Paying to maintain good health doesn't come cheap - that's why companies offer insurance to help pay for costs. However, depending on the state of your health and your finances, you may be asking yourself if getting insurance is worth it, particularly dental insurance.
Strictly speaking, it's not the most necessary type of insurance you can opt for, even if there are many reasons why you should get dental insurance. Here, we break down the hypothetical cost of dental insurance and what you can do to pay the bare minimum.
How to estimate the cost of dental procedures and insurance for them
Estimating your possible dental costs may help you decide whether dental insurance would be financially beneficial. Dental insurance companies will show you a quote online so you can easily see what your premiums might be.
You may want to compare your estimated yearly premiums to the cost of a year of procedures. You can estimate how much your dental expenses might be either by talking with your dentist or by researching costs online.
You can use the estimates to help you decide whether you should pay out of pocket or plan your dental expenses based on your insurance coverage. Two resources for looking up procedure costs are The Fair Health Consumer Organization and the Guardian Insurance website. Estimated costs are sorted by zip code and will show a low and high rate so you can see a range of what a procedure may cost in your area.
Other factors can affect your yearly dental expenses as well. Unfortunately, senior premiums are usually more expensive. Youth orthodontics may also cost more. Smokers are usually quoted higher premiums as well.
Monthly premium rates can also vary greatly by region and area. We found that within the same insurance company rates may vary by as much as 30% depending on the zip code.
While some financial planners suggest dental insurance may not be worth paying for, we did the math to discover that it is usually worth it, provided you attend all of your allowable preventive exams and cleanings. We also learned that if you need any type of work, such as a root canal or filling, you will definitely notice cost savings.
However, as previously mentioned, premiums vary greatly by the type of plan, your location and your age. So you'll want to obtain a few quotes from insurance companies that provide coverage in your area. You'll also want to verify that your dentist accepts your chosen insurance before you sign up with a new provider.
Why do smokers pay more for dental insurance?
Most dental insurance companies charge smokers higher premiums than they do those who don’t use tobacco. This is because insurance companies assume more financial risk when they cover a smoker.
In general, someone is considered a smoker if they have smoked in the past year. Some insurance companies extend that criterion back as far as five years, according to InsuranceQnA.com.
“The reason why smokers are charged higher dental insurance premiums is that those who smoke are more prone to diseases of the gums and teeth,” the article states. “In fact, smoking is considered one of the main reasons for tooth loss.”
The Oral Health Foundation argues that individuals who smoke tend to produce more bacterial plaque in their mouths than normal, which can ultimately cause gum disease. “The gums are affected because smoking causes a lack of oxygen in the bloodstream, so the infected gums don't heal. Smoking causes people to have more dental plaque and causes gum disease to get worse more quickly than in non-smokers.”
How to save on dental expenses for children
One way you can save on your child’s dental costs – and ensure they have an attractive, healthy smile – is to have a dentist coat their teeth with a sealant. This plastic or plastic-like coating helps prevent cavities and can keep tiny cavities from expanding. Not only can it spare your child from developing cavities, it also saves money in the long run.
In another article by the American Dental Association (ADA), the non-profit says sealants have been found to cut the risk of decay in molars by 80 percent. Citing a 2016 report from the Centers for Disease Control, the ADA suggests school-age children who don’t get sealants have almost three times as many cavities as children with sealants. Some adults can also benefit from sealants.
The process is easy. The dentist starts by cleaning and drying the teeth, then applies a gel to help them hold the sealant. After rinsing off the gel, they then apply the sealant and harden it with a special light. Sealants are clear, and they can last for several years.
All the insurance companies we reviewed cover some of the cost of sealants, although coverage varies by provider and policy. In the policies we looked at, the maximum age to qualify for sealant coverage ranged from 14 to 19 years old.
How can I reduce my dental care expenses?
A smart start to reducing dental costs is to visit the dentist, since preventive care – such as routine checkups and cleanings – can help you avoid more expensive procedures in the future. Lacie Glover, writing in NerdWallet, cites Centers for Disease Control and Prevention statistics that show that between 40 and 60% of Americans don’t make dental appointments as frequently as they should – and for 42%, a key reason is cost.
Glover lists several ways to trim dental expenses, including investigating the cost of dental insurance strategically. If your oral health is generally good, you could weigh the cost of two simple annual cleanings against the cost of insurance to see what makes the most financial sense.
However, if it has been a long time since you’ve been to the dentist or you are experiencing pain, you’ll probably need more than basic procedures, and that’s where dental insurance can help. And you can sign up for it at any time during the year rather than only during a specific open enrollment period, which is the case with health insurance. If you opt to not buy dental insurance, Glover cites other options, such as a dental savings plan, health savings account or flexible spending account. You can also look into getting care at dental schools or working with your dentist to arrange payment options.
Money is tight – should I skip dental insurance?
If your budget is tight, you might be considering not taking out dental insurance. It’s true that some people can get by without insurance coverage and that going without can save a substantial amount of money. However, whether it’s worth forgoing coverage depends on how much you are willing to gamble that you won’t need costly procedures during a given year.
It is possible to come out ahead by not paying for dental insurance – assuming all you need is basic work, according to the online financial website Investopedia. For example, if you simply need exams, x-rays and cleanings in a year, you’ll probably pay about $400 out of pocket. According to the website’s calculations, most insurance premiums add up to approximately $600 a year.
