InfoStat | 09-16-14

The Best and Worst Dental Insurers for Out-of-Pocket Costs

 92% of health plans excluded routine dental check-ups for children and 81% excluded adult dental services

In 2013, 92% of health plans excluded routine dental check-ups for children and 81% excluded adult dental services.1 The Affordable Care Act classified dental coverage for children as an essential health benefit, so insurers were required to make dental coverage available to children either as an optional part of their health plans or through a stand-alone dental insurance plan.2 Although dental coverage for adults was not included as an essential health benefit, the majority of dental plans on the federal exchange offered coverage to both adults and children.

HealthPocket examined premiums, deductibles, and other out-of-pocket costs for individual market dental insurance plans on the federal exchange in order to compare costs for different insurers and to see how dental insurance costs varied across the states using the federal exchange. The average monthly premium for adult dental plans in 2014 was $31.81 ($381.72 a year). Monthly premiums ranged between $9.99 and $91.20. Among the states on the federal exchange, Alaska had the highest average monthly premiums ($63.61), while West Virginia had the lowest ($23.70).

Average Costs3 for Federal Exchange Dental Insurance Plans

 
Adult monthly premium$31.81
Deductible$41.55
Coinsurance for routine dental services0.78%
Copayment for routine dental services$0.21
Coinsurance for basic dental services32.46%
Copayment for basic dental services$44.65
Coinsurance for major dental services63.39%
Copayment for major dental services$199.56

Average Costs by State for Federal Exchange Dental Insurance Plans

Click to show table (You may need to scroll sideways to see all columns)

StateAverage adult premiumAverage deductibleAverage routine service copaymentAverage routine service coinsuranceAverage basic service copaymentAverage basic service coinsuranceAverage major service copaymentAverage major service coinsurance
AK$63.61$20.00$0.004.00%none32.00%none58.00%
AL$30.58$35.00$0.000.00%none27.00%none69.00%
AR$32.21$41.21$0.001.03%none24.66%none61.03%
AZ$39.28$51.43$0.000.00%none 27.14%none58.57%
DE$35.84$46.67$0.001.33%none28.83%none71.67%
FL$27.57$37.67$0.000.67%$58.6728.33%$210.6761.67%
GA$34.89$29.62$0.000.77% none 29.23%none66.15%
IA$33.00$33.33$0.003.33%none36.67%none65.00%
IL$33.26$49.29$0.001.43%none34.29%none64.29%
IN$36.25$20.63$0.000.00%none28.75%none63.75%
KS$30.16$50.00$0.000.00%none30.00%none60.00%
LA$29.19$44.62$0.000.00%none30.00%none64.62%
ME$39.01$75.00$11.250.00%$22.5032.50%$22.5055.00%
MI$29.41$31.01 $0.313.47%$9.0038.64%$9.0061.17%
MO$33.24$38.17$0.001.91%none30.71%none61.91%
MS$29.88$49.09$0.000.00%none29.09%none67.27%
MT$38.72$33.75$0.001.25%none26.25%none61.25%
NC$40.36$25.00$0.000.00%none30.00%none60.00%
ND$30.50$69.44$0.000.00%none56.67%none77.22%
NE$28.58$63.89$0.000.00%none56.67%none77.22%
NH$38.79$50.00$11.250.00%$22.5032.50%$22.5055.00%
NJ$35.00$54.00$0.000.00%none26.00%none70.00%
OH$30.95$38.89$1.110.00%none35.56%none62.22%
OK$37.37$36.50 $0.001.00%none27.00%none59.00%
PA$28.35$38.07$0.710.59%$53.2332.26%$278.0070.65%
SC$38.11$30.00$0.003.00%none29.00%none56.00%
SD$39.64$25.00$0.000.00%none31.67%none56.67%
TN$25.56$43.75$0.001.25%none35.00%none61.25%
TX$28.69$40.92$0.351.00%$41.3527.50%$197.1956.50%
UT$34.42$66.25$0.000.00%$43.0024.55%$196.0056.36%
VA$33.86$46.78$0.340.00%none30.61%none61.31%
WI$41.11$34.00$0.000.00%none32.00%none74.00%
WV$23.70$37.50$0.000.00%none20.00%none75.00%
WY$39.65$37.50$0.000.00%none31.67%none56.67%

