The short answer
Dental insurance is worth it when your employer pays part of the premium, or when you expect regular care or bigger work. It is often not worth it if you only need two cleanings a year and you buy the plan on your own.
Dental insurance works differently from health insurance. It is closer to a prepaid discount with a low cap. You can find out in about ten minutes if a plan makes sense for you. Here is how.
How dental insurance works, and what the numbers look like
You pay a monthly premium. The plan pays a share of your dental bills, up to a yearly maximum. Humana describes the common pattern: 100% of preventive care, 80% of basic care and 50% of major care, once you meet a deductible and for in-network care.
Preventive care means cleanings, exams and routine X-rays. Basic care often means fillings, extractions and gum treatment. Major care means crowns, bridges, dentures and surgery. Different plans put the same treatment in different groups, so check yours.
Most plans also include a yearly maximum, waiting periods for bigger work and rules about how often they pay for the same thing. The ADA lists annual maximums, waiting periods, co-insurance and frequency limits as the items that most affect your cost.
Consumer Reports found that individual plans cost about $20 to $80 per month, with deductibles of $50 to $100 and yearly maximums of $1,000 to $2,000. It cites a middle yearly maximum of $1,500 from the National Association of Dental Plans.
A yearly maximum of $1,500 may not go far. The article lists 2018 prices of $959 to $1,650 for a crown. Even with newer plans offering higher caps, a few big treatments can use your yearly benefit. A dental plans association executive told Becker's Dental Review that plans with maximums of $1,000 or less dropped from about 53% of the market to about 34%, and PPO plans with $2,500 or more went from 5% in 2017 to 15%.
When insurance is usually worth it
Insurance tends to pay off in these situations:
- Your employer pays part of the premium. Consumer Reports says to take it if offered, since employers often pay much of the cost.
- You know you need work this year, like a crown, a root canal or gum treatment.
- You have a history of cavities or gum problems and need frequent care.
- You have a family, and several people use the plan.
- You are likely to skip visits without it. Plans that pay for cleanings can nudge you to go.
When it may not be worth it
Consumer Reports makes a point that many people miss. If you only need basic care, you can pay more in premiums than the care costs. Say you buy a plan at $40 a month. That is $480 a year. Two cleanings and exams might cost $300 to $400 out of pocket. Unless you need more, you may lose money.
Waiting periods can also cut value. If a plan makes you wait 12 months for a crown, and you need one now, you may pay full price for a year of premiums before the plan helps. Look at this before you buy, not after.
A ten-minute check
Use this simple method with any plan:
- List the care you expect in the next 12 months. Ask your dentist's office for the fees.
- Add the yearly premium, plus the deductible.
- Estimate what the plan would pay, using its percents and its yearly maximum.
- Subtract what you would save from what you pay in premiums.
- If you come out ahead, or close to even with peace of mind, the plan is worth considering.
- Do it again for a quiet year and a busy year.
A made-up example of a busy year
Say a plan costs $45 a month, or $540 a year. You have two cleanings and exams, which the plan pays in full, saving you about $300. You also need a crown that costs $1,300, and your plan pays 50% after the waiting period. That saves you $650. Your total savings are $950 against $540 in premiums, so you come out about $410 ahead.
Now take a quiet year. You have the same two cleanings, and nothing else. You save $300 and pay $540, so you are $240 behind. Over two years, the plan comes out ahead, but only because of the crown. These are made-up numbers. They show why the answer depends on the care you need, and why it helps to ask your dentist what they expect for the next year.
Other ways to save, and tips for picking a plan
If insurance does not make sense, you still have options. Consumer Reports mentions dental schools, which can cost about 30% to 40% less, and community health centers with sliding-scale fees. You can ask your dentist for a cash price or a membership plan. You can also use an HSA or FSA if you have one, and set aside the money you would have spent on premiums.
Whatever you choose, do not skip care. Many adults skip needed dental care because of cost, and that is true even for some people who have insurance. Cost is one of the main reasons people put off the dentist, but waiting can cost more later. Small cavities become big ones. Gum disease grows quietly. Regular visits help you catch problems early, when the fix is smaller and the bill is lower.
If you decide to buy, a few tips help. Check that your dentist is in the network. Look at the waiting periods, the yearly maximum and the coverage percents for the care you may need. Read about exclusions, such as limits on implants or cosmetic work. If you can get a plan through work, compare it with plans you could buy on your own.
Also, ask about what happens in year two. Some plans raise their price, and some change their networks. Keep your plan documents in one place. When you go to the dentist, bring your card, so the office can check your benefits.
Using your insurance at KDA
At Kendall Dental Associates (KDA), we accept most dental insurance plans, and most Medicare supplemental plans. Financing is available as well. If you are comparing plans, call us with the plan name and we can tell you what to expect at our office.
We are at 8833 SW 107th Ave, Miami, in the Kendall Mall, with free outdoor parking. Call 305-271-1421. We are open Monday to Friday, 8:00 AM to 5:00 PM, and we offer emergency care 24/7.
Common questions
Is dental insurance worth it for one person?
It can be if you need more than basic care or if your employer helps pay. If you only need two cleanings a year, the premium may cost more than the visits.
What does dental insurance usually cover?
Many plans pay 100% of preventive care, 80% of basic care and 50% of major care, after a deductible. Details vary by plan.
Is there a waiting period for dental insurance?
Many plans have one for bigger work. Humana's standard listing shows no wait for preventive care, six months for basic and 12 months for major.
What is a good yearly maximum?
Consumer Reports cites a middle of about $1,500. A higher maximum helps if you may need crowns or other major work.
Can I go to any dentist with dental insurance?
With a PPO you can, but you pay less in network. Some other plan types require a network dentist.
This article is general information, not medical advice. Your dentist will confirm what is right for you at your exam. General information checked against: consumerreports.org, deltadental.com, humana.com, beckersdental.com, ada.org.