Cost of dental care can add up fast -- and insurance may not cover it

Dental plans commonly come with low annual maximum coverage amounts of $1,000 to $1,500 a year

Taking care of your teeth doesn't come cheap.

Just ask Holly Kabrin. She expects to spend at least $1,000 to have her daughter's wisdom teeth removed. And she's still making payments on a $600 bill from a dental crown she got last year.

"My family has a lot of dental needs," says Kabrin, 46, a self-employed resident of Granada Hills. Kabrin says she values her dental insurance plan, but it probably won't come close to covering all of her family's costs this year.

"It only covers up to $1,250 per person per year," she says of her policy.

But that's typical, experts say.

Dental plans commonly come with annual maximum coverage amounts of $1,000 to $1,500 a year.

These policies are designed to encourage preventive treatment. Therefore, most policies cover 100% of such services, including cleanings, X-rays and checkups, and pay 80% for restorative treatments such as fillings and periodontal cleanings.

More advanced — and expensive — work such as implants, dentures and crowns are commonly reimbursed at just 50%.

Although individual dental plans generally don't cover orthodontics, most work-based policies offer a $1,500 lifetime maximum payout to defray the cost of braces.

The Affordable Care Act requires plans to provide dental insurance for children up to age 19 and, in California, to provide free preventive and diagnostic services. Children's braces are covered only in severe cases that meet certain criteria.

According to the National Assn. of Dental Plans, 61% of Americans have dental insurance, and more than 9 in 10 people with private dental insurance get coverage at work.

Evelyn Ireland, executive director of the group, says most plans come with such low annual payouts because policies with higher annual maximums cost more for employers.

Also, she says: "We track the percentage of consumers that hit the annual maximum. It's usually somewhere between 2% and 5%."

"A lot of people get distressed over the annual maximum without realizing the odds are in their favor. Dental care doesn't cost as much as medical care," says Jeff Album, vice president of public and government affairs with Delta Dental of California, which sells dental benefits.

But when you need major dental work, costs can be high and insurance may not cover much of it.

Paula Assad, 52, of South Park, Penn., underwent radiation in 2009 to treat oral cancer, which caused a cascade of dental problems.

Last year alone required her to get five crowns costing her about $800 apiece — only a fraction of which her dental plan covered. Cavities and other dental problems will be a lifelong struggle, she says. "I'm in debt up to my eyeballs on it."

Costs are also prohibitive for the 125 million people with no coverage, including more than 43 million over age 65 because Medicare doesn't cover dental benefits.

Research shows that people without dental benefits are less likely to get preventive dental care and more likely to need expensive extractions, dentures and emergency room treatment.

For some like Assad, there are no simple solutions. Experts offer several ideas for cutting costs.

Get your dentist's advice. Dentists see many of the plans sold in your area, and they can help you sort out your options. "They may be able to offer recommendations based on their experience and the projected needs of the patient," says Matt Messina, an American Dental Assn. spokesman and a practicing dentist in Cleveland.

Your dentist can also be a good resource when it comes to understanding how best to use your benefits.

Consider an HMO. Dental HMO plans are less expensive than most other plans, and they impose no annual maximum on coverage. So for people who anticipate needing a lot of dental work, these plans may be financially worthwhile. The tradeoff is less choice.

"You have to go to your assigned dentist and there are generally only a couple of dentists within 15 miles of where you live or work — it's a narrow network," says John Yamamoto, a vice president with Delta Dental.

Search for discounts. Discount dental plans can reduce common charges with participating providers 10% to 60%.

Just be aware these are not insurance plans. "They are not regulated by the Department of Insurance because it's not an insurance product, so you don't have the same rights to appeal" or quality oversight, says Album of Delta Dental.

Seek and compare prices. Unlike with medical care, dentists are accustomed to providing a clear estimate of what your dental care will cost. Also, insurers often have website tools that provide cost estimates.

In addition, www.fairhealthconsumer.org offers a cost calculator tool for medical and dental services that enables you to search for the average cost of the procedure you need by entering your ZIP Code.

Using the site is a "good way to get a handle on whether your dentist's charges are average," Ireland says. If they're high, use the prices you find to negotiate lower costs.

Go to school. Schools of dentistry in Southern California and throughout the nation provide treatment, often at about 50% of the cost of dentists practicing in the surrounding area. The dental work is done by students under the supervision of veteran instructors.

Assad, the Pennsylvania woman who was treated for oral cancer, says she has found a dentist who works with her to help manage the costs that she says have stretched her budget to the breaking point.

"This dentist works with me," she says. "Thank God I found him."

healthcare@latimes.com

Twitter: @lisazamosky

Zamosky is the author of "Healthcare, Insurance, and You: The Savvy Consumer's Guide."

Copyright © 2016, Los Angeles Times
50°