Buzz
For the majority of people, having health insurance is an obvious choice. Even if you're in great health, the peace of mind knowing that your insurance will cover most of the hefty expenses in case of a serious health issue is invaluable.
But what about dental coverage? Typically, there’s an annual treatment cap of $1,000 to $2,000, which might lead you to question the value you're receiving for your monthly premium. According to Statista, in 2017, 52% of dental services were paid by private health insurance, with the remaining 48% paid out of pocket.
Below, we delve into what dental insurance actually covers—and who might benefit from purchasing it.
How Dental Insurance is Different from Regular Health Insurance
Once you’ve met your annual insurance deductible, you’re usually in the clear, right? Not when it comes to dental insurance.
Restorative dentist Daniel Balaze clarified that dental insurance deductibles function differently from those for health or auto insurance. “Yes, there is a deductible,” he explained, but it operates more like a shared cost arrangement. After reaching the annual cap set by your plan, any remaining dental expenses are your responsibility to cover out of pocket.
What Does Dental Insurance Actually Cover?
Dental insurance generally covers most basic procedures like cleanings, x-rays, and perhaps a filling or two. But if you accidentally injure yourself, knocking out a tooth and needing an implant, you're likely out of luck. “At best, you’ll pay half the costs up to your plan’s maximum coverage,” Balaze said. “Beyond that, you’re on your own.”
“Dental insurance typically covers preventative care at 100%, basic treatments like fillings and simple extractions at 80%, and more complex procedures such as root canals at 50%,” explained John Barnes, a CFP and insurance agent. “However, each provider may vary slightly.”
Dental insurance often includes a waiting period for major treatments. “In some cases, the waiting period can be waived if you can prove continuous dental insurance coverage,” Barnes noted. But for many plans, if you require a cavity filling before the waiting period expires, you’ll be responsible for the entire cost, effectively leaving you without coverage for that particular procedure.
How to Determine Whether Dental Insurance is Right for You
What about the expenses? Despite the various stipulations attached to dental insurance, deciding whether to purchase it can still feel like a gamble. “For individuals needing significant dental work, the coverage provided by the dental benefits company won't be much,” said Balaze. “But for those with minimal dental needs, the plan may end up costing more than what you actually use.”
If your employer offers dental coverage for a small monthly fee, it’s likely a good deal. Families with children and seniors should consider dental insurance, as they’re more likely to require dental treatments, according to Barnes.
If you don’t have access to employer-sponsored insurance, consider this: If you only visit the dentist for routine cleanings and rarely need any additional treatments, you might be able to skip insurance. “People who maintain their dental health well and can afford to pay out-of-pocket for major treatments” are good candidates for going without dental insurance, Barnes noted.
Medicare insurance agent Michael Lovell suggests evaluating the following factors to help decide if dental insurance is right for you:
· Do you go for cleanings twice a year?
· Is your dentist part of your insurance network?
· Does your annual premium cost less than or equal to the price of two cleanings, two exams, and a set of x-rays?
If the numbers add up, Lovell recommends purchasing coverage. “It helps break your large dental expenses into more manageable monthly payments,” he explained.
For instance, if your employer provides dental insurance for $10 per pay period and you have 26 pay periods in a year, your total premium for the year will be $260. If you ask your dentist the cost of cleanings and yearly x-rays without insurance, and that amount exceeds $260, then getting insurance is a smart move to cover your basic visits.
Before making your final choice, it’s crucial to confirm that your dentist is part of the insurance network you're considering. PPO plans typically offer more flexibility in choosing your dentist but often come with a higher monthly premium.
