Dental insurance will cost you much less in premiums than health insurance, but of course there’s a catch. Most health insurance policies cover a hefty percentage of even towering expenses once you’ve paid your deductible. But dental insurance policies have an annual limit to coverage, from $1000 to $1500 a year, along with a $50 to $100 deductible. While plans may pay 80% to 100% of exams, x-rays and cleanings, when it comes to crowns, root canals and gum-disease treatments by in-network dentists the benefit may be only 50% of the cost. Some procedures, such as orthodontia and cosmetic dentistry, are not covered at all.
It's not surprising that cost constraints can make even people with dental insurance delay needed procedures. Some put off care because their insurance doesn’t cover the procedure, and others because they have used up their maximum coverage for the year, according to a survey by Consumer Reports.
To avoid getting caught with unexpected expenses, here some key steps to take when buying dental insurance.
Find Out If You Can Get Group Coverage
The great majority of people with dental insurance have benefits through their employer or other group coverage programs such as AARP, Affordable Care Act marketplace health insurance policies or public programs such as Medicaid, Children’s Health Insurance Program and TriCare for the military.
These plans are generally less expensive than purchasing individual insurance and may also have better benefits.But take a good hard look at the details of even an employer-sponsored plan to decide whether the premiums are worth the money for someone in your situation.
Check Into Individual Policies
More expensive than group policies – and often with more limited benefits – individual policies (whether you're buying one just for yourself or for your family) often have waiting periods for major procedures. If you’re thinking of signing up for a plan “just in time” because you need implants or a new set of dentures, realize that insurers are well aware of that tactic and institute a waiting period of perhaps a year before you can start using certain benefits.
It's best to comparison shop. Get price quotes and policy details from insurance-company websites or talk to a knowledgeable insurance agent.
Examine the List of Dentists in the Network
Indemnity insurance plans allow you to use the dentist of your choice, but the common PPO and HMO plans limit you to dentists in their networks. If you have a dentist you like, ask which insurance and discount plans he or she accepts. If you’re OK with using a new dentist, a PPO or HMO might fit your needs.
But be wary if a new dentist you visit says you need a great deal of unexpected work. A revealing account by the son of a dentist describes how some in-network dentists may recommend unnecessary procedures to make up for income lost on preventive services, for which they are reimbursed at a low rate by dental insurers. Ask health professionals, neighbors and friends if they can recommend a local dentist they’ve found to be good. Then check what insurance and discount plans those practitioners accept.
Know What the Policy Covers
In order to budget for dental expenses, it's important to carefully review the policies you’re considering. For example, from the time your insurance begins, AARP Delta policies cover gum cleanings, denture repairs, restorations, oral surgery and root canals. But you need to wait until your second year of coverage to get benefits for gum-disease treatment, crown and cast restorations, dental implants or dentures. Even then, the benefit is limited to 50% of costs.
If you or your child need major dental work, know that you’ll likely have to pay a hefty share of the cost. With both group and individual policies, remember benefits are limited and can vary significantly. Group plans may also have waiting periods, and almost all plans pay only a fraction of costs for major work, so check the details. Your coworkers or friends may be insured by the same company but have a different benefit package from the one you are offered.
The Bottom Line
The bright spot of dental insurance is that coverage is good for preventive care, such as check ups, cleanings and dental x-rays (though x-rays may be covered less frequently than eager dentists want to take them). Adults and children with dental benefits are more likely to go to the dentist, receive restorative care and experience greater overall health, according to a report by the National Association of Dental Plans. Purchasing insurance may well motivate you to get preventive care and avoid more expensive and uncomfortable procedures.
When purchasing individual dental insurance (rather than group insurance through your employer or another source), be aware that major procedures may not be covered in the first year, and even then the benefit is likely to be only half of what the dentist charges. You’ll need to set aside money in a health savings account or personal fund so you’re not caught short if you need major work.