsurance is the percentage of care you must pay for after meeting your deductible. For example, the ACA dental with the lowest premiums in Texas, Texas Essential Health Benefit plans, cover 100% of preventive care after your deductible. However, they only pay for 50% of restorative care for adults and 50% of orthodontic care for children.
Annual maximums are the most that dental insurance policies will pay in benefits. Once your policy pays its annual maximum, you are responsible for all dental costs for the rest of the year.
For example, the Texas Essential Health Benefits plan has an annual maximum of $1,000.
Annual maximums apply to adults only and are the opposite of out-of-pocket maximums. Once you've reached the out-of-pocket maximum, the insurance will pay the rest of your costs for the year. The out-of-pocket maximum only applies to children's dental insurance. They must be $350 for ACA policies that cover one child and $700 for policies that cover two or more. How Much Is A Root Canal Without Insurance?
How dental plan type affects the cost
There are five primary types of dental insurance. Which one you choose also affects the cost of your dental insurance. Here's what they are and how they affect costs.
- Dental Preferred Provider Organization (DPPO) : DPPOs give you a network of providers to choose from; going to an out-of-network dentist will increase your costs. DPPOs typically have deductibles and copays and coinsurance are common for anything beyond preventive care.
- Dental Health Maintenance Organization (DHMO) : DHMOs give you an in-network and no out-of-network coverage. They typically have no deductible or annual maximum and charge fees for non-preventive services.
- Dental reimbursement: These tend to cost more because they don't limit you to a network or primary care dentist. You will typically pay coinsurance for services when you meet your deductible.
- Dental Exclusive Provider Organization (DEPO) : These plans also typically have deductibles and coinsurance. You do not need a primary dentist, but you must see a dentist within the plan's network to get coverage.
- Dental Point of Service (DPOS): These plans often have higher deductibles, premiums, and copays. You can see an out-of-network dentist, but costs will increase.
Keep in mind that these are generalizations. Always check the details of individual policies before choosing one.
Out-of-Pocket dental costs
Dental insurance policies have restrictions, and you may have to pay out of pocket for some procedures. The cheapest policies only cover preventive care, and even those are subject to limitations. For example, you can only get two free teeth cleanings per year.
The next step up in the policies also covers restorative care, such as fillings for cavities, tooth extraction or root canals. They cost more but are still generally affordable compared to having to pay for these services without any insurance coverage.
The most expensive and comprehensive plans also cover orthodontic services. These correct your teeth and bite alignment.
Some services are generally not covered by any dental insurance. Some examples include cosmetic procedures, such as teeth whitening, and conditions that existed before you signed up for the policy.
Reduce dental care costs
Dental insurance can save you money, but only if you choose the right policy. Accurately predicting your dental care needs is key to keeping costs down.
Say, for example, that you have healthy teeth and that your only desired dental care in the coming year is two dental cleanings. Your research tells you that each would cost you $100 without insurance.
To see if you can save money through dental insurance, look for policies that offer two free dental cleanings. You can find one that costs only $8 in monthly premiums. It would make sense to buy because you would pay $96 a year with the insurance and $200 without it.
But if the cheapest policy available had a $20 premium, coverage wouldn't be worth the trouble. You'd pay $240 a year with insurance versus just $200 without it.
Another way to keep your costs down is to keep track of your dental health. Preventive care and good hygiene can minimize the likelihood that you will need more expensive repair services in the future.
Is dental insurance worth it?
Dental insurance is worth it if you get the insurance that covers the dental services you need for less than you would pay for them without coverage. Compare a plan's cost in premiums, copays, deductibles, coinsurance, and annual maximums to the amount you would pay for your desired services without it.
What does dental insurance usually cover?
Basic dental insurance covers preventive services that keep your teeth healthy, such as semi-annual cleanings. More expensive and comprehensive dental insurance policies also cover restorative and orthodontic services, such as root canals and braces.