However, things get dicey if you need more complex – and therefore more expensive – work done. If you need a crown, root canal or some fillings on top of your semi-annual cleanings, the cost could add up fast, even with insurance. That’s because many dental insurance plans have rather low annual maximums, possibly as low as $1,000, according to Investopedia. Once you rack up more than $1,000 in bills, you’re off the hook for the rest.
Still, dental plan proponents note that going without dental treatments can end up costing you vastly more in the end because tooth and gum problems typically don’t get better on their own. However, many dental insurance plans have waiting periods before you can use them. And if you don’t have insurance and need dental work, you can possibly negotiate a payment plan or lower price with your dentist.
No matter how you look at it, the answer to this question isn’t a simple one.
Why is dental care considered a luxury?
Health insurance is a big deal in the United States. Many worry more about losing their health insurance than their paycheck if they lose a job. However, dental insurance is often overlooked and is generally considered a luxury rather than a necessity.
Shanna McGettrick, a dentist, addressed this question on Quora in 2017, observing that dental care is regarded as a luxury because people are “ignorant” about how important dental care is to their overall health. She partly faults the healthcare system for this, adding that health care providers tend to treat “systems and body parts instead of a whole person.”
McGettrick also faults dental insurance for not keeping pace with the cost of dental care. Additionally, she says she also “partially blames the profession of dentistry for not getting loud and obnoxious enough to wake people up” to the fact that dentists are regarded as “technicians” rather than “health care providers” – a perception she says needs to change.
A 2014 Atlantic article draws the same conclusions. “About a third of people in the U.S. don’t visit the dentist every year, and more than 800,000 annual ER visits arise from preventable dental problems,” the article states. This is due in part to dentistry and medicine being regarded as separate and unrelated professions and may stem from historic prejudices during the 1800s, because barbers and hairdressers did basic dental work.
Can medical insurance help pay for my dental care expenses?
It is certainly possible. In fact, in the United States, some dentists are investigating whether certain mouth and jaw procedures should be billed first through medical insurance and then dental insurance if they are genuinely medical matters.
Medical insurance often pays more than dental insurance, which sometimes caps what it will pay, according to a 2018 New York Times article. Dental insurance covers certain expensive procedures at just 50 percent, and some are not covered at all.
The result is that some people end up paying thousands of dollars in out-of-pocket expenses or have to forego treatment because they cannot afford it. Dr. Chris Farrugia, a dentist in Florida, led a two-day course in medical billing to teach dentists and dental staffers how to code procedures for medical insurance, according to The New York Times.
He recommends getting a medical insurer to pay for full head, neck and mouth exams conducted by a dentist on a new patient “since the goal is to assess more than just the teeth,” the article said. “Medical insurers should also cover oral problems attributable to an underlying medical condition, such as diabetes or dry mouth, a common side effect of many medications,” Dr. Farrugia said.
Dentists also check for temporomandibular joint (TMJ) problems, look at the lymph nodes, do oral cancer screenings, examine soft tissues in the mouth, and inspect muscles and bones in that area “. . . so that is a comprehensive medical exam,” according to Dr. Rashpal Deol, another dentist quoted in the article.
Kristine Grow, a spokesperson for America’s Health Insurance Plans, said that some dental work can be covered by medical insurance but also said that those insurers are careful to watch for inappropriate or fraudulent billing.
What to do when you've hit your dental insurance cap
Many dental insurance plans have a maximum amount they will pay each year. If you have already hit that limit for the year, what do you do if you need an expensive procedure? In many cases, it’s unwise to delay dental work – the condition could get worse, and you could end up losing a tooth or getting a serious gum infection. Luckily, you have options, including the following:
1 – Try negotiating with your dentist, especially if you have to pay out of pocket. Some dentists allow you to set up payment plans, so you can get the care you need and then pay for it in increments.
2 – Anticipate future needs and work with your dentist to set up appointments and treatment so you can get the greatest use out of your dental insurance. An article on DentalPlans.com recommends planning non-emergency treatments to span two years. “For example, if your plan provides a year’s coverage starting in January and you need a root canal and crown that will cost about $3,000 you might be able to get $1500 worth of care in December, and finish your treatment in January,” the article says. It goes on to say that this assumes you haven’t used your entire dental coverage amount in December and aren’t experiencing a painful emergency.
3 – Buy supplemental insurance to augment your dental insurance plan. DentalPlans.com says that, unlike regular dental insurance, supplemental dental insurance typically has no waiting period and no constraints on pre-existing conditions. Unfortunately, supplemental plans can be costly.
What if my dentist is out-of-network?
Dentists can choose to join insurance providers’ preferred networks so patients can get the most out of their insurance benefits. If your favorite dentist isn’t part of your insurance provider’s network, you may end up paying more for your visits.
As with other types of insurance, dental insurance companies prefer you use an in-network dentist and will cover a larger share of the cost than if you visit an out-of-network dentist. As part of their agreement with the insurance company, in-network dentists don’t charge patients more than the costs covered by the insurance plan.
Many dental insurance companies have a list of in-network dentists on their websites. This makes it easy to find a provider your insurance will cover. However, if you choose to see your preferred dentist even though they are out of network, you could end up paying much more out of pocket.
If your dentist isn’t an in-network provider, you need to make some decisions. According to a 2018 article on Benefits Bridge, which is sponsored by United Concordia Dental, you have four choices:
- Stay with your insurance plan, see the dentist you like and simply pay more.
- Try finding a new dentist that is included in your dental insurance plan’s network.
- Try switching to a new dental plan that includes your preferred dentist.
- See if you can join a dental savings plan to help cover the costs of going to your out-of network provider.