Average Costs by Insurer for Federal Exchange Dental Insurance Plans

Click to show table (You may need to scroll sideways to see all columns)

InsurerAverage adult premiumAverage deductibleAverage routine service copaymentAverage routine service coinsuranceAverage basic service copaymentAverage basic service coinsuranceAverage major service copaymentAverage major service coinsurance
Alpha Dental Programs, Inc.$21.48$0.00$4.00none$65.00none$310.00none
AlwaysCare Benefits, Inc.$20.29$57.50$0.000.00%none35.00%none50.00%
Anthem Blue Cross and Blue Shield$33.14$1.62$0.000.00%none35.00%none58.22%
Arkansas Blue Cross and Blue Shield$29.29$30.00$0.003.33%none21.67%none66.67%
BEST Life$36.47$29.30$0.000.00%none30.00%none59.98%
Blue Cross Blue Shield Healthcare Plan of Georgia$30.75$0.00$0.000.00%none35.00%none60.00%
Blue Cross Blue Shield of Illinois$28.80$50.00$0.005.00%none25.00%none50.00%
Blue Cross Blue Shield of Louisiana$18.01$62.50$0.000.00%none35.00%none50.00%
Blue Cross Blue Shield of Michigan$14.82$26.16$0.009.54%none46.97%none50.00%
Blue Cross Blue Shield of Montana$36.43$50.00$0.005.00%none25.00%none50.00%
Blue Cross Blue Shield of Oklahoma$34.37$50.00$0.005.00%none25.00%none50.00%
Blue Cross Blue Shield of Texas$28.63$58.33$0.003.33%$0.0016.67%$0.0033.33%
Blue Cross and Blue Shield of Alabama$21.00$40.00$0.000.00%none20.00%none50.00%
Capital BlueCross$24.63$37.50$5.000.00%$10.0060.00%$10.0085.00%
Cigna Healthcare$24.80$50.00$0.000.00%none20.00%none50.00%
Delta Dental Insurance Company$33.43$28.15$0.000.00%$65.0020.00%$310.0075.00%
Delta Dental Plan of Oklahoma$41.14$50.00$0.000.00%none30.00%none50.00%
Delta Dental Plan of South Dakota$42.70$25.00$0.000.00%none35.00%none50.00%
Delta Dental Plan of Wyoming$40.38$62.50$0.000.00%none35.00%none50.00%
Delta Dental of Alaska$32.00$0.00none20.00%none40.00%none50.00%
Delta Dental of Arizona$44.73$50.00$0.000.00%none30.00%none50.00%
Delta Dental of Arkansas$26.60$25.00$0.000.00%none20.00%none50.00%
Delta Dental of Delaware, Inc.$40.67$40.00$0.000.00%none20.00%none75.00%
Delta Dental of Illinois$36.44$50.00$0.000.00%none50.00%none50.00%
Delta Dental of Iowa$25.43$50.00$0.0010.00%none50.00%none75.00%
Delta Dental of Minnesota$30.73$75.00$0.000.00%none64.29%none82.14%
Delta Dental of Missouri$41.36$50.00$0.005.00%none25.00%none55.00%
Delta Dental of Nebraska$25.90$75.00$0.000.00%none64.29%none82.14%
Delta Dental of Tennessee$22.82$50.00$0.005.00%none45.00%none50.00%
Delta Dental of West Virginia$22.83$32.50$0.000.00%none20.00%none75.00%
DentaQuest USA Insurance Company, Inc.$22.23$62.50$0.000.00%none35.00%none45.00%
DentaQuest Virginia, Inc.$37.68$56.25$0.000.00%none27.50%none47.50%
DentaQuest of Florida, Inc.$18.67$62.50$0.000.00%none35.00%none45.00%
Dental Care Plus, Inc.$18.46$75.00$5.000.00%none40.00%none60.00%
Dentegra Insurance Company$39.86$34.89$0.000.00%none20.00%none75.00%
Dominion Dental Services$20.17$60.42$2.402.51%none53.37%none73.03%
EMI Health$19.23$25.00$0.000.00%$43.0020.00%$196.0050.00%
Florida Combined Life$29.04$50.00$0.000.00%$46.0020.00%$12.0050.00%
GOLDEN DENTAL PLANS, INC.$32.50$0.00$9.00none$9.0037.50%$9.0050.00%
Group Hospitalization and Medical Services Inc.$26.00$25.00$0.000.00%none20.00%none50.00%
Humana$18.92$75.00$0.000.00%none50.00%none100.00%
Humana Health Benefit Plan of Louisiana, Inc.$16.00$100.00$0.000.00%none50.00%none100.00%
Humana Insurance Company$18.10$102.71$0.000.00%none48.71%none100.00%
Northeast Delta Dental$38.10$100.00$22.50none$22.5030.00%$22.5050.00%
Premier Access Dental$40.69$100.00$0.000.00%none15.00%none45.00%
Premier Access Insurance Company$28.36$100.00$0.000.00%none20.00%none50.00%
Renaissance Dental$32.40$0.00$0.005.00%none35.00%none50.00%
Solstice Benefits, Inc.$18.43$60.00$0.000.00%none30.00%none50.00%
The Pennsylvania Dental Corporation dba Delta Dental of Pennsylvania$21.83$16.25$2.000.00%$60.0020.00%$320.0075.00%
iDental from United Concordia$26.63$66.67$0.000.00%none30.00%none66.67%

