At some point all of us probably asked ourselves a question on whether we should sign up for dental insurance.
Be it because the dentist spotted something during your last checkup or because a friend incurred significant expenses for having their teeth fixed and did not have insurance coverage. No matter the reason, the question stays the same – shall I or shall I not sign up for dental insurance?
To help you answer this question, we collected several things to consider before you sign up for dental insurance.
According to statistics, only 9% of the adult population in the US has poor dental health condition with 70% having good to very good dental health. This means that those who have their teeth in prime condition will very likely not need extensive dental care beyond regular cleaning twice a year and/or an occasional root canal. The average cost of cleaning is around $80, depending on the state, and the average monthly insurance premium is $300 (could range up till $600 depending on the state). So, in many cases it might not be worth it to get a supplementary dental insurance.
Interesting fact: if you are 50 years old or older you might consider getting an additional dental insurance, which would theoretically make sense as people tend to have more issues with their health when they age. Although, according to statistics over 72% of adults aged 50 to 64 years have good to very good dental health, meaning it’s still very likely not advantageous to get an additional insurance.
If, however, you still decide to get an additional dental insurance, here are a few things to remember:
- If you’re paying for it, use it. Insurances usually work either on fiscal year basis or on calendar year basis. No matter the model, the payout budget allocated for each member usually cannot be transferred from one year to another. Even if you don’t need any dental intervention, use the allocated budget to have your regular cleanings to help prevent and detect any early signs of gum disease, cavities, oral cancer, and other dental health problems.
- Remember about the yearly maximums. The yearly maximum is the maximum amount your insurance is willing to spend within a year per person. Most insurances set it at around $1000 but it differs per insurance company. This means that if your dental treatment goes over that amount, you will need to pay the difference. If you consider that an average cost for a root canal is $900 and your regular cleaning is $80, you might need to pay for the bigger part of your second cleaning within the same year as it will go over your $1000 yearly minimum. And all this while paying around $300 monthly for the insurance.
- Get informed about deductibles. A deductible is an amount you need to pay before your insurance kicks in. Just like your insurance plan, this fee varies from one plan to another. It can can be higher if you choose an out-of-network dentist. This fee is usually set to $50 per year but make sure to check with your insurance what the amount for your particular plan is. Just like your insurance plan, this fee also rolls over each year.
- Dentist fees. Remember that just like anyone else dentists can and will raise their fees every now and then (usually at the beginning of the year) to cover for ever increasing costs of living, materials and services, meaning it is wise to use your insurance before year-end as the fees might be higher the following year.
- UCR (Usual Customary and Reasonable). Many, if not all insurances use something called Usual, Customary and Reasonable fee guide. It is, essentially, a list of dental procedures and their respective fees that the insurance company is willing to cover. It does not necessarily mean that your insurance will pay the exact same fee your dentist charges you but rather the amount they are willing to cover. For example, if a dental cleaning costs $80, your insurance might only cover $62. If you go to the participating dentist, you would normally not need to pay the difference. Your dentist will have an agreement with the insurance company to write that amount off. If, however, you go to another dentist that is not affiliated with your insurance’s network, you will probably end up paying the difference.
- Your dentist of choice. Most independent dental insurance plans will only pay if you go to a contracted or participating in-network dentist. Find out if you could stay with your dentist or are required to go to a participating one. If you are required to go to a participating one, ask for a list of dentists in your area and see if there’s one you would consider going to. Should you want to stay with your dentist, some plans might accept this option but be ready to them paying out less than with an in-network dentist.
- What your insurance covers and what percentage. In addition to making a list of procedures each insurance covers, they also split them into categories by type:- Preventative: Most insurance companies consider routine dental check-ups and cleanings as preventative dental care. However, there are also companies that would add X-rays, fluoride treatments and sealants to this category as well (other companies consider this as restorative or basic care).
– Restorative (or basic): This category usually includes dental fillings and simple extractions. Root canals can be both basic and major depending on severity, however most insurance providers consider them basic.
– Major: Everything that did not fall into the two aforementioned categories is considered major: crowns, bridges, dentures, partials, surgical extractions, and dental implants.
All insurance companies are different, so it is important to clarify which procedure belongs to which category. In addition, there are insurance providers that do not cover major procedures or have waiting periods for certain procedures. If you know that you might have major dental work and if your insurance plan does not cover it, maybe it’s worth it to look for the provider who will suit your needs better.
- Waiting periods. Waiting period is the time your insurance will make you wait until they pay for certain procedures. For example, your provider’s policy could say they pay for dental implants only after 12 months of membership. This means that if you need one now, you will have to pay for it yourself while also paying monthly premiums and waiting.
- Missing Tooth Clause and Replacement Period. Most dental insurance policies have a “missing tooth clause” or a “replacement clause”. A missing tooth clause is a clause that protects an insurance from having to pay for replacing the tooth that was already missing before your policy started. So, if you have a missing tooth and decide to have a bridge, partial or implant, your insurance will not have to pay for this procedure. The replacement clause is similar, except that the insurance company will not have to pay to replace procedures such as bridges, partials or dentures until a certain period has passed.
- Esthetic Dentistry. Esthetic dentistry covers procedures that are not strictly necessary for your health but are rather done for beauty purposes. Teeth whitening is one of the most popular ones, along with gum reshaping, veneers, crowns and other esthetic procedures. While the effects of cosmetic dentistry are gorgeous, remember that 99.9% of dental insurance companies will not pay for it.
Before deciding to purchase a specific dental insurance plan, talk with your dentist about the extent of your treatment plan.
This way you can decide whether a dental insurance is interesting for you or not. It’s important to remember that dental insurance does not work like your regular health insurance. Indeed is not designed to offer comprehensive coverage. Its main purpose is to cover basic dental care for around $1000 – $1500 per year but not more.
Nowadays many dental offices offer interest-free payment plans because they understand that insurance only covers a small portion. Inquire about this possibility with your dentist. For sure this might be a more interesting option if you need extensive dental work to be done.