New York Dental Insurance

Types of Dental Coverage

Before reviewing our findings on New York dental plans, it's important to clarify a few terms that we will use:

• PPO Dental Plan - A dental preferred provider organization is a dental insurance plan where an enrollee can use a dentist within the plan's network and benefit from lower out-of-pocket costs or use an out-of-network dentist and pay more for care
• HMO Dental Plan - A dental health maintenance organization normally has a narrow network of dentists and services received from out-of-network dentists won't be paid for by the dental plan. Specialized dental care also requires a referral unlike PPO plans where no referral is necessary
• Indemnity Plan - Indemnity dental plans typically reimburse an enrollee for only a share of the total cost of a covered dental service. Indemnity plans often do not restrict an enrollee to a network of dentists, thus providing more options for receiving dental care
• Dental Discount Program - A dental discount program is not insurance. Instead, it is a program where membership is accessed through a monthly fee and the enrollee can receive discounted dental care from dentists belonging to the discount program

Premiums & Deductibles: Dental Insurance Doesn't Have to Be Expensive

Contrary to popular belief, quality dental coverage in the Empire State does not have to have a high price tag. Premiums (i.e. the monthly fee for dental coverage) in our study started as low as $5.10 (the MetLife TakeAlong Dental HMO-Managed Care 350 (Low)"). The average premium across 37 NY plans was $40.11 for a 33 year-old applicant. 18 of the 37 NY plans examined were below the premium average for the state. Three of these plans were HMOs, one a dental discount program, and the remaining 33 were PPO dental plans. The HMOs and discount program were among the most affordable plans but also had the most restrictive networks of dentists.

Since dental benefits are not standardized, it is extremely important to consider premium cost in light of what dental services are covered. For example, none of the three HMO plans reviewed covered dental implant treatments. These same plans offered orthodontic care, which is a dental benefit absent in many of the PPO dental plans. We also observed that none of the PPO plans whose premiums were below $22 a month covered major dental care such as root canals or crowns. Given these variations in coverage, it is essential for New Yorkers to review the Summary of Benefits (or Plan Details) for the options they are considering for purchase.

89.2 percent of the New York dental plans examined paid for regular teeth cleanings without any out-of-pocket costs for the enrollee. Filling expenses were covered at an average of 63.9 percent of total cost by PPO plans. The lowest coverage in the first year of PPO enrollment was 20 percent of filling cost and the best coverage was 80 percent. HMOs charged flat-fee copayments instead of coverage a percentage of costs, with the average cost being nearly $29 for a traditional filling. The HMO copayments ranged from $25 to $36. The charge for a filling under the dental discount program started at $80.

The ceiling on a plan's reimbursements for enrollee dental care is known as the plan's "maximum annual benefit." If a plan has a maximum annual benefit of $2,000, then any dental expenses beyond $2,000 in a single plan year would be the financial obligation of the enrollee, not the insurance company. The three HMO plans included in this study did not have a maximum annual benefit limitation, nor did the discount program have a limit on annual consumer savings. PPO plans, on the other hand, did have maximum benefits and they made up the majority of NY plan options within this study. The lowest of the maximum benefits was $500 per year. It is important to note that a single crown or dental implant has the potential to cost far in excess of this amount. Some plans had a maximum benefit that increased over time. For example, the Renaissance MAX Choice Plus had a maximum benefit of $1,000 in the first year of enrollment, $2,000 in the second, and $3,000 in the third and subsequent years of continuous enrollment. The average maximum benefit for plans having this spending cap was $1,703 (in the first year of coverage). The two plans with the highest maximum benefits both had a $5,000 cap on annual spending: The Humana Extend 5000 and the NCD Nationwide 5000 plan.

Deductibles did not vary among plans to the same degree as maximum benefits. Deductibles are the amount spent out-of-pocket by a dental plan enrollee before the plan begins sharing the cost of dental services. Some plans had no deductibles. This was the case for the three DHMOs included in the study as well as the dental discount program. For the plans charging deductibles, the highest amount for an individual was $100 annually. Family deductibles were higher and were often based on the number of family members covered by a policy (e.g. $50 per family member annually).The average deductible for a single enrollee among plans with deductibles was $51.35.

