Is a dental policy worth the cost, especially when you know that dental insurance premiums can be more expensive than simply paying out of your own pocket for routine checkups and cleanings?
And like so many other questions in modern world, you need to say, "Well ... the depends." The answer depends on whether you are expecting to face aching bills for your teeth.
Dental insurance comes in four varieties:
- The HMO, or health maintenance organization, option restricts coverage to dental professionals within a specified network.
- The most popular plans are PPOs, or preferred provider organization, policies. Some 70 percent of dental policies are PPOs. They are similar to HMOs but allow patients to see dentists outside the network.
- An indemnity plan which allows a patient to see any dentist and picks up a percentage of the costs.
The advantage of PPOs over indemnity plans is that here's a negotiated discount for services. Dentists within the PPO network typically agree to accept lower fees and can't bill you for the difference.
- Discount plan which charges an annual fee in exchange for discounted services from network providers. Enrollment fees often run between about $80 and $120 a year.
Providers' discounts can range from 10 to 60 percent. Before buying in, be sure to take a careful look at what the plan covers. There is often a lot of restrictive fine print. Although these plans typically cost less than HMOs and PPOs, most often they won't save you as much money in the long run.
Most dental insurance policies emphasize prevention and diagnostics, typically covering two annual exams and cleanings, plus X-rays and, for children and older adults, fluoride treatments. But the real benefit is being covered for bigger-ticket procedures, such as fillings, root canals and crowns.
Dental policies vary widely, and choosing the right one can be difficult. People with dental insurance commonly have what's described as "100-80-50" coverage, meaning it pays 100 percent of the cost of routine preventive and diagnostic care, such as checkups and cleanings; 80 percent for fillings, root canals and other basic procedures; and 50 percent for crowns, bridges and major procedures.
The vast majority of coverage is provided through employee and group policies, with annual premiums of between $235 and $435 per person. The cost to buy an individual policy averages about $360 a year. Paying out of your own pocket for two exams and cleanings and a set of X-rays would cost about $370, on average, according to the American Dental Association.
Most plans cap coverage at $1,500 a year, although higher annual limits can be had by paying a higher premium.
The Affordable Care Act requires insurance providers to offer dental insurance for children younger than 18. Although the new act does not require dental coverage for adults, most state marketplaces will also offer dental coverage for adults. Coverage may be offered as part of a comprehensive health plan or as stand-alone dental insurance.
Dental plans don't bar coverage for pre-existing conditions, though some policies may restrict coverage for people with missing teeth. Cosmetic dental procedures are rarely if ever covered by insurance.
Cost savings can be had by traveling to other countries for dental care. An estimated 400,000 Americans cross international borders for dental care each year and there is a lot of competition for this business.
But, if you're considering this option, do plenty of research. The decision to visit another country for dental care should go beyond simply comparing prices or evaluating the dentists' expertise.
Countries differ in their standards for infection control and safety. The use of fresh gloves, sterile instruments and safe water are not standard practice in all countries. Without these precautions, patients could be infected with diseases such as hepatitis B.