Most of us are familiar with insurance because we have a variety of different plans for medical, car, and homeowners/renters insurance. How insurance usually works is that individuals pay a small amount towards a collective pool of money. This is meant to cover costs in the case of a rare, but expensive incident. However, dental insurance doesn’t work that way. Instead, subscribers get a fixed amount of money to spend each year on dental care, subject to exclusions and limitations. Most patients don’t need or use the full $1,000-$2,000 available to them every year, so these funds often go unused. In addition, most insurance companies will only pay 50% of high-cost, major treatments. This leaves you not only paying 50% of the more expensive treatments but also your monthly premiums and annual deductibles. Given this, does “dental insurance” make sense? For most dental patients, it does not.
Some factors to consider when reviewing the value of your dental insurance:
Limitations that Apply to Everyone
There are certain limitations to dental insurance that apply for everyone who uses it. It is important to consider these when deciding if insurance makes sense for your specific situation.
One major factor is that annual benefits are capped. Whether you use them or not, they will not roll over to the next year. Certain procedures also have lifetime maximums, so you will continue to pay the same premium, but will not be able to use that benefit again. Your plan may also cover procedures that you will never need, but you still have to pay for the potential use. There are also frequency limitations, so you can only have a procedure once every 5-7 years depending on your plan.
Additionally, many insurance plans have a waiting period for major care such as crowns, implants, dentures, and other procedures, which is typically one year. It is also common for plans to contain pre-existing clauses for missing teeth, so your insurance will never pay for the replacement of a tooth lost prior to enrollment.
Also, you may only be able to see dentists within a selected network dictated by your insurance. Some plans do allow you to see out-of-network providers. These are called PPO plans.
What to Consider if You’re Paying Out-of-Pocket for a Dental Plan
Consider what your monthly and annual spend is for the plan and what you are getting in return. Are you taking advantage of all the annual benefits your plan can provide for you? What dollar value do they pay your dentist compared to what you pay them? Is the insurance plan forcing you to delay needed treatment due to waiting periods or annual maximums? Do you feel like you’re able to see the dentist you want and get the quality of care you need to achieve oral health? When a dental plan is not subsidized by an employer with a large group plan, the math shows self-paying individuals lose the majority of the time.
What to Consider as an Employee with Dental Benefits
If you are an employee with a dental benefit from your employer, you should consider whether or not you are truly using this plan to its fullest.
There are two scenarios that are very common when it comes to dental insurance. The first is that you are healthy and you don’t need extensive dental work, so you are paying for access to unnecessary procedures. By not utilizing coverage, you are throwing away the potential use of the money you pay to have access to.
The second is that you need expensive treatment, but you can’t afford to pay the 50% not covered by your insurance, or the annual maximum benefit is not enough to pay for all your needs. Many are only willing to complete procedures their insurances agree to help cover, which guarantees the future cost of your dental care needs will go up because treatment is delayed and problems worsen.
What to Consider as an Employer
If you are an employer paying for a group plan, you should consider that only a fraction of employees will use their dental benefits. Those who need it the most are often those who avoid using it. You should also be aware that plans never pay out to exceed the combined contributions of you and your employees. Dental insurances are businesses. They make profits and pay other dentists to review and justify denying coverage of procedures. This is how they stay viable, so like playing slots at any casino, you can only lose in the long run.
The Impact of Dental Insurance on Your Oral Health
By reducing reimbursement rates in the face of inflation, coupled with illegal anti-competitive practices, many dental insurance companies are forcing dentists to provide a lower standard of care. In these situations, dentists need to see more patients, rush through procedures, buy cheaper materials, pay their staff less, not invest in new technology, and take fewer continuing education courses. The overall result is a poor dental experience for the patient. Instigated by dental insurance, the end result is a decreased likelihood the patient will return to the dentist. A lose-lose for the dentist and patient, but a win for the insurance.
Delaying treatment because your dental insurance won’t cover it also worsens your oral health over time. Many patients who need more than what insurance will pay for feel like they can never catch up with their dental care. This turns into an endless cycle.
An Alternative To Dental Insurance
Since dental insurance is not usually the best option, what can you do to get the dental care you need? We also accept a variety of payment methods including health savings accounts (HSAs), flexible spending accounts (FSAs), third-party financing, and more. We know that navigating the financial side of dental care can be challenging and our team is here to help.