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People are often misled by dental insurance, thinking it works like medical insurance with unlimited benefits. Many are surprised by the annual maximum limits and the overall cost of the insurance.

According to the University of Illinois Chicago, more than half of Americans delay dental and other medical care because they can’t afford it, and almost a quarter do not have dental insurance.

Unfortunately, putting off your visit to the dentist can lead to worsening dental health that requires even more extensive and expensive dental care. So what should Americans without dental insurance do? Is dental insurance even worth it?

What is dental insurance?

Dental insurance is insurance for dental care services.

How does dental insurance work?

According to healthinsurance.org, “Dental insurance plans typically have deductibles that must be paid before treatment is provided. They also have benefit caps that limit how much the insurance plan will pay for adult dental care, and there is no limit to how high your out-of-pocket costs can be for adult dental care.”

What does dental insurance cover?

Dental insurance typically covers:

• 100% of preventative services, such as teeth cleanings and x-rays
• 80% of fillings and other basic restorative dental procedures
• Half (50%) of the cost of more major restorative services such as crowns
• Cosmetic dental services are usually not covered by dental insurance.

These percentages are paid on a fee that the insurance company sets, not on the actual fee of the dental practice. Typically insurance companies can have as much as a 30% reduction in the fee.

Additionally, it should be noted that these are just trends in the dental insurance industry. What dental insurance covers will vary depending on your individual dental insurance plan and whether or not your dentist is in-network. If your dentist is an out-of-network (non-participating provider) communication is key so there are no surprises. A good dentist should spell out the actual cost of treatment and what it means to the patient.

Most people have no idea who their dental carriers are or what they cover. To get the most out of your dental insurance (and to understand if it’s worth it) you will need to know what the limits are, how the percentages are paid, and have a clear picture of your own investment.

What does annual maximum mean for dental insurance?

The annual maximum is the maximum amount your dental insurance will pay toward your dental care each year. The annual maximum for dental insurance is typically between $1,000-1,500.

Is dental insurance worth it?

The University of Illinois Chicago notes that “the majority (about two-thirds) of people who have dental insurance get it through their employers, as a separate add-on to health coverage.” For these employees, dental insurance may be worth it, depending on their plan’s coverage and the cost of their dental insurance premiums. Paying a small amount a month is likely a good trade-off to have the protection of dental insurance.

However, those with cost-prohibitive premiums — whether through their employer plan or a private insurance provider — may find that dental insurance isn’t worth it. You’ll want to crunch the numbers to see if dental insurance really saves you money on a yearly basis.

Does dental insurance really save money?

Whether or not your dental insurance will save you money depends on a number of factors:

• The cost of your dental insurance premium
• Your plan’s coverage
• Your plan’s annual maximum
• Whether or not your preferred dentist is in-network
• The type of dental services you typically need
• What your dentist charges for those dental services

If dental coverage is free to you, then it is a savings. If you have to pay a portion of the premium, then you weigh out the numbers. Typically, purchasing an individual plan is never a winning proposition, as premiums are as much or more than the benefit gleaned.

For example, those with good oral health may save money by foregoing dental insurance; Investopedia notes that you could lose money in a year where you only need preventative dental services because the out-of-pocket cost for these services might be lower than what you spent annually on insurance premiums.

What to do if you don’t have dental insurance

If you don’t have dental insurance, you can shop around at your local dental offices and dental schools to get an idea of what procedures typically cost and what type of payment plans might be available.

At DGY Dentistry Ann Arbor, for example, we pride ourselves in clearly communicating your procedures and choices with no-pressure consultations and transparent payment options.  We educate people on other methods to use in lieu of dental insurance or in concert with dental insurance. Pre-tax accounts, health savings accounts (HSA), or even outside resources can be used to assist with costs.

You should not put off dental care if at all possible. Preventative care is the most effective way to keep your oral health in check. The longer you avoid the dentist, the more opportunity there is for issues to worsen and lead to costly problems like gum disease, cavities, and tooth loss.

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