Dental plan enrollees pay their full dental service costs up to the deductible before their dental plan begins to pay any costs. Deductibles were between $0 and $150 for dental plans on the federal exchange. The average deductible for federal exchange dental plans was $41.55, with Alaska having the lowest average deductible ($20) and Maine having the highest ($75).

Insurers with highest average monthly premiums for adult dental insurance plans:

  • Delta Dental of Arizona ($44.73)
  • Delta Dental Plan of South Dakota ($42.70)
  • Delta Dental of Missouri ($41.36)

Insurers with lowest average monthly premiums for adult dental insurance plans:

  • Blue Cross Blue Shield of Michigan ($14.82)
  • Humana Health Benefit Plan of Louisiana, Inc. ($16.00)
  • Blue Cross Blue Shield of Louisiana ($18.01)

Blue Cross Blue Shield of Michigan, the insurer with the cheapest average premium, had an average deductible of $26.16. The insurers with the next two cheapest average premiums had average deductibles of $100 and $62.50 respectively. Five insurers selling adult dental plans on the federal exchange had $0 deductibles for every plan:

  • Blue Cross Blue Shield Healthcare Plan of Georgia
  • Golden Dental Plans, Inc.
  • Renaissance Dental
  • Delta Dental of Alaska
  • Alpha Dental Programs, Inc.

Five other dental insurers had average deductibles of at least $100:

  • Humana Insurance Company ($102.71)
  • Humana Health Benefit Plan of Louisiana, Inc. ($100)
  • Premier Access Insurance Company ($100)
  • Northeast Delta Dental ($100)
  • Premier Access Dental ($100)

The average out-of-pocket costs for routine dental services were especially low since over 90% of adult dental plans incurred no charge for routine dental services. Most insurers offered no charge for routine dental services in all of their plans. Routine dental services typically included oral exams, cleanings, and palliative treatment, but the exact classification of routine services varied from plan to plan. In New York City (zip code 10001), routine dental exams cost $125 each without insurance.4

