Someone who wants to know whether purchasing dental insurance is worth it needs to know what kinds of insurance plans are available, how much plans costs, and if dental insurance is cost-effective.
Types of Dental Insurance Plans
There are three types of dental plans. An indemnity plan allows patients to choose any dental professional. Secondly, the preferred provider organization(PPO) also permits patients to select any dental provider, however, the patient’s cost is lower when they choose to receive care from the network of preferred providers. Finally, a health maintenance organization(HMO) limits patients to getting their care from the HMO’s network of providers. In the United States, PPO plans are the most popular.
What Dental Insurance Covers
Dental plans typically offer 100-80-50 coverage. These numbers mean:
- Preventative care such as two routine exams a year, x-rays, and routine cleanings has 100% coverage.
- Minor procedures, which include fillings, extractions, and periodontal care, have 80% coverage.
- Major procedures such as dentures, crowns, and bridges have 50% coverage.
Indemnity plan patients who need treatment other than preventative care usually have to meet a deductible before plan coverage pays. Most dental plans have an annual maximum payout between $1,000 and $2,000. Plans generally don’t cover cosmetic procedures.
How Much Does It Cost to Buy Dental Insurance?
The cost of annual dental premiums varies widely and is based on the type of dental plan. Based on a 2016 report from the National Association of Dental Plans, the average for one employee’s annual share of a workplace plan was $168.72 for an HMO, $293.88 for a PPO, and $366.84 for an indemnity plan. According to the same report, data was last collected for individual (non-workplace) plans in 2009. At that time, annual cost for such plans was $48 to $180.
When Is Dental Insurance Not Worth Buying
It’s been estimated that one-third of people with dental insurance never go to the dentist. Dental insurance isn’t worth buying for people who are never going to use it. Conversely, dental insurance might not be worth it even for those who do use it. The annual cost of routine dental care may be less expensive than the dental plan’s premium. According to Fair Health Consumer, an uninsured adult patient can expect to pay $114 for a cleaning in an expensive market like Washington DC. That patient’s annual out-of-pocket costs for two cleanings is $228 and is less than an employee’s PPO or indemnity premium. Since some dentists offer discount plans for patients who don’t have dental insurance, the self-pay costs could potentially be even lower.
When Dental Insurance Is Worth It
There are circumstances in which it pays to have dental insurance. Dental insurance provides a cost savings to patients that need major dental procedures. For example, Fair Health Consumer says an uninsured patient in Washington DC could expect to pay $2,462 for upper dentures. An insured patient gets a lower cost for the procedure that the dental plan has negotiated. Then patient only has to pay half of the reduced fee because dental insurance covers the other half.