There is no doubt that dental care is expensive, especially when you need to get major work done, which is why so many people end up asking, “Do I need dental insurance?” If you are not covered by your work, you may have to purchase it yourself. However, purchased individually, dental insurance can be a waste of money if your plan does not meet your needs.
Let’s see how to explore these plans to find out if dental insurance is right for you.
Key points to remember
- Individually purchased dental insurance, as opposed to membership in an employer-sponsored group plan, is not always worth the cost.
- Coverage generally has an annual maximum limit and some procedures have large coinsurance payments.
- Some procedures, such as orthodontics and cosmetic dentistry, are not covered at all.
Dental insurance overview
First, here’s an overview of how individual dental insurance works. You select a plan based on which providers (dentists) you want to be able to visit and what you can afford to pay.
- If you already have a dentist you like and they are part of the insurance company‘s network, you may be able to go for one of the cheaper plans.
- If you don’t have a dentist at all, you can choose from any of the dentists in the network and again have the option of a cheaper plan.
- If your current dentist is not on the network, you can still purchase insurance, but you will pay a lot more to see an off-network provider, so much more that you might not have a chance to get out of it with insurance. . .
Monthly premiums will depend on the insurance company, your location, and the plan you choose. For many people, the monthly premium will be around $ 50 per month. This means that you spend $ 600 on dental expenses every year, even if you are not doing any work.
Is Dental Insurance Worth It?
Now you might be thinking that most people don’t get along with most types of insurance, and you might be right. After all, if insurance companies didn’t make a profit, they would all go bankrupt. Insurance is designed to protect you in the worst case scenario.
However, dental insurance is very different from most other types of insurance. With health insurance or home insurance, for example, the downside potential is so great that hardly anyone can afford the risk of not being insured. With dental insurance, the downside potential is quite low, as is the upside potential.
In a good year, when all you need is standard cleanings, exams, and x-rays that are good preventative care, you could be wasting money buying dental insurance. For example, if you paid for these services out of pocket, you could spend around $ 400 for the year, while you could spend $ 600 for the year on insurance premiums.
Seniors are a group that may find it attractive to enroll in a dental insurance plan. Dental insurance for the elderly is similar to plans for other people, but focuses on the types of coverage that seniors may need. These include crowns, root canals, dentures, and dental replacements. Even though these blankets are not unique to the elderly, there is a higher likelihood that the elderly will need one or more of these procedures. Note that seniors with Medicare may need a different dental insurance plan than one who does not.
Will it be there when you need it?
What about when you need work? In a really bad year, your dentist might tell you that you need a few fillings, root canals, and a crown. On top of that, you will still have to pay for your regular cleanings, exams, and x-rays. Now is the time to be insured, right? It depends.
Unfortunately, your insurance may not be as useful as you think. Some dental insurance plans have low annual limits of around $ 1,000 (this varies by plan and provider, of course). Once your dental bills exceed $ 1,000 in any given year, you are required to pay the rest of the bills in full. The insurer will not pay more than $ 1,000 in treatment.
You can still pay a lower negotiated fee for the work you need as a perk of having insurance, but even the negotiated fee could be quite high. For example, if the dentist’s regular fee for a filling is $ 150, 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 your large dental bill could actually be covered. You could still pay $ 1,000 to $ 2,000 out of pocket, plus your $ 600 in annual premiums.
On top of that, while you can pay 0% in coinsurance on preventive maintenance and 20% on fillings, root canals and extractions, the insured’s share of expensive procedures such as crowns, bridges and extractions. implants tend to be 50.%. This is known in the industry as the 100-80-50 roof structure. Even if you haven’t used up your annual maximum by the time you need the expensive procedure, you will still have to pay several hundred dollars for it.
What is not covered
Dental insurance also rarely covers expensive procedures such as orthodontics and cosmetic dentistry, even if you are trying to argue that you need a procedure to relieve emotional pain and suffering. When insurance covers them, annual maximums often still prevent you from saving much, if anything, after you factor in your semi-annual cleanings and exams.
Most dental insurance plans provide a waiting period during which major procedures are not covered for one year after the start of the plan, while minor procedures are not covered for three months.
Wait will not work
If you think you are just going to hang in there and buy dental insurance when you need it, think again. Due to what’s called a waiting or trial period, this strategy won’t work (you didn’t really think you found a way to outsmart insurance companies, did you?). Waiting periods mean that, for example, one year after your first enrollment, your insurance will not cover any major work (such as crowns or root canals), and for three months after your first enrollment, it will not pay for any minor work. (like fillings). Waiting periods vary by policy.
Insurance companies know that when you need a filling or a crown, you need it now. If you tried to do this, you would likely suffer a lot of discomfort and end up losing your tooth (and having to pay full price for this extraction).
Even with employer-sponsored group plans, it is important to carefully review the details of the plan to see if it is profitable for your particular situation.
Considerations for group plans
Surprisingly, even if your employer offers dental insurance, you might be better off skipping it. Many people assume that employer-provided benefits are automatically a good deal because you are receiving a group rate, but that is not necessarily true.
When evaluating your employer’s dental plan, be sure to consider monthly payments, annual maximum, and coinsurance. Your employer may offer you a great plan at just $ 20 per month to cover your whole family with a generous annual maximum, or a mediocre plan at $ 50 per month with an annual maximum of $ 1,000. With the first one you can really profit from it, but with the second you might lose your money. Do the math for your own situation to see if you are likely to be okay with it.
One situation where it may be a good idea to get dental insurance, which seems like a good deal in the long run, is if you are living paycheck to paycheck to paycheque with little or no money saved. When you don’t have dental insurance, you should be able to pay a bill of $ 1,600 when the work is done (if not all, then in quick installments). If you can’t do it and your options are overpaying for dental insurance, neglecting your only teething, or putting the dental work on a credit card that you’ll struggle to pay, then your best bet is to get the Insurance. You’ll likely waste less money on insurance than if you paid interest on a credit card or your dental health deteriorates.
If you cannot participate in a quality group dental plan, whether it is a Preferred Provider Plan (PPO) or a Dental Health Maintenance Organization (DHMO), then the Perhaps the best way to get ahead of dental expenses is to pay for everything out of pocket. Brushing and flossing regularly, switching to an inexpensive electric toothbrush, getting professional cleanings every six months, and seeing a dentist who does high-quality work that lasts for years can be the most effective ways. effective in saving money in the long run.