Basics of Dental Health Coverage in the us

If you have an employer that offers dental insurance, it will usually be a good idea to accept it, especially if your portion of the premiums will be low. Buying a plan as an individual, however, may not be such a good idea. Individual dental insurance can cost far more than employer-provided insurance and often provides fewer benefits.

The two most common types of dental insurance are HMOs and PPOs. With HMOs you are limited to the dentists in the plan. If the dentist you go to is not a member of the plan, then you won’t be able to use the insurance. PPOs give you more flexibility when it comes to choosing dentists, but they usually have a cap, which is a maximum amount that they will pay out per year.

In order to decide if it is worth it to join a particular plan, you should consider the costs compared to the benefits. For example, say you are considering an individual plan where the premiums are $50 per month, for a total cost of $600 per year. You will probably get 2 free check-ups per year, plus free or reduced-cost x-rays. But that routine work alone would not cost you $600 per year if you paid out of pocket. If you only have routine work done, you would be better off paying for it yourself, rather than pay for the plan premiums.

But what about work above and beyond the routine, such as fillings, root canals, periodontal work, oral surgery, crowns and dentures? Here, you need to look at what caps and deductibles the plan has. Say a plan has a deductible of $100 per year and a cap of $1200 per year. If you have dental work done that costs several thousands of dollars, how much will the insurance save you?

Suprisingly, the most that you can gain from having insurance, in this example, would be $500 per year. You will pay $660 per year for premiums and $100 for the deductible. The most you can get back per year would be the cap amount of $1200. So you pay $700 and get back $1200, for a net gain of $500.

That sounds okay – $500 is certainly better than nothing. But is it really worth it to get the plan? In this example, you will be paying $600 every year, whether you are having expensive dental work done that year or not. Chances are, most years you will not be getting new dentures, having oral surgery, etc. Having insurance may give you a feeling of peace of mind, but if the plan has high premiums and a low cap, as most individual plans do, then financially it may not be worth it.

If you are interested in buying dental insurance and you are unable to get a plan through an employer, see if any associations or groups you belong to offer group plans. Alumni associations may offer group plans. AARP has plans for people over 50, and Costco has plans for its executive members. You may also be able to get dental insurance as an add-on to an individual health plan from companies such as Blue Shield and Kaiser.

One alternative to dental insurance is something called a dental discount plan. These plans are usually a lot cheaper than traditional dental insurance. They enable you to get a discount, sometimes substantial, on work done by participating dentists, and there are no annual caps. The disadvantage of the dental plans is that you are limited to the dentists who are members of the plan. These are usually dentists who, for one reason or another, are trying to attract new patients. The plans also usually don’t have many specialists to choose from – mostly just general-practitioner dentists. If you are interested in a discount plan, they are easy to find and buy online. Just make sure that you check first and see if your dentist, or a dentist you are willing to use, is a member.