Is Dental Insurance Worth The Cost?

Do you have dental insurance? For an increasing number of Americans, the answer is yes. Does it cover everything you want and need? For many of us, the answer is probably not. Dental insurance is a decidedly mixed bag. Most policies are excellent for routine care but less than perfect for more complex and expensive procedures. Let’s explore some of the ins and outs–and what is and isn’t covered.

Do I Need Dental Insurance? What Should I Consider?

More Americans than ever now have dental coverage. According to the National Association of Dental Plans, 293 million Americans had dental coverage in 2022. Now, nearly 90 percent of us have coverage. The downside is that most policies offer only partial coverage. Many dental policies are limited to preventive care with a high deductible or out-of-pocket costs for other treatments. If you’re shopping for a dental policy, here are a few things to remember.

• What are your premiums (the amount you pay for dental insurance)? Premiums can be billed monthly, quarterly or annually).
• What is your copay for each visit? This is the amount you pay when you go to the dentist. For example, you might pay $20 for a checkup, with your insurer covering the rest.
• What is your deductible? This is the amount you have to pay each year before your benefits kick in. High deductible plans are less expensive, but patients pay more upfront.
• Does your plan have an annual maximum? Many plans limit the total amount they will cover each year. Once you reach that number, you’re responsible for additional costs.
• What procedures and treatments are excluded from coverage under your plan?
• Does your policy only cover dentists in its network? If you have a good relationship with your family dentist, confirm they are in-network when looking at a new plan.
• What are your unique needs? Is preventive care a priority, or do you need more extensive treatments like crowns, root canals or implants? Is it worth paying for coverage if your plan doesn’t include the treatments you need?’

What Will My Dental Insurance Cover?

Most policies are adequate for preventive care, and that’s something to celebrate. However, patients should read the fine print regarding other treatments. We can put dental coverage into three categories:

• Preventive care includes exams, cleanings, X-rays and fluoride treatments. Most plans cover two visits a year with a copay. You can also choose a preventive care-only plan at a lower premium.
• Basic treatments include fillings, extractions and other routine care. These less complex treatments are often partially covered. For example, a filling may be 80 percent covered, while a patient would pay more out of pocket for a crown.
• Major procedures, including restorative treatments like bridges, crowns and implants, may be partially covered, or you may have to pay out of pocket. Unfortunately, these procedures also tend to be the most expensive.
• Be aware that most policies don’t cover cosmetic procedures like whitening and veneers. Many families also pay out of pocket for orthodontic treatments.

Does My Medical Insurance Cover Dental Procedures?

Even though oral and overall health are closely linked, your health insurance usually doesn’t cover dental care. However, sometimes your healthcare policy will cover treatments your doctor says are medically necessary: a missing tooth caused by an injury, a severe oral infection or a tooth extraction needed to prevent illness. Oral cancer treatments are also usually covered, even though your dentist may be the first provider to diagnose it. Your health insurance may also cover treatments to help you quit smoking, which benefits both oral and overall health. It’s always best to talk with your insurance company before you get treatment.

What If My Dentist Doesn’t Accept My Dental Insurance?

Ask any dentist, and they will tell you that the amount they get reimbursed by insurance companies for their services is paltry, making it very hard for some practices to justify participating with insurance. But, most dental practices will still submit to your insurance for you, and you will likely still see some benefit, perhaps not at quite the same percentage as a participating dentist. In many cases, the difference is negligible, and if you love your dentist, it’s probably worth staying with them even if they are not participating providers with your insurance.

What If I Don’t Have Dental Insurance?

Regular preventive care is still essential if you don’t have dental insurance. Seeing the dentist every six months may seem like a burden, but paying for checkups is always less expensive than paying for fillings and crowns down the road. Every dental office is equipped to support self-pay patients. Some practices are open to installment plans. However, many patients find low or no-interest financing through companies like Care Credit or making payments on a low-interest credit card an excellent solution.

Is Dental Insurance Worth It?

If paying out of pocket makes you less likely to get routine dental care, dental insurance is worth the cost. According to the NADP, people without dental insurance are more likely to need extractions and dentures. If your employer offers a group plan, signing up is worthwhile since your employer shoulders a significant portion of the premiums. If you’re self-insured, the best approach is a conversation with your dentist and doing the math.

Low-cost preventive care plans are an excellent option for covering the basics. If you’re self-insured, talk to your family dentist, do the math and examine coverage and exclusions closely. At Greenhill Family Dental Care, we’re happy to discuss the costs and benefits of dental coverage and self-pay and help you find an approach that works for you.