Having dental work done can be costly, so it’s not surprising that people would look to dental insurance to help. But, is it worth it?
We asked dental professionals for their thoughts. Here’s what they had to say:
The short answer is NO.
Of course, if your employer offers you a dental incentive package, great. But if you have to go out and buy dental insurance, the maximum coverage usually doesn’t justify the premium. For a single, insurance usually costs about $600-700. The maximum payout per year is usually $1,000, or if you’re lucky, $1,500. Most people don’t spend enough money year after year on their teeth to make the premium make sense financially. Now, if you know you need to have several thousand dollars worth of dentistry done then insurance may make sense. Just be sure there isn’t a waiting period for major dental services (crowns, etc), as companies often have a 12-month waiting period for these procedures, just to stop the patient from getting on the insurance, fixing their teeth, and then canceling the insurance. Most patients don’t consistently have several thousand dollars worth of dental expense every year. That’s the only way to “make money” with dental insurance.
Short answer: I do not endorse the individual purchasing of dental insurance unless the treatment and coverage outweighs the premiums.
Many factors determine whether an individual “should have dental insurance.” Their dental needs: A very healthy individual, needing only 2 hygiene visits a year has to calculate the premiums invested for the year to see which cost is greater. There are times when the yearly premium outweighs the yearly cost of 2 hygiene visits paid directly to the dental office. Also, bear in mind that “you get what you pay for.” Getting an individual plan at a low premium comes attached with limitations, deductibles, mandated fees for reimbursement and waiting periods that can cause a person an additional out of pocket.
Dental insurance is “worth it” When your employer provides it at a high-tier level, indemnity, high maximum, high-percentage of coverage, with no downgrades and you have much dental treatment needed.
I would say, as a rule, it’s not worth personally spending money on it. The first reason is that you need to remember that dental insurance was invented in the mid-1970s by medical insurance providers as an additional profit-making mechanism. To that end, the initial caps on coverage were in the $1,200-$1,500 range. While in 1976 that was probably a decent amount of dentistry, now, that’s a crown and a filling at most. The caps have NEVER been raised to account for the increased costs of providing dentistry.
I also recently found out that as an industry standard that between 30-40% of dental insurance premiums are kept as profit by the companies who provide the “insurance.” I’ll also mention the profit-focused policies all dental insurance companies have such as missing tooth clauses, wherein they won’t pay to replace a tooth that was missing prior to the policy coverage start date. Therefore, if a patient needs a bridge, implant, denture or partial denture, they won’t pay for it. They also routinely employ “waiting periods” where you get to pay premiums for up to 2 years(!) before they will cover a percentage of a crown or a root canal. By contrast, when a patient needs treatment, if they use Care Credit they can immediately get the treatment they need and the money is INTEREST-FREE as long as they make their payments on time.
In concluding, keep in mind renowned dental educator Dr. Peter Dawson’s axiom of dental insurance: ”Dental insurance will never allow you to have a healthy mouth.” My own axiom is that dental insurance is designed to take care of the company shareholders, not the patient.
Most private insurance policies are not good. If someone has the opportunity to get benefits through their employer that is usually better coverage but even that is changing. I have seen quite a few policies lately that tell the employee they pay 100% of everything when in reality they pay 100% of what they think it should cost. This is often 50% or less than the actual cost. So if the patient knows that going into it they can plan accordingly. You are not going to be able to get a policy that will pay for the majority of the work unless you are working for a large company. One also needs to be aware if there is a waiting period for certain types of work.
All in all, if you are looking to buy coverage on your own, add up what your premiums will be and your deductible and see if it is more than you usually spend on dental care. You may be better off just putting it in the bank.
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