From 2000-2010 one in four Americans put off seeing a dentist for necessary treatment because they couldn’t afford it. While similar issues in healthcare may be improving under the Affordable Care Act, only pediatric, not adult, dental coverage is included as an “essential health benefit.” With millions more shopping for and purchasing health insurance, people are searching out the best coverage for their dental needs.
There are three main options when it comes to paying for dental care: cash, dental insurance, and dental savings plans. Dental insurance and savings plans can save you money over paying with cash but do have some caveats. Beyond financial benefits, those who either have dental insurance or savings plan as a group, get treatment more often and have fewer teeth extracted. Although you can get better dental health for less money with either of those options, it is worth the time to look into the differences between the choices so that you can get the best plan for your needs. The results might surprise you!
With a dental insurance plan, you pay a monthly premium in return for the insurance company paying a percentage of your cost when you see a dentist. People commonly have “100-80-50” coverage, which means that the insurance would pay 100 percent of the cost of basic care (cleanings, 1-2 checkups annually); 80 percent for fillings, root canals, and other basic procedures; and 50 percent for crowns, bridges, and major procedures. Dental insurance comes with some surprising drawbacks and causes for concern. With these plans, you have to think about claims paperwork, waiting periods, deductibles, maximum benefits, and the potential for surprise exclusions and limitations. You usually have to wait 6 months (up to 18 months on some plans) for treatment beyond a basic exam, so if you want to enroll in a plan because you need expensive work soon, dental insurance might not be for you. When choosing a plan, be sure to do some research to discover any exclusions: one investigation into dental insurance found that certain plans don’t even help pay for a root. What really makes dental insurance less of a value is the stingy annual maximum caps that insurance companies give, with most policies capping at only $1,000 annually. Dentists say these caps haven’t changed since the late 1970s.
In general, dental insurance comes with “free” twice-a-year cleaning and exam, meaning you pay nothing out of pocket and they don’t count toward the coverage limit. Annual premiums for a family of four usually run between $1,100 – $1,400 in 2015.
Dental Savings Plans
The first thing to understand about dental savings plans is that they are NOT insurance. Dental savings plans are like membership programs (think Costco) —you pay a monthly premium, typically substantially lower cost than dental insurance, to join and get access to discounted services at participating dentists.
One of the benefits of these plans is that they don’t have deductibles, co-insurance, waiting periods, annual maximums, or claim forms to deal with. Dental discount plans generally involve more out-of-pocket expenses with a lower premium that works to offset payments made at the time of service.
Dental Insurance vs Dental Discount Plans
*Prices above are representative of a sample set and may not reflect actual pricing.
First, it’s worth repeating that both of the options will save you money compared to paying in cash. Both plans also have network limitations, only covering your visits or getting you the negotiated discount at providers they work with. With that in mind, each plan has certain benefits depending on your needs. If you need a lot of work done quickly, dental discount plans usually are better. Dental insurance with its waiting periods and annual maximums may leave you with a hefty bill to pay. Dental insurance also generally has a higher premium, so if you only want limited work done or one cleaning per year, a discount plan may be a better option. If you are diligent to get your two cleanings with exams per year for every member of your family, dental insurance might be a better deal.
When deciding between the two, you need to consider a lot of different variables. If you have a favorite dentist, talk to him about what plans they accept. If not, your options are more open. For the typical user we say go with a dental savings plan as the premiums are drastically cheaper, you can use it immediately and the lack of caps or paperwork make things easy.