There's no question that dental work is expensive - especially
when you need to have major work done. If you're not covered through
your job, you may have to purchase it on your own. However, purchased
privately, dental insurance
can be a huge waste of money if your plan doesn't match your needs. In
this article we'll show you how to drill through these plans to find out
if dental insurance is right for you.
SEE: Should You Bite On Dental Insurance?
Overview of the SystemFirst, here's a breakdown
of how private dental insurance works. You select a plan based on the
providers (dentists) you want to be able to choose from and what you can
afford to pay:
- If you already have a dentist you like and he or she's in the
insurance company's network, you'll be able to opt for one of the less
expensive plans.
- If you don't have a dentist at all, great! You can choose from any
of the dentists who are in-network, and again have the option of a less
expensive plan.
- If your existing dentist is not in the network, you can still get
insurance, but you'll pay significantly more to see an out-of-network
provider - so much more that you may not have any chance at coming out
ahead by being insured.
The monthly
premiums
will depend on the insurance company, your location and the plan you
choose. For many people, the monthly premium will be around $50 a month.
This means that you're spending $600 on dental costs each year even if
you don't get any work done.
SEE: How An Insurance Company Determines Your Premiums
Things to ConsiderNow,
you may be thinking that most people don't come out ahead with most
kinds of insurance, and you may be right. After all, if insurance
companies didn't make a profit, they would all go out of business.
Insurance is designed to protect you in a worst-case scenario. Dental
insurance is significantly different from most other kinds of insurance,
however. With policies like health insurance or
homeowners insurance,
the potential downside is so high that almost no one can afford the
risk of not being insured. With dental insurance, the potential downside
is fairly low - and so is the potential upside.
In a good year when you only need the standard cleanings, exams and
x-rays, you are likely to lose about $200 by having dental insurance.
While these services will generally be completely covered by your
insurance because they are considered preventive care. If you paid
out of pocket for them you would probably only spend around $400 for the year instead of the $600 you're spending on insurance premiums.
Will It Be There When You Need It?What
about when you need some work done? In a really bad year, your dentist
may inform you that you need a couple of fillings, a root canal and a
crown. On top of that, you'll still have to pay for your usual
cleanings, exams and x-rays. This is the time to be insured, right?
Unfortunately, your insurance may not be as helpful as you'd expect.
Many dental insurance plans have very low annual maximums of around
$1,000 (this will vary by plan and by provider, of course). This means
that once your dental bills exceed $1,000 in any given year, you're
stuck paying the rest of the bills in full.
You may still pay a lower negotiated fee for the work you need as a
benefit of having insurance, but even the negotiated fees are quite
high. For example, if the dentist's regular fee for a filling is $150,
the negotiated fee might be $100. In this situation, your regular oral
maintenance and fillings will use up most or all of your annual maximum,
so only a fraction of your large dental work bill will actually be
covered. You're likely to still pay $1,000 to $2,000 out of pocket, plus
your annual $600 in premiums. On top of that, while you may pay 0-10%
in
co-pays
on preventive maintenance and 20% in co-pays on fillings, the co-pay on
expensive procedures like root canals tends to be a whopping 50%. Even
if you haven't used up your annual maximum by the time you need the
expensive procedure, you'll still have to pay several hundred dollars
for it.
Dental insurance also rarely covers expensive procedures like
orthodontics and cosmetic dentistry, even if you try to argue that you
need a procedure to alleviate emotional pain and suffering. When
insurance does cover them, the annual maximums still often prevent you
from saving very much, if anything, after you factor in your biannual
cleanings and exams.
Waiting Could Be WorseIf
you're thinking that you'll just hold out and then purchase dental
insurance when you need it, think again. Because of what's called a
waiting or probationary period, this strategy won't work (you didn't
really think you'd found a way to outsmart the insurance companies, did
you?). Waiting periods mean that, for example, one year after you first
become insured, your insurance will not cover any major work (like
crowns or root canals) and for three months after you first become
insured, they won't pay for any minor work (like fillings). Insurance
companies know that when you need a filling or a crown, you need it now -
you won't be able to find out you need a crown, buy insurance, wait 12
months, and then get it taken care of. If you tried to do that, you'd
probably suffer from a lot of discomfort and ultimately lose your tooth
(and you'd have to pay full price for that extraction, too).
SEE: Are Vision And Dental Plans Worth It?
Considerations for Group PlansSurprisingly, even if your employer offers dental insurance, you might be better off skipping it. Many people assume that
employer-sponsored benefits
are automatically a good deal because you're receiving a group rate,
but this isn't necessarily true. When evaluating your employer's dental
plan, make sure to really look at the monthly payments, the annual
maximum and the co-payments. Your employer may offer you a great plan
that's only $20 a month to cover your entire family with a generous
annual maximum, or a mediocre plan that's $40 a month with a $1,000
annual maximum. With the former, you can really benefit, but with the
latter, you're probably wasting your money. Do the math for your own
situation to determine whether you're likely to come out ahead.
There is one situation where it can make sense to get dental
insurance regardless of whether it seems like a good deal in the long
run, and that is if you are someone who is currently living from
paycheck-to-paycheck
with little or no money in savings. When you don't have dental
insurance, you have to be able to pay a $1,600 bill when you have the
work done (if not in full, then in prompt installments). If you can't do
it and your options are to overpay for dental insurance, neglect your
only set of teeth or put dental work on a credit card that you'll have
trouble paying off, your best bet is to get the insurance. You'll
probably waste less money on insurance than you would
paying interest on a credit card, not to mention that you wouldn't want to ruin your
credit score over a few fillings.
Parting ThoughtsIf you can't participate in a quality group plan - either a
preferred provider plan (PPO)
or a Dental Health Maintenance Organization (DHMO) - the best way for
most people to come out ahead on dental expenses is to pay for
everything out of pocket. Brushing and flossing regularly, switching to
an inexpensive electric toothbrush, getting professional cleanings every
six months and going to a dentist who does high quality work that lasts
for years can be the most effective ways to save money in the long run.