Is Dental Insurance Worth It?
- February 27, 2018
- Posted by: Jeff Gitlen
- Category: Insurance
Dental insurance is basically health insurance for your mouth. Policyholders pay a monthly insurance premium, and in exchange the dental insurance policy covers some of the costs associated with routine dental care. There might be a copay for regular cleanings, and the insurance generally pays a percent of additional care that the insurance company considers to be medically necessary.
How Do You Get Dental Insurance?
Dental insurance is a common part of a comprehensive benefits package provided to employees of most large companies. Around two-thirds of Americans have dental insurance, according to a 2017 report from the National Association of Dental Plans.
Dental insurance is available through an insurance marketplace for those who cannot get coverage through their employers. The average cost of dental insurance depends on where you live, but purchasing your own individual plan can cost around $360 per year. Group plans generally run between $234 and $432 per year.
What Does Dental Insurance Cover?
Typical dental insurance plans have what is called 100/80/50 coverage. This means that preventative care is usually 100 percent covered by insurance. This includes standard cleanings and exams twice a year.
Insurance typically covers 80 percent of the cost of basic procedures such as filling cavities and extractions. And it can cover around 50 percent of the cost of major procedures such as root canals, bridges, implants, and dentures. In addition, dental insurance policies usually have an annual maximum payout of somewhere between $1,200 and $1,500.
Chances are that if you need anything that falls into the category of a major procedure, you will easily reach the maximum annual payout. Of course, those are the situations in which dental insurance is most helpful because the out-of-pocket cost likely would have been thousands of dollars higher without the dental insurance.
As with health insurance, there are various forms of dental insurance. Indemnity or fee-for-service plans provide the greatest flexibility in the choice of providers. You can choose to use any provider who accepts your insurance plan, and then your insurance company simply pays a set percentage of the total cost of service. These plans, however, do tend to have the highest annual premiums.
Preferred Provider Organization (PPO) plans allow you the option of using any provider you choose, but they also offer lower prices if you opt for a provider who is in their network. Health Maintenance Organization (HMO) plans require that you use one of the company’s in-network providers in order for them to cover any expenses. The annual premiums on these plans tend to be the lowest, but they also offer the least flexibility.
What is Not Covered by Dental Insurance?
You’ll probably find that anything deemed to be purely cosmetic in nature or excessive preventative care procedures to not be covered by dental insurance. As with any type of health insurance, the dentist must make a case to the insurance company for why a procedure is medically necessary.
Insurance simply does not cover a lot of new procedures beyond the standard preventative care. X-rays more than once a year, fluoride treatments, gas during surgical procedures such as root canals, and white rather than silver fillings may be out-of-pocket expenses that are not covered at all by a dental insurance policy. Most dental insurance policies do not offer any type of coverage for orthodontic care, although some offer optional coverage.
Although dental insurance doesn’t restrict coverage due to pre-existing dental problems, individual policies often have a waiting period before policyholders can make certain types of claims. This prevents an individual from purchasing dental insurance one day and getting a root canal the next day.
Depending on the policy and type of procedure, the waiting period can range from three months to one year.
Does Dental Insurance Make Sense for You?
Whether or not dental insurance is worth it really depends. If you are young, take good care of your teeth, and generally don’t have a history of needing much dental work, you might not want to spend your money on dental insurance. The cost of a cleaning and exam twice a year might be lower than the insurance premium where you live.
As people age, however, they tend to need more expensive dental procedures like root canals, bridges, and crowns. In this case, the dental insurance policy can reduce your out-of-pocket costs. As with other types of insurance, dental insurance is not for the times when everything goes well but for the times when there is a problem.