17 May 2023

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Which insurance plans cover the most expensive dental procedures?

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DentalInsurance.com, which compares dental plans from different insurers within a single online marketplace, published a dental insurance study on May 9 examining which plans cover the most expensive oral care services. Three procedures were chosen for the study — crowns, braces, and dental implants — based on their potential to cost thousands of dollars.

DentalInsurance.com used its own database of plans across the nation to identify trends in coverage.

Of the three procedures, braces had the fewest plans covering treatment. Only 28 percent of DentalInsurance.com plans offered orthodontic coverage. Among those plans, four-out-of-five restricted treatment to children. Waiting periods delaying availability of orthodontic coverage were frequently encountered, with postponement of orthodontic coverage typically lasting 12 months. These waiting periods were limited to the PPO and indemnity plans, while HMO and dental discount programs had no waiting periods. Some plans had a cap on lifetime spending for orthodontic care. These caps, when present, were often $1,000. In comparison, the average cost for adult braces is approximately $6,000.

Depending on material used — gold, porcelain, zirconia, etc. — a crown may cost as much as $2,500 or as little as $500. Among plans reviewed, 91 percent had coverage for crowns. 42 percent of plans with crown benefits had progressive coverage that increased the longer a person was enrolled in the plan.

For example, a plan may cover only 20 percent of a crown's cost in the first year of plan membership, 30 percent in the second year, and 50 percent if performed in the third. In some instances, crown coverage began in the second year of plan membership. PPO and indemnity plans with fixed coverage often paid 50 percent of the crown cost.

The total cost of an implant often ranges from $3,000 to $4,500 and a little more than half (53 percent) of DentalInsurance.com's plans nationwide had coverage for the treatment. The out-of-pocket cost among several HMOs covering implants was $1,500 for a single tooth. Other HMOs offered a discount of 15 to 25 percent on the price of the procedure.

The dental discount card offered a 20 percent discount at participating dentists. Some PPO plans began with low-cost coverage (20 percent) in the first year of enrollment and increased insurer expense contribution in the second and third year. Waiting periods delaying availability of orthodontic coverage were frequently encountered, with postponement of orthodontic coverage typically lasting 12 months. Some plans restricted implant coverage to one tooth per five years of enrollment or no more than one implant for the same tooth position within a 10-year period.

For the full findings of the study as well as examples of dental plans covering each procedure, see "Which Dental Plans Cover the Three Most Costly Dental Procedures?"

About DentalInsurance.com

Launched in 2001 by Mark Kelsey, DentalInsurance.com is the pioneer of the online dental insurance marketplaces. DentalInsurance.com is headquartered in Los Angeles, California, and has an A+ rating from the Better Business Bureau and 4.8 out of 5 stars on TrustPilot.