How Much Should a Crown Cost with Insurance?

Pinpointing the exact cost of a dental crown with insurance isn’t a one-size-fits-all answer. On average, you can expect to pay between $350 to $1,000 out-of-pocket for a crown with dental insurance, after your deductible is met and the insurance pays its portion. However, this range can fluctuate significantly based on several factors.

Understanding the Variables: Unpacking the Price of a Crown

Several key elements influence the final cost you’ll shoulder for a crown, even with dental insurance. Let’s dissect these elements to give you a clearer picture.

1. The Type of Crown: Material Matters

The material your crown is made from is a major cost driver. Here’s a quick breakdown:

• Porcelain-Fused-to-Metal (PFM): These are a common and relatively affordable option, typically costing less than all-ceramic crowns. They offer a balance of strength and aesthetics but can sometimes show a dark line at the gumline over time. Insurance typically covers PFM crowns without issues.
• All-Ceramic Crowns (Porcelain or Zirconia): These are highly aesthetic and blend seamlessly with your natural teeth, making them a popular choice for front teeth. Zirconia crowns are particularly strong. However, these usually have a higher price tag than PFM crowns. Insurance coverage is often good, but some plans may limit coverage for all-ceramic crowns on back teeth if a PFM is considered a viable alternative.
• Gold Crowns: Extremely durable and biocompatible, gold crowns are often used for molars where strength is paramount. While they’re less aesthetically pleasing, their longevity can make them a worthwhile investment. Insurance coverage varies; some plans may cover the cost of a PFM crown and require you to pay the difference for gold.
• Base Metal Alloys: These are the least expensive crown option, often made of non-precious metals. They are strong and resistant to corrosion but are not as aesthetically pleasing as other options. Insurance generally covers base metal alloy crowns.
• Temporary Crowns: These are usually made of acrylic or stainless steel and are placed while your permanent crown is being fabricated. The cost of the temporary crown is typically included in the overall crown fee.

2. Your Dental Insurance Plan: Decoding Your Coverage

Navigating dental insurance can feel like deciphering a secret code. Here’s what to look for:

• Deductible: This is the amount you must pay out-of-pocket before your insurance kicks in.
• Coverage Percentage: Most dental insurance plans cover a percentage of the cost of restorative procedures like crowns. This coverage often falls between 50% and 80%, depending on the plan.
• Annual Maximum: Your insurance plan has a maximum amount it will pay out in a year. Once you reach this limit, you’re responsible for all remaining costs. Check if you are close to reaching your annual maximum to avoid unexpected expenses.
• In-Network vs. Out-of-Network: Dentists who are in-network with your insurance company have agreed to accept negotiated fees, which can lower your out-of-pocket costs. Out-of-network dentists may charge higher fees, and you’ll likely pay a larger percentage.
• Waiting Periods: Some dental insurance plans have waiting periods before covering major procedures like crowns. This can range from a few months to a year.

3. Geographic Location: Where You Live Matters

The cost of dental care varies significantly depending on where you live. Urban areas and regions with a higher cost of living typically have higher dental fees.

4. Dentist’s Experience and Expertise: Skill Comes at a Price

A highly experienced dentist or a specialist (like a prosthodontist) may charge more for a crown than a general dentist with less experience. However, their expertise can translate to a better-fitting, longer-lasting crown.

5. Additional Procedures: The Ripple Effect

Sometimes, you may need additional procedures before getting a crown, such as a root canal or core buildup. These procedures will add to the overall cost. For instance, if the tooth is heavily damaged or decayed, a core buildup might be necessary to provide adequate support for the crown. If the nerve is infected or damaged, a root canal might be required before the crown can be placed.

FAQs: Your Crown Questions Answered

Here are some frequently asked questions about the cost of dental crowns with insurance:

1. Will my insurance cover the cost of a temporary crown?

Generally, yes. The cost of a temporary crown is usually included as part of the overall fee for the permanent crown.

2. What if my insurance denies coverage for a specific type of crown?

Discuss alternative crown materials with your dentist and contact your insurance company to understand the reason for the denial. Sometimes, submitting additional documentation or appealing the decision can lead to coverage.

3. Can I get a pre-treatment estimate from my insurance company?

Absolutely. It’s highly recommended to get a pre-treatment estimate before proceeding with the crown. This will give you a clear understanding of how much your insurance will cover and what your out-of-pocket expenses will be.

4. Are there financing options available for dental crowns?

Yes, many dental offices offer financing options or payment plans to help make the cost of a crown more manageable. Additionally, you can explore options like CareCredit, which provides financing for healthcare expenses.

5. Can I use a health savings account (HSA) or flexible spending account (FSA) to pay for a crown?

Yes, you can typically use funds from your HSA or FSA to pay for dental crowns and other eligible dental expenses.

6. Is it possible to negotiate the price of a crown with my dentist?

It never hurts to ask. Some dentists may be willing to offer a discount or work with you on a payment plan.

7. What happens if I need a root canal before getting a crown?

A root canal will add to the overall cost of the procedure. Check your insurance coverage for root canals to understand your out-of-pocket expenses. Root canals are typically considered major dental work by insurance companies.

8. How long do dental crowns typically last?

With proper care, dental crowns can last 10-15 years or even longer. Factors like oral hygiene, diet, and bruxism (teeth grinding) can affect their longevity.

9. What are the signs that I might need a dental crown?

Common signs include a cracked or broken tooth, severe decay, a large filling that needs replacement, or after a root canal.

10. Are there any alternatives to getting a dental crown?

Depending on the extent of the damage, alternatives might include fillings, inlays, onlays, or dental bonding. Discuss these options with your dentist to determine the best course of treatment for your specific situation.

11. How does insurance handle crowns needed for cosmetic reasons?

Insurance coverage for crowns is typically focused on restorative needs (e.g., repairing damaged teeth). If a crown is primarily for cosmetic reasons, insurance may not cover it.

12. Should I get a second opinion before getting a crown?

If you are unsure about the need for a crown, getting a second opinion from another dentist is always a good idea. This can help you make an informed decision and ensure you’re receiving the appropriate treatment.

The Bottom Line: Plan Ahead and Stay Informed

While the cost of a crown with insurance can vary, understanding the factors that influence pricing and your insurance coverage will empower you to make informed decisions about your dental health. Always communicate openly with your dentist and insurance provider to avoid surprises and ensure you receive the best possible care at a price you can afford.