Projected Dental Health Care & Insurance Costs for 2023

The average dental patient pays between $300 and $500 annually, if all they need is a checkup and cleaning. But other dental procedures, like deep cleanings, cavity fillings, root canals, crowns, and dental implants cost much more. For example, a root canal and crown can cost $1,500 and up. Dentures typically start at $2,500 per upper or lower plate. In 2022, dental implants cost an average of between $4,800 for a single implant to $8,500 for bridge implants, and $75,000 for full-mouth implants.

The typical cost of dental insurance in NJ ranged between $22 and $83 per month in 2022 for coveraged purchased through the exchange. Stand-alone family dental plans sold between 2020 and 2021 averaged $62.68 per month. While out-of-pocket expenses aren’t capped for adult dental plans, the total amount a plan will cover — based on the specific procedure — is capped. And those benefit caps have remained fairly stagnant (between $1,000 and $2,500) for decades, even though dental care has grown more expensive.

The biggest influence on dental cost trends? Inflation. Increased labor and supply costs affect dental practices. So does the number of operating clinics, which has declined as practices consolidate and, thus, have more leverage to negotiate higher reimbursement rates which, in turn, drive price increases.

Technological Advances

New technology and innovative equipment has revolutionized the dental industry. But with these advancements comes higher fees for healthcare services, too. Teledentistry, which increased in popularity during the global health crisis, brings a long-term solution for rural and urban patients alike.  

Virtual visits have allowed people to address urgent care issues like infection, pain, and swelling — and some offices equipped with specific equipment can even diagnose cavities thanks to newer virtual technology.

Historical data on dental PPO trends is forecasting higher trends moving into 2023. Dental PPO plans dipped to 03.5% in 2020 but rebounded to 4.5% in 2021(far above the projected 2.5% of utilzation). The Segal Health Plan Cost Trend Survey Report projected 3.1% for 2022 and anticipates 4.0% in 2023. According to the 2022 State of America’s Oral health and Wellness Report, almost 70% of parents with a child not covered by dental insurance in 2021 planned to get coverage in 2022. Other trending projections for most dental coverages have returned to similar, pre-pandemic levels.

• Dental schedule of allowance plans: 2.3% (2022) and 3.8% (2023)
• Dental fee-for-service/indemnity plans: 3.4% (2022) and 4.0% (2023)
• Dental provider organization (DPO) plans: 3.1% (2022) and 4.0% (2023)
• Dental maintenance organization (DMO) plans: 3.0% (2022) and 3.5% (2023)

Managing Costs

To manage costs into 2023 and beyond, dental clinic managers must consider all the dynamics driving operational costs. A few strategies to consider include:

• Leveraging competitive bidding to secure improved pricing terms. Experts recommend putting contracts to bid every three to five years.
• Implementing a cost-management negotiation service for out-of-network services by negotiating directly with plan sponsors to prevent balance billing and setting benchmark schedules for out-of-network reimbursement.
• Using value-based arrangements, which are more efficient and effective because they hold dental clinics accountable for quality of care.
• Conducting periodic vendor audits to ensure their value aligns with cost.

The Future of Dental Coverage with Medicare

Dental visits increase with age. A 2021 Urban Institute analysis found people age 60 and older visit the dentist twice as frequently as younger patients. Yet Medicare covers only 27% of enrollees’ dental costs — almost 10% pay over $1,000 in out-of-pocket costs annually.

Earlier this summer, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2023 Physician Fee Schedule rule, which included revenue adjustments, a new equity adjustment, investments to lower-revenue organizations, and more.

CMS proposed expanding dental services from the current coverage, where Medicare pays only for specific treatments like tooth extraction needed after cancer care or post-injury jaw reconstruction. The updated proposals include covering the cost of dental exams and treatment prior to an organ transplant.

In July, over 100 House representatives sent a letter requesting the CMS expand what it considers ‘medically necessary’ dental care under Medicare. Traditional Medicare won’t cover dental (or vision) needs, although people can purchase Medicare Advanage plans to add those benefits.

Other services CMS has been asked to add to Medicare include dental care for people who’ve had strokes or been diagnosed with Parkinson’s, which can lead to worse health outcomes should a patient get a dental infection.

As we’ve seen with inflation’s effect on food, fuel, housing, and more, healthcare hasn’t escaped the rise, either. Without a crystal ball, it’s impossible to forecast with 100% accuracy what effects digital and other technological advances, a tumultuous economy, regulatory changes, clinic consolidation, and demand will have on the cost of dental services next year — or these factors’ influence on insurance plans.

Need help setting up your payment system or negotiating a new contract with your insurers? My team and I can help. Contact us today.