A dental crown can be a life-changing restoration, protecting a damaged tooth and restoring your ability to chew, speak, and smile with confidence. However, the cost of this procedure can be a major source of anxiety for many, particularly for those without dental insurance. At EIMA Health Insurance, we understand the financial concerns of families and individuals, especially in the areas we serve, including our home state of Texas and our locations in New Jersey, Kentucky, Maryland, and Virginia.
The cost of a dental crown varies widely, with national averages ranging from $800 to $2,500 per tooth without insurance. But what does that truly mean for your wallet, and how does dental insurance change the equation? This article will break down the true cost of a dental crown, highlight the key factors that influence the price, and demonstrate the vital role that insurance plays in making this essential treatment affordable.
Understanding the Factors that Determine the Cost
The price of a dental crown is not a one-size-fits-all number. Several variables contribute to the final cost, and being aware of them is the first step toward smart financial planning.
1. Material of the Crown: This is the most significant factor affecting the price.
- Porcelain or All-Ceramic: These are popular for their natural look, making them ideal for front teeth. They are also a good option for people with metal allergies. Without insurance, these can cost anywhere from $1,000 to $3,000 per tooth.
- Porcelain-Fused-to-Metal (PFM): These crowns offer a blend of strength and aesthetics. They have a metal base for durability and a porcelain exterior for a natural appearance. They are a common choice for both front and back teeth, with costs typically ranging from $800 to $1,500 without insurance.
- Metal Alloys: Often made from gold or a base-metal alloy, these crowns are known for their exceptional durability and are best for back molars. Their cost can vary widely, from $800 to $2,500, depending on the type of alloy used.
- Resin: This is the most affordable option, but also the least durable. Resin crowns are often used as a temporary solution. The cost can be as low as $300 to $800.
2. Geographic Location: The cost of dental care can vary significantly by state and even by city. For instance, the average cost of a crown in a major metropolitan area like Dallas, TX, or Northern Virginia may be higher than in a more rural part of Kentucky.
- New Jersey: Average costs can range from $1,000 to $2,500.
- Kentucky: Average costs are often similar to the national average, ranging from $800 to $2,200.
- Maryland: Costs in urban areas like Bethesda can range from $800 to $2,500.
- Virginia: Costs can be anywhere from $1,000 to $3,500 per tooth.
3. Additional Procedures: The final price of a crown is not just the cost of the cap itself. You may need preliminary procedures that add to the total bill, such as:
- A root canal to treat an infected tooth, which can add $700 to $2,000+ to the overall cost.
- A core buildup, which is a filling placed to support the new crown, adding $200 to $500.
- Temporary crowns and X-rays.
The Cost of a Dental Crown Without Insurance
For an individual without dental insurance, the full financial burden falls on them. Let’s consider a common scenario for a patient in Dallas, TX: a porcelain-fused-to-metal crown.
- Crown Cost: $1,200
- Diagnostic X-rays: $100
- Core Buildup: $300
- Total Out-of-Pocket Cost: $1,600
This estimate doesn’t even include the possibility of a root canal. A lack of insurance can lead to people postponing treatment, which often results in a more complex, painful, and expensive procedure down the line, such as a full extraction and implant, which can cost thousands of dollars.
The Impact of Dental Insurance
Dental insurance fundamentally changes the financial equation. While plans and their coverage vary, most dental insurance policies classify a crown as a “major” procedure. Most plans follow a “100-80-50” coverage model, with major procedures covered at 50% after the deductible is met.
Here’s how that same scenario plays out with a typical dental insurance plan:
- Plan Type: Standard dental insurance with a $50 deductible and a $1,500 annual maximum.
- Crown Cost: $1,200 (The plan has a negotiated rate with the dentist, which is usually lower than the sticker price).
- Diagnostic X-rays: $0 (Most insurance plans cover preventive and diagnostic services at 100%).
- Core Buildup: $150 (Covered at 80% after deductible).
- Total Billed: $1,350
- Deductible: -$50 (You pay this out-of-pocket).
- Insurance Pays (50% of the remaining amount): 50% of ($1,350 – $50) = $650
- You Pay (50% of the remaining amount): 50% of ($1,350 – $50) = $650
- Total Out-of-Pocket Cost: $700 ($50 deductible + $650 coinsurance)
As you can see, dental insurance can cut your out-of-pocket costs by more than half. Even with premiums (which typically range from $20 to $50 a month for an individual), the savings on a single crown can be substantial.
Frequently Asked Questions
What if my plan has a waiting period?
Many dental insurance plans have waiting periods for major procedures like crowns, typically 6 to 12 months. This is why it’s crucial to enroll in a plan before you need major work done. The good news is that preventive services like cleanings and exams are usually covered immediately.
What is the difference between an in-network and out-of-network dentist?
A dentist who is “in-network” has a contract with your insurance company and has agreed to provide services at a negotiated rate. You’ll typically pay less when you see an in-network dentist. An “out-of-network” dentist does not have this agreement, and while your insurance may still cover a portion of the cost, your out-of-pocket expense will be higher.
Can a dental discount plan help with the cost of a crown?
Yes, dental discount plans are a viable alternative. They are not insurance, but a membership-based service where you get a card that provides a 10% to 60% discount at participating dentists. While a discount plan won’t cover a portion of the bill like insurance, the discount on a $1,600 crown could save you several hundred dollars, and there are no deductibles or annual maximums to worry about.
Will my insurance cover a crown for cosmetic reasons?
No. Most dental insurance plans, including those offered through the Affordable Care Act, only cover crowns that are considered “medically necessary.” A crown used to fix a broken tooth or one with extensive decay will likely be covered, but a crown to change the appearance of a healthy tooth will not be.
Let EIMA Health Insurance Be Your Guide
The decision to get a dental crown should be based on your oral health needs, not on your financial situation. As a licensed health insurance agency with our corporate office in Dallas, TX, we are uniquely positioned to serve the diverse needs of residents across Texas, New Jersey, Kentucky, Maryland, and Virginia. We work with all major dental insurance carriers and can help you find a plan that not only fits your budget but also provides the coverage you need, when you need it.
Don’t let the fear of a high bill prevent you from getting the essential dental care you deserve. Contact EIMA Health Insurance today for a complimentary consultation. We will help you understand your options, compare plans, and find the right coverage so you can protect your teeth and your wallet.
Sources:
- American Dental Association: https://www.ada.org/resources/research/dental-statistics/dental-expenditures
- Healthline: https://www.healthline.com/health/how-much-do-dental-crowns-cost
- Consumer Guide to Dentistry: https://www.yourdentistryguide.com/crowns-cost/
- KFF (Kaiser Family Foundation): https://www.kff.org/medicaid/state-indicator/medicaid-adult-dental-benefits/
