Going to the dentist can be wellscary. Americans have a lot of reasons for not going to thedentist. They include fear of actually going, inconvenience,and trouble finding a dentist who's covered by insurance. Butthe top reason by far is cost nearly 60% of Americans saidcost was the main reason they haven't visited a dentist withinthe past 12 months. That's the case regardless of their age,income level or the type of insurance they have. That'sbecause dental insurance is well, wonky. It functionsdifferently than medical.
Insurance, and that can beconfusing for patients. Dental insurance is a mixed bag.It's a misnomer, it's called dental insurance because inreality, it's really not insurance. It's reimbursement. It is frustrating for a consumerwhen they visit several different offices and they findout that the fees are varying widely. People may question whethergetting dental insurance or even going to the dentist at all isworth it.
The public may look at dentistryas elective and that's where the problem therein in lies. That mindset can actually drivecosts up in the long run, there were roughly 2.2 millionemergency room visits in 2016 for dental conditions. Accordingto the American Dental Association, the American DentalAssociation estimates that diverting these emergency roomvisits could save $1.7 billion per year. Preventive care is the key tooral health care, and also a key.
To systemic health care. The system isn't easy tonavigate with or without insurance, but there are wayspatients can save at the dentist. Access is frequently available,but people are unaware of how to access the access. Let's break down what itactually costs to go to the dentist, whether dentalinsurance is worth investing in and what patients andpolicymakers can do about it.
Dentistry and medicine havealways been considered separate fields in terms of the educationsystem, medical records and benefits. This separation canalso cause some blind spots and treatment. My name is Dr. Marie Jackson.I'm a general dentist based out of Montclair, New Jersey, andI'm the owner of Stellar Smile Center. A lot of companies cutdental benefits, because the mindset is that it is anelective care type of issue. So when these issues come about,people have let it go because.
They didn't think of it asessential to their well being. There's a lot of emergingevidence that what happens in the mouth can impact a lot ofchronic disease management. Your mouth's part of your body.That's the bottom line. Dental insurance is a nearly $85billion industry in the US. Historically, there have beenseparate companies for dental and health insurance but theindustry landscape is shifting more health insurance carriersare now offering dental benefit options according to a 2020survey conducted by the firm.
West Monroe Partners. Years ago when I went intopractice, the big players were Delta and Horizon. Now the bigplayers are the commercial carriers because they've beenable to do the formulation to figure out what they need tocharge and premium provide a quality service but at the sametime assure high profitability. According to West Monroe's data,dental insurers are making plans to stay competitive with most ofthose surveyed planning to either partner or bundlebenefits with a health insurer.
By 2025. Much of the dentalinsurance industry is run at the state level, with some statesbeing more competitive than others. Now the big publiclytraded health care companies such as MetLife, Aetna and Cignaare offering consumers the option to supplement theirhealth insurance with separate dental plans. Dental insurance is extremelyprofitable to the insurance companies, which is why many ofthe major carriers offer dental insurance.
Putting the medical componentaside when it comes to business, dentistry and medicine arebetter off separate. Think about when you go to thedentist and how that office is set up versus the office whenyou go to a physician. When you walk into a dental office, yousit in that operatory that treatment room costs over$100,000 to set up and you have to have more than one treatment.Well, what we provide requires more specific equipment andsupplies, and also hence the cost. A dental office isoperates at a 65% overhead where.
A medical office will beconsiderably lower than that. These challenges make it veryunlikely that dental insurance will combine with medicalinsurance because it could cause problems for dental offices. The billing systems are totallydifferent. And so providers would have to switch over to amedical model that's very daunting to many offices,especially small offices. Dental benefit plans cansometimes be unclear about pricing, causing problems forboth patients and dental.
Offices. It's a lose lose all around whenwe don't have that transparency that we can show to the patient.It's gonna be this much. And that's really that's the bottomline. We always say it, we think it's going to be this much andthen we just cross our fingers and hope that it's going to betrue. I think it's also important forthe dental provider to be very transparent and let a patientknow costs upfront before the work is done. So if there areany questions, you should be.
Able to get an answer from yourprovider. You don't want to be hit with a surprise In the area where Dr. Jacksonworks in New Jersey a dental exam for a new or returningpatient is estimated to be around $130 without in Insuranceaccording to fairhealthconsumer.org. Dr.Jackson charges a little over $100 for an exam for newpatients, that's the out of pocket price. But if a patientgoes through insurance fair health estimates the dentaloffice would receive around $80.
From the insurance company forthat visit. When insurance carrier takes 35or 40% off of your usual fee, it then becomes very difficult tomeet your bottom line in your practice. Here are the estimated costs forsome other common dental services. X rays, which arecrucial for diagnosis can cost around $185 for a patientwithout insurance in Montclair, New Jersey. A filling for justone surface can run $250, but if three surfaces on the tooth needto be filled, it can go up to.
$385. A root canal for a fronttooth can cost around $1,100. And a crown for a back tooth canrange from 15 to $1,600. Depending on what sort ofmaterial is used. It may seem counterintuitive, but dentistssay the best way to avoid high prices is by going to thedentist more. I think the solution to patientsnot having huge out of pocket dental costs is to stay with theprevention side of it. So if we can reach consumers, whenthey're younger college age 20s they can, we can get the wordout that you need to take care.
Of your teeth so that they don'tnecessarily break down on you down the road. Getting any type of insurance isabout risk you're paying upfront in the event that you're goingto end up paying something more in the future. So the questionis whether a person feels like that risk is warranted when itcomes to dental insurance. Most dental benefit plans have annualmaximums or the amount of dental care the plan will cover for thewhole year. I think back to when I startedpractice 38 years ago, the.
