Is dental insurance worth the cost? – Forbes Advisor

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Dental insurance is useful when you need dental treatment that can be expensive to pay for yourself.

But whether dental insurance is worth it depends on how much it costs and what you get from the coverage. You should also consider why you want dental cover. Do you want something that only pays for preventative measures, or would you prefer more comprehensive coverage?

What dental insurance costs do you pay?

Dental insurance picks up the tab for many covered services and treatments, up to a certain percentage, based on your plan. But make no mistake: you will be responsible for paying some or most of the cost of most dental care.

Here are the types of costs with dental insurance plans:

  • Premiums: Premiums are what you pay for dental benefits.
  • Additional payments: Copays are the fixed dollar amount you pay for a service covered by your dental plan, such as a dentist visit.
  • Self-participation: A deductible is the dollar amount you pay for covered services for the year before insurance benefits take effect. Many dental plans cover preventive procedures without requiring a deductible.
  • Coinsurance: Coinsurance is the portion of the cost you pay for dental services after your insurance plan has paid its share and you’ve met your deductible.
  • Annual highs: Your Annual Coverage Maximum is the most amount your dental insurer will pay for the cost of covered dental care within the benefit plan year. Every time a dental claim is made, your insurer deducts the amount it pays for the treatment from your annual maximum cover. After reaching this maximum, you are responsible for 100% of the cost of additional dental treatments within that plan year. Once your next plan year begins, your maximum annual coverage resets.

Some plans add a portion of any unused benefits from the previous year to the next year’s annual maximum, helping to build a cushion for unexpected emergencies like crowns, root canals and surgeries.

How much does dental insurance cost?

The average cost of dental insurance is $47 per month for a stand-alone dental plan. The average price of a a dental plan for preventive care only is $26 per monthbut these plans will not include coverage for fillings, extractions, or major operations such as root canals.

Premiums are only part of the cost equation. Depending on your plan, you may also be responsible for copayments, coinsurance, deductibles, and treatment that exceed the annual coverage maximums. A cheap dental insurance plan can leave you paying a lot out of pocket if you visit the dentist.

What is usually covered by dental insurance?

Most dental insurance plans typically cover three areas of care: preventive, primary, and essential. Michael Bass, client advisor for World Insurance Associates, says many dental insurance policies typically provide:

  • Preventive services (such as exams, cleanings, x-rays and fluoride treatments for younger patients) at 100% coverage
  • Basic services at 80% to 100% coverage (such as fillings, non-surgical extractions and root canals)
  • Basic recovery services at 50% to 80% coverage (such as crowns, bridges, inlays/onlays and dentures)

What is usually not covered by dental insurance?

Many dental plans decline coverage for certain treatments, including:

  • Teeth Whitening
  • Cosmetic dentistry
  • Orthodontics (braces) which may be covered but usually have a lifetime maximum benefit

If your dental insurance plan includes coverage for one or more of these services, it may be at a lower percentage, meaning you’re picking up more of the cost.

Pros and Cons of Dental Insurance

Dental insurance can provide many benefits, including paying for preventative care.

“Insurance usually covers all preventive care,” says Albert Abena, assistant dean for community partnerships at the University of New England College of Dentistry. “Keep in mind that regular preventive care can protect your oral health from future problems and provide advance notice of possible problems that your dentist can address proactively instead of reactively.”

Bill Green, owner of Green Insurance Agency in Orange Park, Fla., says dental insurance can keep costs down when you need care.

“Even if you only get two cleanings a year, it should pay off,” says Green.

But dental policies also have their drawbacks. Daniel Cho, a dentist in Portland, Ore., says plans have special rules, such as age limits for fluoride treatment or missing teeth clauses.

“Insurance typically does not cover 3-D X-rays, moderate or deeper levels of sedation, sleep dentistry and cosmetic work. And your plan may only cover a fraction of the total cost of advanced surgical procedures,” says Cho.

Here are the pros and cons of dental insurance:

Professionals

  • Plans often include coverage for preventive services at 100%, providing an incentive for regular checkups and cleanings that serve as an investment in better oral health.
  • You can offset premiums with money saved when you need dental care, especially for expensive treatments like fillings, root canals and extractions.
  • You’ll probably pay a little more for coverage if your employer offers a group dental plan.

cons

  • Plans may have exclusions and conditions of coverage.
  • Policies may not cover certain treatments, including cosmetic and orthodontic services, and may only cover a small portion of the total cost of advanced surgical procedures such as implants.
  • Your plan may only cover treatment provided by an in-network dentist, limiting your ability to see any provider you want.

How to choose dental insurance?

You may benefit from a dental insurance plan if you visit the dentist regularly and can get a plan with a low premium, or if you have to visit the dentist and find a plan with no waiting period and high annual benefits.

Be sure to look closely at the plan’s network of participating providers, the different types of dental plans available in your area, and what’s covered in each plan, advises Joseph Dill, chief dental officer of the Delta Dental Plans Association.

Green recommends a dental plan “that has the highest annual coverage limits, as well as one that has the highest coinsurance for essential and major services.”

Other ways to pay for dental care

An estimated 76.5 million Americans lack dental insurance, according to the CareQuest Institute for Oral Health, a nonprofit organization that advocates for affordable oral health care. If you need dental care but don’t want to purchase a dental insurance plan, you can pay the full amount out of your savings or choose the following options:

  • Develop a payment plan with the dental practice. They may allow you to pay in installments or provide internal or external financing options for certain services. “Be sure to review all potential fees and interest rates, as some can be a bit onerous,” Dill adds.
  • Pay for dental services with one or more credit cards— preferably a card with a low introductory rate that will allow you to pay off the balance quickly and avoid exorbitant interest charges.
  • Look for other financingincluding a personal loan, home loan or home equity line of credit.

Is dental insurance worth it?

Dental coverage makes dental care more affordable by saving on dental treatment costs and helping you avoid future dental health problems.

“Routine brushing and flossing at home is a great place to start. But dental care is critical to achieving and maintaining a healthy smile,” Dill says.

Green says a dental plan can be worth it if you get regular care, including checkups and cleanings, but takes into account the dental plan’s return on investment. In other words, make sure you save enough money to offset the plan’s premiums.

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Is dental insurance worth it FAQ?

Do all dentists carry dental insurance?

Many, but not all, dentists accept dental insurance within certain limits.

Dentist Daniel Cho says that accepting a dental insurance plan is not the same as being an in-network dentist within that plan. The latter means that the practice operates on a negotiated fee basis and will agree to charge the patient a pre-agreed price. The former means that they will bill the insurance, but if they are out of network, there may be little or no benefits.

In other words, your dentist will likely accept your dental insurance plan, but it may be out-of-network, in which case you may pay more or all of the costs than if you went to an in-network provider. For best results, contact your dentist or insurance company before receiving treatment to learn if and to what extent your upcoming services will be covered.

How do you know if your dentist accepts certain dental insurance?

Contact your insurer to see if your provider is in their network or call your dentist’s office and ask if they are in network and accept your plan. Don’t rely solely on a dental insurance company’s website. Provider directories may be wrong or out of date on the insurance company’s site.

Do you need dental insurance to see a dentist?

Your dentist will not require you to have dental insurance. Some practices actually prefer not to operate or accept insurance due to lower reimbursement and claims processing challenges.

What is the waiting period for dental insurance?

A dental waiting period is a period of time you must wait before a dental insurance plan will cover a service. For example, it could be six to 12 months from the first date your plan started.

Most group dental insurance plans do not have waiting periods. These are more common in individual plans. Preventive services usually have no waiting period, but major services (like crowns and root canals) usually have a longer waiting period.


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