Major Services

Major dental services include care such as crowns and root canals. This can be very expensive care. For dental coverage of crowns where a flat fee was charged in 2023, a dental discount program within the study had the highest copayment ($701 for members of Careington's 500 Series Dental Savings Discount Card). HMO plans' crown copayment charges ranged from $245 to $430. 14 percent of the NY coverage options reviewed did not include crowns among their dental benefits. Most PPO dental plans contributed a percentage of the crown cost with the average being 49 percent of the total cost, the remaining 51 percent of the cost paid by the plan enrollee.

Root canal procedures had similar cost-sharing trends as found among crowns. Some plans didn't cover the care, others had flat fees between $110 and $399, and the rest had coinsurance payments. With respect to this coinsurance, the plans paid an average of 49 percent of the cost of the root canal.

How to Shop with Confidence

Armed with your knowledge from this article, it’s time to compare rate quotes for New York dental insurance. The following link will get dental insurance quotes in a matter of seconds. If you are interested in what your fellow New Yorkers are purchasing, below is a list of the bestselling New York dental plans on DentalInsurance.com.

Chart of NY Dental Plan Details for this Study

Frequently Asked Questions

Do I have to Buy Dental Insurance on the state’s health insurance exchange?

No. There are many dental plans offered off-exchange in the state of New York. This website allows you to compare premiums and benefits without obligation and, if you wish to purchase coverage, you can complete an enrollment form online in a matter of minutes.

Dental insurance purchased by consumers is sometimes called private dental insurance (because it is bought by a private person and not a company for its employees). Dental insurance can cover a single individual, or it can cover multiple related individuals in the form of family coverage.

Can I purchase a “kids only” dental plan?

This depends on the insurance company. Some companies do allow an adult to buy dental insurance for a child without insuring him- or herself. These policies are referred to as “kids only” or “child only.” Sometimes this type of insurance is sought by a non-custodial parent after a divorce.

Are dental plans compliant with the Affordable Care Act?

The Affordable Care Act is a law largely concerned with the regulation primary medical insurance. The law does, however, touch upon dental coverage. The ten Essential Health Benefits standardizing medical insurance coverage has requirements pertaining to dental coverage for children under the age of 18. This pediatric dental coverage can be part of the medical plan or supplemented through a stand-alone dental plan. Adult dental coverage, in contrast to pediatric, is not required of ACA-complaint medical plans.

From which insurance companies can I choose a dental insurance plan?

The following is the list of insurers offering dental plan options on our dental insurance exchange: Ameritas Life of New York, Careington, Empire BlueCross, Empire BlueCross BlueShield, Guardian Direct, Humana, MetLife, Nationwide, and Renaissance Dental.

What type of dental insurance plans are offered within this online dental insurance marketplace?

As of writing, 89.2 percent of the New York plans offered on this exchange are Preferred Provider Organization (PPO) dental plans. 8.1 percent are Health Maintenance Organizations (HMO). Dental discount programs represent 2.7 percent of the options.

Do I have to wait for an enrollment period to apply for dental insurance coverage?

No. Private dental insurance can be purchased at any time of the year. Usually it takes a few weeks before the paperwork is process and the coverage begins. During the application process, the system will display the date on which the insurance becomes effective for use.

Does Medicaid and NY Child Health Plus provide dental coverage in New York?

Medicaid is a government insurance program jointly run and funded between the federal government and the state of New York. This program serves a variety of demographic groups in the state including pregnant women, children, the disabled, and low-income adults. New York Child Health Plus is the name for the state’s Children’s Health Insurance Program (CHIP) serving the medical needs of disadvantaged children.

Both Medicaid and the New York Child Health Plus program provide dental benefits. Dental coverage in Medicaid is extensive and may be accessed in a fee-for-service model or through a managed care plan like an HMO. The dental coverage from Child Health Plus includes preventive care such as oral exams, fluoride, and x-rays. Beyond that, traditional procedures such as fillings, extractions, and root canals.