There’s no question that dental work is expensive—especially when you need to have major work done, which is why so many people eventually ask themselves, “Should I get dental insurance?” If you’re not covered through your job, you may have to purchase it on your own. When you decide to purchase it on your own, make sure your dental insurance plan meets your needs so you get your money's worth.
Here's how to review dental plans to find the best dental insurance that's right for you.
Key Takeaways
- Dental insurance purchased individually, as opposed to participation in an employer-sponsored group plan, may not be worth the cost for everyone.
- The coverage usually has an annual maximum limit, and certain procedures may have hefty coinsurance payments.
- Some procedures, such as orthodontics and cosmetic dentistry, may not be covered at all.
Overview of Dental Insurance
Like health insurance, you select a dental plan based on the providers (dentists) you want to be able to visit and what you can afford to pay.
- If you already have a dentist you like in the insurance company’s network, you’ll be able to opt for one of the less expensive plans.
- If you don’t have a dentist at all, you can choose from any of the dentists who are in the network and again have the option of a less expensive plan.
- If your existing dentist is not in the network, you can still get insurance, but you’ll pay significantly more to see an out-of-network provider—so much more that you may not have any chance at coming out ahead by being insured.
The monthly premiums will depend on the insurance company, your location, and the plan that you choose. For some people, the monthly premium can be as much as $50 a month. This means that you’re spending $600 on dental costs each year even if you don’t get any work done.
Is Dental Insurance Worth It?
Dental insurance is designed to protect you in a worst-case scenario. In a good year, when you need only standard cleanings, exams, and X-rays that make up good preventive care, the insurance could cost more than what two checkups per year might cost without insurance. For example, if you pay $50 per month for dental insurance, that is $600 per year compared to two annual checkups that might cost less than $300 apiece. Depending on the dentist and other factors, you might even pay less than $100 per checkup even without insurance.
Older adults represent a group that may find it worthwhile to enroll in a dental insurance plan. Dental insurance for seniors is similar to plans for others but focuses on the types of coverage seniors may need. These include crowns, root canals, dentures, and tooth replacements. Even though these coverages are not unique to older individuals, there is a higher probability that seniors will need one or more of these procedures. Note that seniors on Medicare may require a different dental insurance plan than those without it.
Will It Be There When You Need It?
What about when you need some work done? In a really bad year, your dentist could inform you that you need a couple of fillings, a root canal, and a crown. On top of that, you’ll still have to pay for your usual cleanings, exams, and X-rays. This is the time to be insured, right? That depends.
Annual Maximums
Your insurance may not be as helpful as you would expect. Some dental insurance plans have annual maximums as low as $1,000, depending on the plan and provider. Once your dental bills exceed $1,000 in any given year, you’re stuck paying the rest of the bills in ful.
You still may pay a lower negotiated fee for the work you need as a benefit of having insurance, but even negotiated fees could be quite high. For example, if the dentist’s regular fee for a filling is $150, then the negotiated fee might be $100. In this situation, your regular oral maintenance and fillings could use up most or all of your annual maximum, so only a fraction of a large dental bill might be covered. You might still pay $1,000 to $2,000 out of pocket, plus your annual insurance premiums.
Coinsurance Costs
On top of that, while you may pay 0% in coinsurance on preventive maintenance and 20% on fillings, root canals, and extractions, the policyholder’s share of expensive procedures such as crowns, bridges, and implants tends to be a whopping 50%. This is known in the industry as the 100-80-50 coverage structure. Even if you haven’t used up your annual maximum by the time you need the expensive procedure, you’ll still have to pay several hundred dollars for it.
What’s Not Covered
Dental insurance also rarely covers expensive procedures such as orthodontics and cosmetic dentistry. When insurance does cover them, the annual maximums still often prevent you from saving very much, if anything, after you factor in your biannual cleanings and exams.
Most dental insurance plans have a waiting period during which major procedures are not covered for a year after the plan begins, with minor ones not covered for three months.
Waiting Won’t Work
If you think that you’ll just hold out and purchase dental insurance when you need it, think again. Because of what’s called a waiting or probationary period, this strategy won’t work. Waiting periods vary by policy and mean that your insurance will not cover any major work (such as crowns or root canals) for a specified period after you first become insured.
Insurance companies know that when you need a filling or a crown, you need it now—you won’t be able to find out that you need a crown, buy insurance, wait 12 months, and then get it taken care of. If you tried to do that, you would probably suffer from a lot of discomfort and ultimately lose your tooth (and have to pay full price for that extraction).
Even with employer-sponsored group plans, it’s important to scrutinize plan details to find out if it is cost-effective for your particular situation.
Considerations for Group Plans
When evaluating your employer’s dental plan, make sure to examine the monthly payments, the annual maximum, and the coinsurance. Do the math for your own situation to determine whether you’re likely to come out ahead.
One situation where it can make sense to get dental insurance regardless of whether it seems like a good deal in the long run is if you are living from paycheck to paycheck with little or no money saved. When you don’t have dental insurance, you might need to pay an expensive bill when you have the work done. If you can’t do it, and your options are to overpay for dental insurance, neglect your only set of teeth, or put dental work on a credit card that you’ll have trouble paying off, then your best bet is to get the insurance. You’ll probably waste less money on insurance than you would paying interest on a credit card or letting your dental health deteriorate.
How Much Does Dental Insurance Cost?
It can vary greatly due to numerous factors, which is why it is important to shop around for the best deal for your specific situation. Monthly premiums can range from less than $10 to more than eight times that much depending on your age, where you live, your maximum coverage, your deductible, copay, and more.
Is Dental Insurance Necessary?
This is a personal preference. If your only expenses each year are for routine six-month checkups, it might be less expensive to skip the insurance and pay out of pocket. However, unexpected dental work—such as fillings, crowns, or root canals—can be expensive, and it is for those situations when dental insurance can be most helpful.
Does Dental Insurance Cover Cosmetic Procedures?
In most cases, it does not. Procedures such as teeth whitening are not considered medically necessary, so expect to pay for them out of pocket even if you have dental insurance.
The Bottom Line
If you can’t participate in a quality group dental plan—either a preferred provider plan (PPO) or a dental health maintenance organization (DHMO)—then the best way to come out ahead on dental expenses may be to pay for everything out of pocket. Brushing and flossing regularly, switching to an inexpensive electric toothbrush, getting professional cleanings every six months, and going to a dentist who does high-quality work that lasts for years can be the most effective ways to save money in the long run.