Insurers with highest average copayments for routine adult dental services:

  • Northeast Delta Dental ($22.50)
  • Golden Dental Plans, Inc. ($9)
  • Dental Care Plus, Inc. ($5)
  • Capital BlueCross ($5)

Insurers with highest average coinsurance for routine adult dental services:

  • Delta Dental of Alaska (20%)
  • Delta Dental of Iowa (10%)
  • Blue Cross Blue Shield of Michigan (9.54%)

Basic dental services, which usually included fillings and simple extractions, had an average copayment of $44.65 and an average coinsurance of 32.46%. Costs for amalgam silver fillings in New York City ranged from $260 for one surface to $495 for four or more surfaces,5 while simple non-surgical tooth extractions cost $450.6

Less than 5% of adult dental plans on the federal exchange had copayments for basic or for major dental services. Some plans had both copayments and coinsurance for basic and major dental services.

Insurers with highest average copayments for basic adult dental services:

  • Alpha Dental Programs, Inc. ($65)
  • Delta Dental Insurance Company ($65)
  • The Pennsylvania Dental Corporation ($60)

Insurers with lowest average copayments for basic adult dental services:

  • Blue Cross Blue Shield of Texas ($0)
  • Golden Dental Plans, Inc. ($9)
  • Capital BlueCross ($10)

It would be misleading not to mention that Golden Dental Plans and Capital BlueCross also charged coinsurance in addition to copayments. Golden Dental Plans had an average coinsurance of 37.5% for basic dental services, while Capital BlueCross had an average coinsurance of 60%. Every plan offered by Blue Cross Blue Shield of Texas had either coinsurance for basic dental services or no charge.

Insurers with highest average coinsurance for basic adult dental services:

  • Delta Dental of Minnesota (64.29%)
  • Delta Dental of Nebraska (64.29%)
  • Capital BlueCross (60%)

Insurers with lowest average coinsurance for basic adult dental services:

  • Premier Access Dental (15%)
  • Blue Cross Blue Shield of Texas (16.67%)
  • Twelve-way tie (20%)

Premier Access Dental’s adult plans had only coinsurance and no copayments for basic dental services. Among the twelve insurers with a 20% coinsurance average for basic dental services, none had plans with both copayments and coinsurance.

Major dental services had an average copayment of $199.56 and an average coinsurance of 63.39% across all federal exchange dental plans for adults. Some typical examples of major dental services include anesthesia, crowns, inlays, onlays, and dentures. In New York City, the cost of a ceramic crown was $2,000 without insurance.7

Insurers with highest average copayments for major adult dental services:

  • The Pennsylvania Dental Corporation ($320)
  • Alpha Dental Programs, Inc. ($310)
  • Delta Dental Insurance Company ($310)

Insurers with lowest average copayments for major adult dental services:

  • Blue Cross Blue Shield of Texas ($0)
  • Golden Dental Plans, Inc. ($9)
  • Capital BlueCross ($10)

While Blue Cross Blue Shield of Texas had either coinsurance or no charge for major dental services in all of their federal exchange dental plans, Golden Dental Plans had both copayments and coinsurance in the same plans. Golden Dental Plans had an average coinsurance of 50% for major dental services. Capital BlueCross did not combine copayments and coinsurance in the same plans, but it offered some plans with copayments and other plans with coinsurance.

Insurers with highest average coinsurance for major adult dental services:

  • Humana (100%)
  • Humana Insurance Company (100%)
  • Humana Health Benefit Plan of Louisiana, Inc. (100%)

Insurers with lowest average coinsurance for major adult dental services:

  • Blue Cross Blue Shield of Texas (33.33%)
  • Premier Access Dental (45%)
  • DentaQuest USA Insurance Company, Inc. (45%)
  • DentaQuest of Florida, Inc. (45%)

None of the adult dental plans sold by the three Humana insurers above provided coverage for major dental services. Blue Cross Blue Shield of Texas sold some dental plans with no charge after deductible for major dental services, as well as plans with 50% coinsurance after deductible. Premier Access Dental and the two DentaQuest insurers above did not charge copayments for major dental services in any plans.

