A $284 premium, a $1,399 crown, and the $4.20 that separates two dental plans
Federal open enrollment runs Nov. 9 to Dec. 14, and the choice comes down to arithmetic: this issue prices the 2027 dental break-even on Delta Dental and MetLife, shows where a $4.20 premium gap buys $500 of annual maximum, and works through the pre-tax and cash-pay routes for whatever is left.
Open enrollment for the 2027 plan year opens Nov. 9 and closes Dec. 14, and federal dental and vision coverage renews automatically for anyone who changes nothing 1. Employer elections at most US companies land in the same weeks. Whatever gets picked, the number holds for a full year.
Underneath sits one question: at what size of dental bill does a premium cost less than paying cash? This issue prices that question on the two largest plans in the federal dental program, Delta Dental and MetLife, whose 2027 rates are published 2.
One caveat shapes every plan figure below. The shares, maximums and frequency rules come from the current design, because the 2027 benefit brochures are still unpublished 3. The premiums come from the 2027 rate charts.
The week added one item for anyone paying with a tax-advantaged account. On Oct. 7 the Consumer Healthcare Products Association released survey findings that 83% of health savings and flexible spending account holders would spend those funds on everyday oral care products if federal law allowed it 4. Toothpaste, toothbrushes, floss and mouthwash sit outside today's eligible expenses, and H.R. 1219 would bring them inside 4. Dental and vision treatment is already eligible.
What the two largest plans pay
Both carriers sell a nationwide preferred provider organization, a network of dentists that accepts a negotiated fee. Members pay less inside that network than outside it. Each carrier offers the network at two levels: a High option with a larger premium and a smaller share of the bill, and a Standard option that trades a lower premium for a larger share.
Three terms carry the whole comparison. The deductible is what the member pays before the plan pays anything. The annual maximum is the most the plan will pay in one year, which is a ceiling on the plan rather than on the member. The plan allowance is the most the plan will recognize for a given procedure, and every share below is a percentage of that figure rather than of the dentist's charge.
Both plans sort covered work into the same three classes. Class A covers exams, cleanings and X-rays. Class B covers fillings and periodontal maintenance. Class C covers crowns, bridges and root canals.
| Option, 2027, one person, rating region 1 | Monthly premium | Your share in network: Class A / Class B / Class C | In-network annual maximum |
|---|---|---|---|
| Delta Dental High | $39.67 2 | 0% / 30% / 50% 5 | Unlimited 5 |
| Delta Dental Standard | $23.68 2 | 0% / 45% / 65% 5 | $1,500 5 |
| MetLife High | $40.76 2 | 0% / 30% / 50% 6 | Unlimited 6 |
| MetLife Standard | $24.03 2 | 0% / 45% / 65% 6 | $2,000 6 |
The share column is identical down all four rows, and that is real. Both carriers charge the member 30% of the allowance for Class B work under a High option and 45% under Standard. Both charge 50% or 65% for Class C work 56. Both set the in-network deductible at $0.
Out of network, the two diverge hardly at all. Both leave the member 40% or 60% of the plan allowance on Class B work and 60% or 80% on Class C work 56. The member also owes every dollar the practice bills above that allowance, which is the part that turns a percentage into a surprise. Out-of-network deductibles run $50 on both High options and $75 or $100 on the Standard ones.
Two fields do separate the pair. The Standard annual maximum is $1,500 at Delta Dental and $2,000 at MetLife. Adult cleanings are counted as two per calendar year at Delta Dental and two in any 12 months at MetLife 56. Under both, the maximum counts in-network and out-of-network spending together.
Three years, priced out
The table prices a year three ways: paying cash, carrying the Standard option, and carrying the High option. The treatment prices are national retail averages from a consumer financing company's published cost list, used in place of a plan allowance that neither carrier publishes 7. The premiums are the 2027 region 1 rates, multiplied by twelve.
| A year of dental care | Cash | Delta Dental Standard | Delta Dental High | MetLife Standard |
|---|---|---|---|---|
| Annual premium | No premium | $284.16 | $476.04 | $288.36 |
| Two exam, cleaning and X-ray visits, at the $203 average | $406 | $0 | $0 | $0 |
| One porcelain crown, at the $1,399 average | $1,399 | $909.35 | $699.50 | $909.35 |
| Total for a cleanings-and-one-crown year | $1,805 | $1,193.51 | $1,175.54 | $1,197.71 |
Strip the crown out and the year is the premium and nothing else. Two preventive visits run $406 at the average cash price 7. That puts Delta Dental Standard $121.84 below cash and MetLife Standard $117.64 below it.
The same two visits cost $476.04 on Delta Dental High and $489.12 on MetLife High. Both High options come out above what cash would take.
A single preventive visit flips the answer. One exam, cleaning and X-ray visit runs $203 in cash against $284.16 of annual Standard premium, so a reader who goes once a year pays $81.16 less by skipping coverage. The second visit is what turns the premium into a bargain.
Restorative work moves the total much further. One porcelain crown at the national average adds $909.35 to a Standard member's bill and $699.50 to a High member's 7. Both plans come out hundreds of dollars below the $1,805 cash price for that year.
The High option only separates itself once that work appears. The extra premium is $191.88 a year against Delta Dental Standard, and the crown share it buys back is $209.85. That leaves High ahead by $17.97 in this year, and behind in every year without a crown.
Where the two Standard options part company
The two Standard premiums for 2027 sit $4.20 apart for the year: $284.16 at Delta Dental against $288.36 at MetLife. A year earlier the same gap was $14.64, and the 2027 rate moves narrowed it 8.
Behind that $4.20 sits $500 of extra annual maximum. A 35% plan share means $1,500 of plan money absorbs about $4,286 of allowed Class B and Class C charges, and $2,000 absorbs about $5,714. The gap between them, about $1,429, is close to one more $1,399 crown before the plan stops paying.
Price that against a heavy year. Four crowns at the national average come to $5,596 of charges 7. Delta Dental Standard pays out its $1,500 maximum and leaves $4,096, so the year totals $4,380.16 with premium. MetLife Standard pays $1,958.60 and leaves $3,637.40, for a year of $3,925.76. The $454.40 difference belongs to the reader who expects that much work, and it costs $4.20 to hold.
Most years never reach either maximum. Below roughly $4,286 of restorative charges the two Standard options behave almost identically, which is where the choice simplifies to the smaller premium.
The pre-tax dollar
A health savings account can pay dental and vision costs that the health plan and the dental plan leave behind. Delta Dental's own brochure points members at that route 5. The account requires a qualifying high-deductible health plan, and the 2027 contribution limits are $4,500 for self-only coverage and $9,000 for family coverage 9.
Run the one-crown member share through it. The $909.35 a Standard member owes on that crown costs about $709 of after-tax pay for a reader in the 22% federal bracket, before payroll tax is counted. That is $200 kept on a single procedure, and the whole year's member share qualifies.
A flexible spending account reaches the same money with a shorter fuse. The federal program requires a new election every year, and for 2027 it adds a Visa card that pays qualified dental and vision expenses at the point of sale 1. Every dollar has to be elected before the year starts, so the election is where the planning happens.
The account carries one gap worth knowing. Toothpaste, toothbrushes, dental floss and mouthwash are not eligible expenses under current law 4. The Oct. 7 survey found 91% of account holders with children under 18 would use the funds for those products if they qualified, and the ADA has backed the bill that would let them 4. The bill is proposed law and changes no expense category today.
Vision at a smaller scale
Vision premiums are an order of magnitude smaller, so the break-even arrives faster. For 2027 VSP Standard costs $7.76 a month, or $93.12 a year, and VSP High costs $14.56, or $174.72 10. MetLife's vision plan runs $8.21 a month on Standard and $12.18 on High 10. VSP carried both its options into 2027 at the 2026 price 11.
Start with the eye exam alone. A basic exam at a warehouse club runs $79 to $110, and the optometrist there is an independent doctor who sets that price 12. Against a $93.12 Standard premium, an exam-only year is a wash, and the cheaper end of the cash range wins outright. Private optometrists charge $95 to $250 for the same exam 12, which is where the premium starts paying.
