Q: Is it better for me to pay out of pocket for dental care and not worry about dental insurance?
A: For those who purchase their own insurance, the decision to purchase dental coverage is not always as clear-cut as the decision to purchase health insurance.
While an uninsured patient can incur hundreds of thousands of dollars in medical costs relatively quickly, being without dental insurance will not directly result in that sort of financial ruin. But untreated oral infections can lead to other systemic health problems that can be life-threatening, and access to affordable dental care is much more than just a cosmetic issue.
Compared with other medical care, Americans are far more likely to skip necessary dental care because they can’t afford it – and the Affordable Care Act hasn’t helped dramatically for adults. (The law did mandate some expansion of pediatric coverage.)
For now at least, there’s no premium assistance available to offset dental premiums for low-income families, and embedded adult dental coverage (dental coverage included within a health policy) is very rare.
And, while private dental plans generally present a better value than self-insuring, they can leave patients with significant out-of-pocket costs if extensive dental work is needed.
Running the numbers
But how would the costs of your dental care with dental insurance compare to your expenses without?
A recent insurance industry study of hypothetical dental scenarios compared the cost of self-insuring (paying the full dental bill yourself, without buying insurance) versus a variety of dental insurance plans and dental discount plans. The three scenarios involved minor, moderate, and extensive dental work, and associated costs. In every case, the most expensive option was to self-insure.
Their model scenarios included x-rays, exams, and biannual cleanings, which some people forego. And of course their model scenarios also included obtaining the necessary dental care, whereas in reality, a not-insignificant number of people simply don’t go to the dentist at all.
According to Gallup, one in three American adults said that they did not visit the dentist in the last year. Obviously, for the group that didn’t seek care, dental costs are zero. But as Christopher Smith’s story illustrates, unaddressed dental problems can lead to much more significant health problems.
Clearly, going entirely without dental care isn’t a viable long-term solution. Given that virtually everyone needs at least basic preventive dental care – and even with preventive care, most people end up needing additional dental care as well – it stands to reason that some sort of dental coverage will be beneficial to most people who buy it.
And for some people, the monthly premiums actually serve as an incentive to encourage them to seek out preventive dental care and treatment for minor dental ailments before they become major issues.