Conclusion

55% of adults in the United States visited dental health professionals less frequently than the recommended twice a year in 2012.8 When choosing a dental insurance plan, it is desirable to pay as little in total as possible for premiums and dental service out-of-pocket costs, assuming that the plan’s provider network and customer service are satisfactory. Consumers who predict that they will only need routine dental exams twice a year should look for a dental plan with low premiums, low deductibles, and low copayments or coinsurance for routine dental services. Otherwise they might spend money unnecessarily by purchasing a dental plan that costs more than their dental services would cost without insurance.

Consumers who anticipate needing more extensive dental services such as crowns or removal of impacted wisdom teeth should choose a dental plan that minimizes the out-of-pocket costs for the particular services that they require, in addition to premiums and deductibles. Moreover enrollees should take into account whether their dental insurance plan has a cap on annual benefits, which is the maximum amount of costs that the insurer will pay, after which the enrollee must pay 100% of incurred costs.

Some dental plans require enrollees to wait for a period of time, such as one or two years, before they will cover certain services. If a dental service requires urgent attention, then a consumer should make sure not to choose a plan with a long waiting period for that particular dental service. In addition, if a consumer wishes to see a particular dental care provider, then they should verify that the provider is in their plan’s network prior to enrolling in a dental plan.

Methodology

Average costs for each dental insurer9 were calculated based on the plan records in the QHP Landscape Individual Market Dental file from data.healthcare.gov. The landscape file is current as of May 12, 2014 and included data from dental plans in federally-facilitated marketplace states.

Only plans that covered dental services for adults were included in the analysis. For average copayments and coinsurance, a plan having no charge for a particular service was treated as having both a $0 copayment and 0% coinsurance for that service, while not covering a particular service was treated as 100% coinsurance for that service. For plans with both copayments and coinsurance for a service, the copayment was included in the copayment average for the service and the coinsurance was included in the coinsurance average for the service. For plans with only copayments (resp. only coinsurance) for a service, just the copayment (resp. coinsurance) was included in the copayment (resp. coinsurance) average for the service.

This analysis assumes that the underlying government data is accurate, and HealthPocket makes no guarantee that the government data is comprehensive. Dollar amounts and percentages are rounded according to standard industry practices.

AUTHORS

This analysis was written by Jesse Geneson, data researcher at HealthPocket. Correspondence regarding this study can be directed to Mr. Geneson at jesse.geneson@healthpocket.com.

Jesse Geneson on Google+

Sources:

1 Kev Coleman, Top 10 Medical Services Excluded by Health Insurance. July 31, 2013. HealthPocket. http://www.healthpocket.com/healthcare-research/infostat/top-10-medical-services-excluded-by-health-insurance
2 Dental Coverage in the Marketplace. https://www.healthcare.gov/can-i-get-dental-coverage-in-the-marketplace/
3 In the coinsurance and copayment averages, plans that do not cover a service are considered to have 100% coinsurance for that service, and plans with no charge for a service are considered to have 0% coinsurance and $0 copayment for that service.
4 Routine dental exam cost data from fairhealthconsumer.org.
5 Fair Health Consumer.
6 Ibid.
7 Ibid.
8 Crude percent distribution of length of time since last visit with dentist or other dental health professional among adults aged 18 and over, by selected characteristics: United States, 2012. Table XXI. Page 158. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012. February 2014. HHS. http://www.cdc.gov/nchs/data/series/sr_10/sr10_260.pdf
9 The names of the insurers compared in the analysis are from the issuer names in the QHP landscape individual market dental file.

 

 

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