Why Moms Dads Need to Remember Dental Insurance

Why Moms, Dads Need to Buy Dental Insurance for Their Kids  

Whether you are an adult or a child, brushing and flossing teeth daily and visiting the dentist for routine exams and cleanings are important for cavity-free living. However, we all know that good oral health does not come free. Dental costs account for about 20 percent of a child’s total healthcare expenses, and they are increasing.[1] Total spending on dental care is expected to increase 58 percent from 2009 to 2018, according to a Pew Center on the States report.[2]Buying dental insurance can go a long ways in saving families money on dental bills and ensuring kids have healthy teeth and gums. Obamacare’s pediatric dental and vision essential health benefit can help parents and guardians obtain affordable dental benefits for their children through state-based and federally facilitated health insurance exchanges. The private marketplace also offers quality, budget-friendly dental insurance plans for the whole family.

What dental services cost without insurance

Professional dental organizations including the American Dental Association and American Academy of Pediatric Dentistry recommend that children see the dentist no later than their first birthday and then at regular intervals as advised.[3],[4]

Over the course of a childhood, from birth to age 18, the cost of preventive care, including exams, cleanings, fluoride, sealants and X-rays, alone can amount to thousands out of pocket. Factor in sealants, extractions, fillings and braces, and dental expenses for a single child can easily exceed $10,000. For most families budgeting for day-to-day living expenses and saving for college, that is a lot to pay out of pocket, even across 18 years.

Below is a sampling of costs for various dental services an individual may require throughout childhood—most of these will not be one-time occurances:

Braces[5]:   $5,000 to $6,000

Amalgam filling – child, 1 surface[6]:  $110

Orthodontist – periodic treatment visit[7]:  $184

Prophylaxis (cleaning) – child[8]:  $55

Sealant – child, per tooth[9]:  $45

Tooth removal – erupted tooth or exposed root, with elevation and/or forceps removal[10]:  $134

Tooth removal – impacted, completely in bone[11]: $404

Topical fluoride application[12]:  $30

X-rays (complete set)[13]:  $103

On average, CostHelper users reported paying $100 to more than $300 for a complete dental appointment including a cleaning, exam and X-rays—the average was $198.[14] Brighter.com provided a similar range for locations across the country, with $262 as the national average cost for an exam, cleaning and X-rays.[15] The website showed a kids’ checkup in Minneapolis, including exam, X-ray and cleaning, averaged $228 with the low-end at $180 and the high-end at $285. In Portland, the average was $259, and in Boston it was $287.

These figures can fluctuate greatly from city to city and dentist to dentist. As Wendell Potter reported in the Huffington Post, Brighter.com found that prices for the same dental procedure performed by “comparable dentists in the same city – even on the same street” varied up to 700 percent.[16]

Dental insurance helps oral health, takes a bite out costs

Dental caries, commonly referred to as tooth decay or cavities, is the No. 1 chronic disease among children in the United States.[17] It is also highly preventable through at-home oral care, including brushing and flossing, and professional oral care, including exams, cleanings, fluoride and sealants. Studies show that dental insurance is a primary indicator of access to such care.[18] In other words, people with dental insurance visit the dentist more frequently than those without it.

Most dental insurance plans cover preventive care at 100 percent—or at least close to it. That typically includes two cleanings and exams per year, a set of X-rays and even sealants. In addition, they provide benefits that help reduce the cost of basic and major care such as fillings, extractions, crowns and root canals. Some plans even include orthodontic care benefits or, through partnerships, provide access to orthodontic discount programs.

For around a dollar a day, an entire family can obtain dental insurance benefits. While the National Association of Dental Plans has not calculated the average monthly and annual dental insurance premium for individual and family plans since 2009, at the time family coverage cost $20 to $35 more annually than a typical group plan, which ranged from $19 to $35 per month or $231 to $415 per year.[19]

Pediatric dental benefits and the Affordable Care Act

The Affordable Care Act’s essential health benefits include pediatric dental and vision. The pediatric dental and vision EHB must be available embedded in or bundled with health insurance plans or sold as standalone coverage. Parents and guardians are not required to buy these benefits, but they are strongly encouraged to do so.

Much like benefits vary from plan to plan in the private marketplace, benefits will vary form plan to plan on the exchanges. Each state has selected a benchmark plan upon which all other benefits must be based. They typically cover preventive care, and some may include benefits for medically necessary orthodontics.

In states with federally facilitated health insurance exchanges, the out-of-pocket spending limit is $700 for plans covering a single child and $1,400 for plans covering multiple children. State-based exchanges set their own limits. Once the out-of-pocket limit has been reached, the dental plan pays for all additional covered expenses. It is important to note that exchange-based financial assistance does not apply to standalone dental insurance, even the pediatric dental and vision benefit.

As you enroll your family in a health insurance plan this year, be sure to shop for dental benefits, too. It can save you money in the long term, and having dental coverage when you need it rather than waiting until you need care will help you avoid waiting periods. Competitively priced dental insurance for the whole family is also available in the private marketplace through sites such as HealthCare.com.

 

 

[1] Briody, Blaire. “Kids and Dental Health: Rising Costs and Struggling State Programs a Dangerous Mix.” The Fiscal Times. July 20, 2010. Retrieved from http://www.kaiserhealthnews.org/stories/2010/july/21/ft-dental-care-costs.aspx.

[2] Ibid.

[3] American Academy of Pediatric Dentistry. “Oral Health and Children.” N.D. Retrieved from http://www2.aap.org/commpeds/dochs/oralhealth/index.html.

[4] American Dental Association. “Babies and Kids.” MouthHealthy.org. N.D. Retrieved from http://www.mouthhealthy.org/en/babies-and-kids/.

[5] Academy of General Dentistry. “Can Adults Wear Braces?” Know Your Teeth. N.D. Retrieved from http://www.knowyourteeth.com/infobites/abc/article/?abc=c&iid=322&aid=1303.

[6] HealthcareBluebook.com

[7] Ibid.

[8] Ibid.

[9] Ibid.

[10] Ibid.

[11] Ibid.

[12] Ibid.

[13] Ibid.

[14] CostHelper Health. “Teeth Cleaning Cost.” N.D. Retrieved from http://health.costhelper.com/teeth-cleaning.html.

[15] Brighter.com. “Check-Up & Cleaning Overview.” N.D. Retrieved from https://www.brighter.com/dentists/procedure/check_up_cleaning.

[16] Potter, Wendell. “Why a Trip to the Dentist Cost So Much Now – And What We Can Do About It.” Huffington Post. March 20, 2014. Retrieved from http://www.huffingtonpost.com/wendell-potter/why-a-trip-to-the-dentist_b_4992826.html.

[17] U.S. Centers for Disease Control and Prevention. “Children’s Oral Health.” Last revised Sept. 10, 2013. Retrieved from http://www.cdc.gov/oralhealth/children_adults/child.htm.

[18] Bloom, Barbara, and Robin A. Cohen. “Dental Insurance for Persons Under Age 65 Years with Private Health Insurance: United States, 2008.” NCHS Data Brief, No. 40. June 2010. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db40.pdf.

[19] National Association of Dental Plans. “What Do Dental Benefits Cost on a Group Basis or If I Buy Them Directly As an Individual?” N.D. Retrieved from http://www.nadp.org/Dental_Benefits_Basics/Dental_BB_7.aspx.

Colleen McGuire

About Colleen McGuire

Colleen McGuire is an independent consultant who has spent most of her career writing about healthcare and the health insurance industry. For fun she blogs, travels and takes a lot of pictures along the way.

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