Does dental insurance make sense for you?
Dental insurance is often discussed purely in terms of dollars and cents, with people wondering whether the benefits they get from dental coverage will make the premiums “worth it.” But the first question you should ask yourself is “will having dental insurance make me more likely to visit the dentist and stay on top of my dental health?”
If you’re like most people, the answer is probably yes. According to the National Association of Dental Plans, people without dental insurance are 2.5 times less likely to visit the dentist than people who do have dental insurance.
And it’s much more common to be without dental insurance than it is to be without health insurance. Only about half of American adults have dental coverage, versus roughly 90% who have health insurance.
Nearly a third of Americans haven’t been to the dentist since before the COVID-19 pandemic began. If dental insurance is the thing that gets you into the dentist’s chair in the first place, it probably doesn’t matter whether you “come out ahead” in terms of how much the coverage saves you when you’re paying the bill.
And if you take full advantage of the preventive care benefits that your dental plan provides, you likely will come out ahead, or at least come close to breaking even in terms of how much you spend for the coverage versus how much you save at the dentist’s office, depending on the plan selected.
If you’re considering dental coverage, let’s look at several questions you should consider before picking a plan.
Where should you buy your dental plan?
You can buy dental insurance through the health insurance exchange/marketplace in your state, but this is generally limited to the same open enrollment and special enrollment periods that apply to health insurance.
And in most states (including all 33 states that use HealthCare.gov as their exchange), you can only buy a marketplace dental plan if you’re also buying a health insurance plan at the same time.
But you can buy stand-alone dental coverage through private channels year-round. These plans can be obtained directly from insurers, via local brokers, or from online vendors that offer multiple insurers’ plans.
Is your dentist in the dental plan's provider network?
Some dental plans have provider networks and only pay for services if you use an in-network dentist. Others have provider networks but will still cover some of the cost if you see an out-of-network dentist. And there are also dental plans that don’t use provider networks, and will pay the same amount regardless of what dentist you choose.
If you have a dentist you want to continue seeing, check with their office to see if they recommend a particular dental plan. If they are not a participating dentist with a plan you’re considering that does provide out-of-network benefits, ask how claims are processed. Will the dental office file the claims for you – or are you required to file the claims with your dental insurance?
If you haven’t been to the dentist in a while and would be OK with changing to a new provider, you can compare dental plan options and pick the one that provides the best value. Just keep in mind that if the plan uses a network of dentists, you’ll want to select your new dentist from among those who are in the plan’s network.
Will your dental plan have a waiting period?
If you’re shopping for a dental plan because you’re in need of dental work other than preventive care, be aware that it’s common for adult dental plans to have waiting periods before they’ll pay for basic or major services. The waiting period can usually be waived if you’re transitioning from a comparable dental plan, but it will be applicable if you haven’t had recent dental coverage.
(Basic services include fillings and extractions. Some plans also cover deep cleanings as a basic service. Major services include crowns, bridges, root canals, implants, and dentures.)
Alternatively, some plans will initially pay a small percentage of the cost of basic or major services, and then increase that percentage over time. So a plan might provide better coverage in your second year of coverage than you had in your first year.
You may also find dental HMO plans (DHMO) that have a very limited network of participating dentists, but no waiting periods.
How will your dental plan cap your benefits?
It’s also important to understand that adult dental plans have benefit caps. The benefit cap varies depending on the plan, but it’s common to see plans with a $1,000 or $1,500 annual benefit cap. You’ll find some plans with lower or higher caps, but it’s rare to see benefit caps above $2,000.
So if you’re in need of multiple root canals, for example, you may find that you exhaust the plan’s benefit cap before your procedures are finished. You could still come out well ahead in terms of how much the plan pays versus how much you’ve spent in premiums. But it’s important to understand how much you might have to pay out-of-pocket if you need extensive dental work, even with a dental insurance plan.
If you know that you’re going to need particularly expensive dental procedures such as implants or dentures, you’ll want to pay careful attention to the coverage details of the plans you’re considering. You may well come out ahead with a dental plan, but you’ll need to make sure that the procedures you need are covered by your plan, as some dental plans do not cover procedures such as implants and dentures.
(Note that pediatric dental coverage does not have benefit caps. Dental coverage for kids works more like health insurance – with an out-of-pocket cap rather than a benefit cap.)
How much will your dental coverage cost?
When you’re shopping for adult dental coverage, you’ll see a wide range of plans available. Some have premiums as low as $10 or $15 per month, while others have premiums of more than $50 per month.
In general, higher premiums will tend to get you some level of improved benefits. That could be lower out-of-pocket costs when you need dental care, a more extensive provider network, shorter waiting periods, or a higher benefit cap.
Many dental plans will fully cover the cost of preventive care, including routine exams, cleanings, X-rays, and sealants from in-network providers. But some plans – especially those with very low premiums – will have out-of-pocket costs for these services. You’ll want to look at the details of each plan to make sure you understand how much you’ll pay for various services.
Even if you don’t anticipate needing anything other than preventive care, you may find that you at least break even with the preventive care benefits that the dental plan provides. You can check with dentists in your area to see how much they charge for services such as routine check-ups, x-rays, and semi-annual cleanings. Then total up the amount you’ll pay for the dental insurance, plus the amount that the plan requires you to pay for those services (if any).
Is dental insurance worth it?
Depending on the premium for the plan you’re considering, you may find that you come out ahead by paying for the dental insurance. But that’s assuming you’ll make full use of the benefits and get yourself to the dentist for all of your routine care.
That part is important. If you’re currently spending $0 on dental care because you just don’t go to the dentist, you’ll obviously be spending more with a dental plan, since you have to pay the premiums. But routine dental care can help to avoid major dental care down the road. Your future self — and your wallet — will thank you.
If you have questions about dental coverage in your state, be sure to visit our state-by-state dental insurance guides.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.