dental cost calculator insurance costs can be a bit confusing. Understanding things like copays, deductibles, annual maximums and monthly premiums can help you decide if you want to get a plan or not.
As a dental billing service, we’ve seen many dental teams struggle to correctly calculate patients’ out-of-pocket costs. This can cause frustration for the patient and loss of trust with the office.
Costs for In-Network Services
In-network dental care typically costs 25-50% less than out-of-network services. The reason is that in-network providers have negotiated with your insurance company to provide services at a set price. This reduced fee is usually lower than the provider’s regular rates, but the patient still pays a copay or percentage of the cost of services based on their specific plan coverage.
To avoid surprise bills, your employees can use our online dental cost estimator to get a detailed, personalized estimate of their out-of-pocket costs for each visit. The tool displays their expected cost for a given service – including the network savings and what their insurance plan covers – as well as a range of costs for in-network and non-participating providers based on the usual and customary charges in their ZIP code.
The tool also calculates the average amount that a specific procedure will cost in their area for a non-participating Delta Dental general dentist and displays the estimated low-to-high cost of the service to help patients make the best choices for their oral health. It’s a great way to encourage in-network utilization while helping them understand the significant cost differences between in- and out-of-network visits.
Clear, accurate communication with your patients about how much a procedure is likely to cost, whether it’s a routine cleaning or a crown, can build trust and loyalty. This is why Dental ClaimSupport is dedicated to educating our customers on the complexities of insurance billing, so that when they are in the front desk, they can accurately and confidently calculate patients’ out-of-pocket costs for each service.
Costs for Out-of-Network Services
As a dental professional, it is your job to educate your patients on how their insurance works. This includes explaining how their deductible and coinsurance work, as well as the importance of choosing in-network dentists. This is important to help ensure your patients are receiving the care they need, not the care that an insurance company thinks they need.
In-network providers negotiate their fees with insurance companies and therefore are able to offer discounted services. In exchange, they agree to be paid a pre-established amount for each service provided. Insurance companies then determine how much of a patient’s out-of-pocket expense they are responsible for, based on whether the visit is in or out-of network.
Outside of a DPPO or DHMO, most dental plans have a deductible that must be met before the insurance begins to pay for anything. Some plans also have an annual maximum benefit, which is the highest dollar limit that the plan will cover in a calendar year.
There are also plans that do not have provider networks, such as fee-for-service or indemnity insurance. These types of plans allow you to see any dentist that you choose, but your out-of-pocket costs may be higher. This is because out-of-network dentists don’t have agreed rates with insurance companies. They may charge what they feel is a fair price for each service they provide, and this could be significantly more than the in-network rate.
Costs for Preventive Care
Regardless of whether their employer provides dental insurance or they purchase a stand-alone plan, most enrollees pay similar costs for basic procedures. Generally, employer-provided and private dental plans cover 100 percent of preventive services like regular exams and cleanings, 80 percent of basic services like fillings, extractions or root canals and 50 percent of extensive work such as crowns or bridges.
The cost of routine care can be significant — even for those with good insurance. A recent industry study found that self-insuring (paying full fees out of pocket, without dental insurance) for a visit for an oral exam, two cleanings and x-rays would cost an average of $162. That’s the equivalent of one month’s premium for a mid-range dental plan.
Most Medicare Advantage plans include some form of dental coverage. Virtually all Medicare Advantage enrollees who have access to dental benefits have access to preventive services, such as oral exams and teeth cleanings. However, most of those who have access to more extensive dental benefits are in plans that limit their annual coverage amounts, averaging about $1,300 in 2021.
Providing members with transparent information about the cost of their care can encourage them to take advantage of the preventative benefits their plans provide, including annual visits and preventive screenings. This will help them avoid costly and painful complications that can result from neglecting their oral health.
Costs for Restorative Care
When it comes to estimating costs, you have to be aware of how the insurance industry classifies dental services. Preventive, basic and major services are the main categories most plans use to determine how much of a procedure the plan covers. Most dental insurance plans take a 100-80-50 approach to coverage, where preventive services are covered at 100%, basic care is covered at 80% and major restorative work is typically covered at 50%.
The cost of a service depends on where it falls within this classification, but there are other factors that impact your out-of-pocket costs. Most plans have a deductible that patients must pay before their benefits kick in. This amount varies by plan. You may also be subject to a waiting period for certain services, such as a crown or denture.
Some types of dental plans set annual maximums on how much they’ll pay for a year, so you could reach your limit and have to pay for any further services. This is especially common with DHMOs, but other types of plans can have them as well.
It’s important to consider these limits when shopping for a plan that will fit your needs. If you expect to need a lot of restorative procedures, you may want to find a plan with higher annual maximums. And, make sure to check out our dental calculators to get a better idea of how much you’ll pay for different procedures.