The law requires you to buy car insurance and health insurance, and people with financial dependents should always carry life insurance.
But what about dental insurance?
Do you really need it, or could you get by without it?
Only you can answer that question.
To make the most informed decision, you may need to learn a little more about how dental insurance works.
Should You Buy Dental Insurance?
Dental procedures can cost thousands of dollars. Standard dental insurance plans cover half the cost of major dental work, 80 percent of routine dental work, and 100 percent of preventive care.
So why wouldn’t you buy coverage?
Here are some reasons people often cite:
- Premiums cost too much.
- Plans limit annual benefits.
- Waiting periods delay coverage.
- Many insurance plans don’t cover every dental procedure.
- Preventive care costs about the same as insurance premiums.
- You don’t go to the dentist anyway.
All these reasons include some elements of truth and some fallacies in logic. How they apply to your specific situation can help determine your needs, so let’s take a closer look:
Premiums & Caps
Premiums for dental coverage vary from state to state, but on average Americans pay about $350 a year for dental insurance. That’s about $30 a month.
Dental plans usually cover all of your preventive care, which includes X-rays, cleanings, and exams. But they pay only a portion of other procedures. They also tend to cap annual payouts at $1,000 to $2,000.
To summarize: You’ll pay about $350 a year in return for preventive care and access to up to $1,000 or $2,000 in dental procedures. Dental insurance can save you money each year if you use it. Most people never use their full coverage amounts in any given year, though.
How much of your coverage you’d use can help determine whether dental insurance would be cost-effective for you.
Waiting Periods and Non-Covered Procedures
While a new dental insurance policy should pay for preventive care right away, the plan likely will not pay toward any dental work during the first year.
This prevents someone from buying an insurance plan only to max out the annual cap and then cancel the coverage once the work is complete.
Unfortunately for cost-conscious consumers, you often have to accept this limitation and wait a year before getting expensive covered by your policy.
The good news? You probably won’t be paying higher premiums to cover the cost of other policyholders who get dental work and then cancel their plans.
Even after you’ve waited a year, your plan won’t pay toward every service your dentist offers. For example, cosmetic procedures such as teeth whitening typically are not covered in your health insurance plan.
Premiums and Preventive Care Cost the Same
It’s true in many cases: You could pay out of pocket for preventive dental care and spend about the same — perhaps a bit more or even a little less — than you’d pay in annual premiums for a dental insurance plan.
People cite this as a cause to avoid dental insurance, but this fact also supports buying a plan. If you’ll be paying about the same amount, shouldn’t you be getting more for your money, such as access to $1,000 to $2,000 a year in dental work if you need it?
Maybe it’s a glass-half-empty/glass-half-full scenario: It depends on how you look at it. But if you can get more value out of the same amount of money, that’s usually a win-win.
You Don’t Go to the Dentist Anyway
Here’s another tricky scenario. If you don’t go to the dentist, you won’t use the coverage dental insurance offers. But at the same time, not going to the dentist makes you statistically more at risk for an unexpected dental procedure.
If you had an urgent need — an abscess, a painful cavity, or an accident requiring restorative care — and had no choice but to get dental work done, you’d need to pay out of pocket for the entire expense.
Of course, you hear stories about people who haven’t been to the dentist in decades and have never had a problem.
Where you fall on this spectrum can help determine whether you need dental coverage and which kind of coverage you should seek.
Different Kinds of Dental Insurance Plans
How often you expect to visit the dentist should influence your decision about which kind of dental plan to buy. Most plans fall into one of three categories:
Health Maintenance Organization Plan (HMO)
HMO dental plans require you to choose a dentist from a list of providers. They also tend to have lower premiums other plans.
These plans emphasize preventive care more than most other plans. HMOs often have lower maximum annual payouts.
Best for: An HMO may work for you if your dentist is already in-network and if you don’t anticipate any high-value work such as a crown or root canal.
Preferred Provider Plan (PPO)
With a PPO you’ll have more freedom to choose a provider, though you’ll still need to be aware of your network’s limitations.
The plan won’t require an in-network provider, but it will pay less to an out-of-network dentist. It may even require you to pay 100 percent and then seek reimbursement from the PPO.
Best for: A PPO provides an in-between option: You don’t have full control over which providers you can see but you also don’t have the strict limits of an HMO.
This kind of plan allows you to choose your own provider. You’ll also benefit from lower deductibles and higher annual caps.
Of course, you’ll also pay a higher premium in most cases for this kind of coverage.
Best for: If you’re a regular in the dentist’s chair, the higher premiums for an indemnity plan can be money well spent.
How Do You Choose a Dental Insurance Policy
Your needs as a dental patient — or your family’s needs if you’re getting a family plan — should influence your choice in dental insurance.