Add a pair of glasses and the allowance settles it. VSP Standard covers the exam at no copay at Premier Edge locations such as Visionworks and Eyemart Express, and at a $10 copay elsewhere in its network. It then pays $200 toward a Featured Frame Brand or $150 toward a standard frame, and each of those benefits renews every calendar year 13.
MetLife Standard covers one exam and one pair of eyewear per calendar year, with no copay on the exam. It pays $190 on a Featured Frame Brand, $150 on a standard brand, and $85 at Costco, Walmart or Sam's Club, with a $20 copay on that last group 14.
The allowance is where the two carriers genuinely differ, and one store shows it. At Sam's Club, VSP applies its $150 standard frame allowance while MetLife applies $85 and collects a $20 copay, which leaves the member $65 of frame value. That is an $85 gap on the same frame in the same store.
Contact lens wearers see no gap at all. Both Standard options pay $120 toward contacts instead of glasses, with a fitting charge of up to $55 1314. Out of network, MetLife reimburses up to $45 for an exam and up to $70 for frames, a schedule worth checking before assuming an out-of-network optometrist is covered 14.
Preventive dental care also has a cash-priced substitute, sold as a membership rather than insurance. Wally charges $249 a year in New York City for unlimited cleanings, whitening and diagnostics with no insurance involved 15. That lands below a $284.16 Standard premium, and it covers preventive visits only, which is the same boundary the two-visit scenario above draws.
What this week's threads show
Three threads in r/DentalInsurance ran during this window. Each is one person's account of one situation, and each points at a question worth settling before treatment starts.
On Oct. 6 a member described a plan where the spouse's share of the premium rose from $15 to $34 per biweekly paycheck, about $494 more across the year, and asked whether to keep it 16. Replies pointed at the annual maximum and at the reset. One reader priced three fillings at a $50 copay before the year ended against $900 or more in office fees in January 16. The check that thread hands over is to look at how much maximum remains before Dec. 31 and what treatment is already scheduled.
On Oct. 11 a reader described a filling done the same day as the exam and a cost sheet brought in to sign, with a desensitizing-resin code added to the filling 17. Several replies said that code commonly accompanies a filling and can be justified. One advised reading the explanation of benefits alongside the carrier's own record before treating any line as an error 17. The check is to ask for the procedure codes in writing before signing anything.
On Oct. 10 a reader booked through the plan's in-network directory, paid $66 at the desk, and then found the claim filed under a dentist the plan treats as out of network, a partner in the same office 18. Replies advised confirming which dentist actually did the work and asking the office to reprocess the claim under the in-network dentist, with an appeal as the fallback 18. The check is to get the treating dentist's name on the estimate, not just the practice's.
Before you book
Six questions turn the arithmetic above into a number that applies to one reader and one mouth.
- Ask what treatment is needed, with the CDT codes attached, and get it in writing.
- Ask which dentist will actually do the work, and whether that dentist is in network for this plan.
- Ask whether the office bills the plan directly or wants the full fee at the chair.
- Ask what the plan allowance for that code is, and what the office's own cash price is for the same code.
- Ask how much annual maximum remains, and whether any waiting period applies.
- Ask what the same visit costs at a dental school clinic, where fees run below private practice under faculty supervision 19.
References
- 1
- 22027 FEDVIP Dental Premiums
opm.gov
- 3
- 4
- 5
- 6The MetLife Federal Dental Plan 2026 brochure\
fedvip.metlife.com
- 7Dentist Prices: Dental Procedure Cost List
carecredit.com
- 82026 FEDVIP Dental Premiums
opm.gov
- 9Rev. Proc. 2026-24
irs.gov
- 102027 FEDVIP Vision Premiums
opm.gov
- 112026 FEDVIP Vision Premiums
opm.gov
- 12Costco Eye Exam Cost With and Without Insurance
costcoguides.com
- 13VSP 2026 FEDVIP brochure
federal.vsp.com
- 14Federal Vision Plan Details
fedvip.metlife.com
- 15Wally
carebywally.com
- 16Is it worth it?
reddit.com
- 17
- 18
- 19Access Lower-Cost Dental Care
penndentalmedicine.org
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