Dental insurance is confusing...
It really should save you money, but it depends on your circumstance and needs. So read on to discover how dental insurance can effect your smile and your wallet!
Insurance might make more sense under the following circumstances;
- have an employer offering you coverage.
- have a large family that gets reasonable group plan rates.
- get a free or low cost dental plan.
- have a child that needs dental coverage.
- just want piece of mind of knowing one is covered.
And depending on your needs, certain plans could be more beneficial:
- Large families typically use dental insurance the most and may opt for more comprehensive plans, particularly if children need orthodontics coverage or adults need specialty care.
- Single adults without major dental problems may find a PPO or DHMO plan financially attractive.
- Those in need of major procedures often prefer traditional or indemnity plans.
- Young adults with pristine teeth might consider a discount plan..
But, dental insurance only covers a percentage of dental care expenses in exchange for a monthly premium.
This means for most people, the less one can pay in premiums the better. Because in most cases the dental work you’ll really wish you had insurance for will be far beyond any plans maximum.
So what are these expenses…
The Costs of Dental Insurance
Dental care can be expensive, even with insurance. In addition to a monthly premium payment, there is usually a co-payment at each visit and a coinsurance responsibility. Understanding these costs takes time and a good way to find out what you’re actually paying is to analyze all your annual dental expenses versus what was covered… and remember to include the cost of the dental plan itself.
Additional expenses can include:
Deductible: The specific out-of-pocket expense before the insurance company begins making payments for any claims. It is not part of the copayment.
Copayment: The fixed amount paid at the time of the dentist’s visit. It is a separate charge and not applied toward your deductible, which you need to reach before insurance kicks in.
Coinsurance: Given as a percentage, coinsurance is what you pay after satisfying the co-payment and/or deductible for the plan. This can vary for different services.
Maximum out-of-pocket cost: is the total amount policyholders will have to pay for dental care throughout the year.
That sounds like a lot, so what is covered….
Included Dental Services
Dental insurance companies separate dental care services into various categories and based on the service you require you may need to buy a bigger plan that can bundle more treatments together.
These service categories can include:
- Preventive care: such as routine oral examinations, periodontal examinations, X-rays, general cleanings, topical fluoride treatment and sealants, (are covered with exams generally included bi-annually in most dental insurances).
- Basic procedures: such as emergency care, extractions, fillings, space maintainers, minor oral surgery and crowns, (are sometimes covered, for good coverage of basic procedures consumers may need to pay more).
- Major procedures: such as crowns, bridgework, dentures, periodontal cleanings, gum therapies and root canals. (are generally not covered and only offered with top-of-the-line coverage).
In general, every plan covers preventive care and basic procedures, but it’s uncommon to find insurance that covers major dental work past a certain dollar amount.
So which is best?
Premiums vary greatly, not only by the type of plan, but by location and age. So you’ll want to obtain a few quotes from insurance companies that provide coverage in your area. You’ll also want to verify that your dentist accepts your chosen insurance before you sign up with a new provider.
Here are some plans to think about.
- Wider selection of dentists.
- Not required to visit in-network dentists.
- Dentists agree to perform services for patients at pre-negotiated rates.
- Usually will submit the claim to the dental insurance company for you.
- Less paperwork.
- Lower out-of-pocket costs.
- PPO in-network dentists will have lowest out-of-pocket costs.
- Little bit higher priced.
- Pay a copayment for procedures.
- Varying percentage copayments make it difficult to predict exact fees.
- Require you to reach a deductible and have a maximum.
- Maximum payout over calendar year (generally $1,000 – $1,500)
- Very well priced.
- No waiting periods.
- Good option for someone who needs extensive dental work right away.
- Some procedures are zero out-of-pocket costs.
- Low set copays so you know exactly what dentist will charge.
- Unlimited. No maximum payout over calendar year.
- No deductibles.
- Very limited providers.
- Choose one dentist only.
- Out of network procedures will not be covered.
- Pay a coinsurance for procedures.
- You pay a copayment for certain procedures.
Traditional Plans (Indemnity or Fee-for-Service)
- The largest choice of dentists.
- Usually pricier than other plans
- These plans usually have a co-payment, deductible and maximum out-of-pocket cost
- May have to pay for services up front.
- Additional fee for the dentist since they are not reimbursed.
- File your own claims and wait for the insurance carrier to reimburse you.
- Broadest choice of dentists.
- Includes all networks.
- Pay discounted rates off the sticker cost for dental care.
- Little or no paperwork.
- This option is best for those who do not require or want consistent oral health care..
- No deductible or maximum.
- Need to find dentist in PPO that offers the discounts.
- Reduced fee-for-service is completely out-of-pocket.
But what if it doesn’t add up?
Can I Cancel or Change My Dental Insurance?
Dental insurance is purchased separately from health insurance and generally you can cancel a dental plan at anytime, by not paying, if it’s a stand-alone dental plan. If you have a plan that includes dental, you can switch it during open enrollment, but can’t drop the dental part of the plan without dropping the whole plan.
Or, what will happen if I just do nothing?
The Cost of Reactive Care
You could be the most dedicated brusher and flosser and still have dental problems if you go years without seeing a professional.
“I’ve had patients with excellent home dental care still develop severe gum disease from years of tartar build up” says Dr Gopisetty, a dentist in Wicker Park, Chicago. “Also patients that fail to come for regular checkups and cleanings can have decayed teeth that were previously small, fixable issues.”
While some financial planners suggest dental insurance may not be worth paying for, our math shows it is usually worth it, provided you attend all of your allowable preventive exams and cleanings. We also learned that if you need any type of work such as a root canal or filling, you will definitely notice cost savings.
In addition to financial costs, there’s pain and often embarrassment that comes with dental problems. Few pains are as brutal as a toothache and few imperfections make you more self-conscious than missing teeth.
Should I Buy Dental Insurance?
For some people, buying dental benefits may cost more than paying a dentist’s office directly, so you need to consider what kind of care you receive from your dentist. Are your regular checkups enough, or do you routinely need procedures (like cavity fillings) performed?
Talk to your dentist about your dental history and possible care needs before making your decision and because your health is always changing, revisit these conversations with your dentist before your policy is renewed each year.
Then you can start to save money.