Average dental plan covered 1000to $1,500 for a patient and back then that provided the patientwith a decent amount of dentistry and it reallyincreased access to care for many patients. So they reallylook forward to having that dental insurance. Well now ifyou fast forward 38 years that insurance maximum is still thesame. It's still $1,000 or $1,500, which has not changedwhile the premiums have gone up. A typical plan works like this,patients pay into the plan in several ways. There are monthlypremiums which are typically 25.
To $30. According to the datafrom the National Association of Dental Plans or the NADP. Therecan also be deductibles, which is the amount of money a patienthas to pay out of pocket before their plan starts to cover anycare those typically run from 50 to $99. So $360 in premiums peryear if you're paying at the high end of the typical rate,another $100. Again, worst case scenario totals $460. Most planscover preventative care, such as one or two cleanings a year andone set of x rays with no out of pocket cost to the patient. Butthe plans vary in coverage when.
It comes to major services likecrowns or surgery. If a person decided not to get insurance,had no other issues with their teeth and just focused onpreventative care, such as getting two cleanings a year andone set of x rays, it would cost them around $485 out of pocketcompared to the $460 a year a hypothetical dental plan maycost they would essentially break even if they did getinsurance. According to the NADP 95% of Americans do not hit theannual benefit maximum. It all depends on the patientand what their needs are. So if.
Someone's getting a lot of workdone, it is a benefit to them. It does give them a break. Itworks rather much like a coupon rather than insurance. According to a study that wasput out by the National Association of Dental Plans, 68%of people that don't have dental benefits, they'll actually goand get dental care but it's a whopping 88% that have dentalbenefits are actually going to use those benefits. When it comes to preventivemeasures, dental insurance is.
Definitely worth it so you canhave some type of method of getting you in so that you'reencouraged to make sure your dental health is in check. Patients have this perceptionthat they need dental insurance to go to the dentist. For manyindividuals having access to dental insurance, it does assistthem, does it assist them at the level that it should? It doesnot. When you're talking about the maximums that these policieshave it does not assist individuals that truly need it.
It's not just patients whoquestion whether insurance is worth it, dental offices cansometimes struggle to make ends meet if they decide to acceptinsurance. So when we take on insuranceplans, we're taking a break on fees. So for a small office thathas majority insurance patients, if you're in network, you areliterally taking a cut of hundreds of 1000s of dollarswithin a year. I've seen figures went up as much as $600,000 ofinsurance breaks that colleagues of mine have taken in onecalendar year you'll find a lot.
Of offices will take insuranceplans because if they're a smaller office or new to an areato bring patients in patients will often look for an innetwork provider on their benefit website. So they'll login see who's a provider in the area and it'll draw them to theoffice. Dental offices have found waysto help patients who choose to opt out of insurance. Typically a membership plan willbe a fixed cost per year and you'll get a certain percentageoff of the practice's fees. So.
For example, you could end uppaying $450 for the year, and then you would get 10 to 15% offof the practice's fees. There's no limitations. There's nodeductibles, it's just a straight buy into the practice.They're huge in the dental marketplace now, because thereis such consumer demand for an insurance alternative. There's this misnomer that youneed dental insurance to go to the dentist. You really don't,dental insurance is not the panacea that most people thinkit is.
There are ways people can accesslower cost care without policy changes. Another option for lowcost care is to tap into dental education programs. If a patient is able to travelto a dental school, most of the time, you'll see dental schoolsaccept Medicaid. And if a person doesn't have Medicaid orMedicare plan, they are able to usually pay out of pocket at amuch lower rate than you would at a private office. There's also the option of goingto a community health center.
Which could provide patientswith affordable care. These are federally qualified healthcenters spread across the country that mainly providemedical services but some of them also offer dental care. There is access to dentalservices through that community health center. Primary careassociations are agencies that oversee the function and theefficiencies of health centers and they help with the verysmooth running of health centers who are needed in a particulararea, they help with needs.
Assessment and patient access tocare. Policy changes can also be usedto help those who struggle to pay dentist frequently say thatMedicaid, the government funded health insurance program for lowincome Americans, needs to be overhauled in order to helppatients. Medicaid is a wonderful conceptand many offices are able to work with it. However, there's alot of changes in the Medicaid programs. In some years, you'llhave adult Medicaid benefits approved and they're given out.And then when administration's.
Change or midterms come along,sometimes those adult benefits are yanked out or the childbenefits are pared down. So it's a very fluid program in moststates. And so dentists struggle with that and they struggle withkeeping on top of it. We know that children do betterwith their dental appointments and their preventive visits whenparents have coverage. And the American Dental Association'scollaborated with other agencies to advocate for predictableadult dental benefits and an opportunity to change some ofthe administrative burdens so.
That it is easier for dentiststo participate in a program that they know is here today and willbe here tomorrow. And not here today and gone tomorrow. Another issue with Medicaid thatI hear very often from dentists is that the reimbursement isjust too low. It's not enough for them to even recoup theiroverhead. There's a huge risk to the livelihood of your practice.If you make that a huge chunk of your practice. If I were to take Medicaid, Iwouldn't be able to call, cover.
My costs of operations and Iwouldn't be able to stay open. Ultimately, the best way to saveat the dentist is by putting in the long term investment andcare into your teeth. I'll see patients who may notcome in for years at a time because nothing hurt but theproblem is when a patient does come in, we hope to catch thingswell before something is painful or before something is broken.Preventive care is essential in keeping costs more reasonable inthe dentist.