- Who should get an HMO? Someone who doesn’t expect to visit the dentist more than twice a year for preventive care could get by with an HMO and save on premiums each year. If you consider a cavity an anomaly, an HMO can cover your bases.
- Who should go with a PPO? Have you been putting off dental care? If so you may need more spending power at the dentist over the next few years. A PPO costs a little more but gives you more flexibility.
- Who should look into an indemnity plan? Some dental patients have a list of dental procedures they need: Root canals, crowns, implants — these procedures require a variety of specialists, and if you want more control to choose your providers, an indemnity plan will be worth the money.
What about Orthodontic Care?
Many dental insurance plans cover braces and other orthodontic procedures. If you’re shopping for dental insurance because someone in your family needs braces, be sure to check the plan’s details about orthodontic care.
With orthodontic care, you’ll probably face many of the same challenges we’ve already discussed, including:
- Waiting Periods: These apply to orthodontic as well as dental procedures.
- Spending Caps: Spending caps can be more of an issue with orthodontics because a single procedure — such as getting braces — can last more than a year. Some orthodontics can break down their costs into annual installments to simplify the issue.
- Partial Payments: Expect to cover a significant portion of the procedure out of pocket, whether as a co-pay or a percentage. The best plans pay up to 75 percent.
As you shop for a dental plan, try to find the right balance. If you’re a frequent flyer at the dentist’s office, a plan with higher premiums can be worth the cost if you’re getting higher annual caps in return.
If you’ll seldom or never tap into your annual allotment, a lower-cost plan emphasizing preventive care will save on premiums.
Beyond Insurance: Other Options for Dental Care
If you already have tooth pain but don’t have dental insurance, you’re in a tough spot: An insurance plan’s waiting period will prevent you from getting care right away, and you probably can’t wait a year to resolve the issue.
You’ll need another option.
Some of these ideas may also work if you need help covering your balance after insurance has paid its portion:
- A Plan Without a Waiting Period: Shop around enough and you can find a plan without a waiting period. However, you’ll have to sacrifice in other areas — either with higher premiums, lower spending caps, or both.
- A Dental Discount Club: Joining a club like 1Dental.com or: DentalPlans can help you negotiate lower fees for preventive care and more complicated procedures. You’ll pay a participating dentist directly rather than filing for insurance payment.
- Health Savings Accounts: Many employers offer a Health Savings Account, and some individual insurance plans also include this feature. These accounts set aside pre-tax earnings in a separate account which you can use exclusively at health care providers, including dentists.
- Your Own Savings: If you’re in a bind but you have the savings available to cover the dentist’s bill, you may simply have to part with the cash. This isn’t ideal, but you probably started saving money to cover unexpected expenses.
- CareCredit or Other Plans: Many dental providers will hand you a CareCredit brochure if you can’t pay off your balance. These plans are nothing more than a credit card which you can use to pay for medical procedures. Be sure to take advantage of any promotional interest-free periods, and try to pay off the balance before interest kicks in. Interest rates on these accounts tend to be painfully high.
- Wait for a Free Clinic: Some communities have free dental clinics — often on weekends in schools or churches. If you have a relatively simple need, such as a filling or extraction, the dentists at a free clinic should be able to help. A site like this can help.
- Check with a Dental School: Dental schools at major universities sometimes welcome patients for routine procedures at no charge. You’ll be in the hands of students, but they’d be supervised and working in a safe environment. This could work for simpler issues like extractions or fillings. Call your closest university or check this list of dental schools.
Bottom Line: Getting Ahead of the Pain
Ultimately, dental insurance protects your wallet against unexpected or cost-prohibitive fees which can result when you have a tooth problem.
As with any kind of insurance, you should assess your personal risk of racking up excessive fees and then use insurance to hedge your exposure to these fees.
For some people, this could mean going without dental insurance.
For others, spending a few hundred dollars a year in premiums can lead to a couple of thousand dollars in savings.
When you’re shopping for dental coverage, compare policies, get quotes and read your policy carefully before signing so you understand exactly how much you’ll be paying in premiums, co-pays, and unpaid balances after your insurance pays its share.
When you’re ready to shop for dental insurance, consider these companies:
- United Healthcare: Lots of options without waiting periods for preventive care.
- Spirit Dental & Vision: Find a plan without waiting periods for dental work. With some plans, the annual cap on expenses increases during the first several years.
- Delta Dental: Dental plans created by dentists and offering a wide variety of plan options.
- Humana: A good option for people who want to save on premiums but don’t anticipate needing major dental work. You’ll save the most by staying with an in-network provider.
Leave A Comment: