Should You Get Dental Insurance? Options For Dental Coverage

by Kosmo on 2011-12-1245

When I was in high school, I had braces. It was a very unpleasant experience, and when I was old enough to be in charge of my own health care (18), I began skipping the dentist entirely. In hindsight, this was a really dumb decision.

When I was about 24, I had a tooth problem that required attention. A friend of mine suggested his dentist.

I had some cavities. I needed a root canal. I also needed a couple of crowns. Those receding gumlines? Yeah, it took three surgeries to fix them — a process that involves taking a patch from the roof of your mouth and sewing it into your gumline. Did I mention that you’re awake and alert when this happens?


The one silver lining in this whole affair was that I had dental insurance. I honestly don’t remember signing up for it when I was hired, but I must have — because when I needed it, it was there. I quickly maxed out the annual benefit, but it still saved me a ton of money over the course of a couple of years.

What about YOU? Should you purchase dental coverage?

dental insurance
Image from trainingtime.files.wordpress.com.

The Nature of Dental Expenses

Dental expenses tend to be a bit more predictable than general medical expenses. While some plain dumb luck might cause a spike in medical expenses, it’s less common for someone with no history of dental problems to suddenly have six cavities in a year. It can happen, but it’s unlikely.

The best way to keep your dental expenses in check is prevention. Brush regularly, floss regularly, and see the dentist on a regular basis. While six month appointments are common, if you have a history of problems, it might not be a bad idea to shift to fourth month intervals to catch problems before they get out of control. Insurance often covers just two visits, but spending your own money on the additional annual visit can save you money in the long run.

It’s also possible to delay some dental expenses. I’ve got a tooth that needs a crown. I’m having this done in January. This allows me to put some money into a flex spending account to cover my share of the cost.

What Does Dental Insurance Cover?

You’re probably going to see multiple levels of coverage. Generally, they are broken down like this:

  • Preventive — This category consists of your standard checkups, x-rays, and such. Often, these are completely covered, with no deductible. This makes sense for the insurance company — catching a problem early means that it is much easier to fix.
  • Basic restorative — This generally refers to fillings. Note that coverage is often for the cost of amalgam (silver) fillings. If you opt for a different material (often for cosmetic reasons), the extra cost is generally your responsibility.
  • Advanced restorative — These are big problems such as root canals, crowns, bridges, implants, and dentures.
  • Orthodontics — Braces. This is usually a separate category, often with a high deductible and/or co-insurance.

There’s some variation in how certain procedures are categorized, though. My current plan pays 80% of the cost of simple fillings and 50% on crowns. My wife’s plan (which we are switching to in January) pays 80% on crowns, but 50% of things like implants.

Cost of Insurance vs. Expected Dental Expenses

The dental plan offered by my employer is so cheap that it’s a no-brainer. The routine checkups for the four members of the family would cost more out-of-pocket than the dental premium. The coverage for other procedures is gravy.

If the cost of your dental coverage is considerably more than the out-of-pocket cost of the dental checkups for your family members, then you’ll need to take a moment to estimate the costs your family will incur. If the family has averaged three fillings each year for the past five years, then it’s reasonable to estimate three fillings for this year. Past performance is not a guarantee of future results, but it’s generally a decent predictor.

Do you have reasons to believe that your dental expenses will be higher during the next year? Maybe your dentist has mentioned that your wisdom teeth are starting to get in the way of other teeth, or perhaps you have a crown that has seen better days and will need to be replaced soon.

You’re also going to have to determine your tolerance for risk. Are you willing to pay an extra $300 in premiums in order to avoid having to pay the full cost of a crown (currently $943 in my locale)? If you have 80% coverage on crowns, you’d save $750 on the cost of the crown if you had insurance. However, if you only have two checkups during the year, then you may have been better off just to pay out of pocket.

Dental Discount Cards

Another way to decrease your out-of-pocket cost is to use a dental discount card. Often, the dental discount cards will be cheaper than full blown dental insurance, but the benefits may be limited, and you may need to choose from a small number of dentists who are on the plan. If you have limited dental expenses, the dental discount cards could be a good option, but if you have significant dental expenses, a regular insurance plan might make more sense.

Let me close with a tale that emphasizes why we probably need coverage — you see, anything can happen!

My dental horror story may very well be one of the highlights of my oral surgeon’s career. You see, I have a tendency to downplay health issues and only see a doctor when I’m seeing St. Peter beckoning in my direction. Several days after my third gum surgery, I noticed swelling in the roof of my mouth. The surgeons were both out of town on that day, so I agreed to call back the next day.

By late afternoon, not only had the swelling increased, but the site was beginning to bleed. I called the emergency number for the clinic, and within a half hour, the surgeon was tending to me and taking a look.

I had developed a subcutaneous hematoma. He told me that I should have been more insistent when I called in the morning as this was not normal. “I should have brought my camera,” he exclaimed with a broad grin. “This is the biggest hematoma I’ve even seen. My partner will never believe this.” Gee, thanks, Doc.

 
This piece is written by Kosmo, a writer of fiction and the blogger who runs The Soap Boxers, a web magazine on a variety of compelling topics. Oh, and he’s got a background in the insurance industry.

Copyright © 2011 The Digerati Life. All Rights Reserved.

{ 45 comments… read them below or add one }

Silicon Valley Blogger January 28, 2010 at 2:39 am

Thanks to Kosmo for such a captivating piece! I’m not happy with health care costs and neither are most Americans. Well, especially since I’m a small business owner.

Here’s my own situation: as folks who run our own business, we carry our own medical insurance. But we don’t have dental insurance, because it seems that dental insurance premiums plus co-pay and out-of-pocket expenses may be equivalent to whatever it is we’d be paying anyway, if we had no insurance at all. I talked with our dentist about it and their suggestion was to make estimated calculations to figure out whether dental insurance is worth getting at all.

And since dealing with insurance matters is my #1 most dreaded financial task (with taxes a close second), I’m not particularly excited about the prospect of shopping for dental insurance. Well it’s either that or spending $600 for each filling! With one of my kids (one who is under 6) being cavity prone, it will cost us a fortune to remain insurance-free, so we’ll have to carve out some time here to check out all the options.

So if you’re self-employed (like me), have you gotten yourself or your family any dental insurance?

Mike @ GLBL January 28, 2010 at 2:06 pm

Yes you should seek dental insurance… before your teeth fall apart!

Erica Douglass January 28, 2010 at 3:43 pm

I ran the numbers and self-employed dental insurance was not good for me (and dental is the #1 thing I spend money on, health-wise.)

Alternatives:

#1 HSA. Saves you 30% or so right there.
#2 Most dentists will knock a huge % of their fee off if you pay cash. The fee discount should be 30% or more. If your dentist refuses to do this, shop around!
#3 If you need a lot of dental work done, it may be cheaper to fly somewhere else and have it done. Not talking another country, but since you live in a high-$ area, it’s worth it to call around. Try Stockton/Sacramento for local-ish care without the local cost!

Don’t settle for paying a lot of money for dental work. It’s not worth it.

-Erica

Silicon Valley Blogger January 28, 2010 at 4:18 pm

Erica,

Thanks for the great tips! Yes, definitely not worth the high price just to clean and do minor work on teeth. It’s hard for me to feel comfortable about switching dentists for my kids though — since she’s really awesome about calming jittery nerves (yes, even if it’s just for regular maintenance). Ugh — I’m torn about switching dentists, but I should ask about cash only options and yes, definitely should look into an HSA!

Toni House January 28, 2010 at 5:27 pm

I have been a small business owner for more than 25 years and providing insurance has been unbelievably expensive. As far as dental insurance: the answer can be yes and no. For my family typically a cleaning each every 6 months and occasionally a filling here and there it was not worth the $144 per month with a maximum amount of $1,000 that the insurance company was willing to pay per person with a $500 deductible. The insurance did not cover braces at all and would only pay up to 50% of crown and bridge work and no coverage on root plaining if you had periodontal disease.

So for our family the answer was easy. No but there are so many different insurance policies out there and even discount cards which in some cases are great.

Please check out my book Save Your Money Save Your Family out in Spring 2010.

Mike January 28, 2010 at 7:34 pm

At best dental insurance is dollar swapping. You pay x in premium and you get x back in benefit. The only time dental insurance is actually good is if your employer is either subsidizing or completely paying for it. Otherwise save your money. There are a few discount plans out there that might make sense but definitely don’t buy a premium plan.

I’m an independent insurance broker. I try to talk just about everyone out of buying the dental. And don’t get me started on vision insurance!

Silicon Valley Blogger January 28, 2010 at 7:41 pm

Mike,
I’m going to have to start asking about vision insurance next! I’d love to hear more about that as well! Doesn’t help that we’re all so visually challenged.

kenyantykoon January 29, 2010 at 12:05 am

i haven’t got dental insurance and i am not planning of getting it. luckily my teeth are made of rock :) .

Michael January 29, 2010 at 7:16 am

We ran the numbers last year, and used our Flex Spend money for dental checkups (no cavities!). This year we got insurance since our Flex Spend money is earmarked for a C-section.

Dollarwise it’s the same as paying cash as long as all we need are checkups (2 adults, 2 kids) and if we get them twice a year. If anyone has even one cavity though, we’ll come out ahead.

If it were just me, I would just wait till my teeth hurt.

20smoney January 29, 2010 at 7:22 am

Most people I know spend about the same on check ups as they do on dental insurance. With that said, if you have a low cost option, why not?

Neal A. Deutsch, CFP January 29, 2010 at 9:09 am

Just going through dental work, I did an analysis our our company plan. With a coverage maximum of $1000 anually, it cost me about $400 in annual premiums, netting $600. Since my overal bill was $2800, it only “bit into” 20% of my overall cost. For our employees though, it adds to the benefits package that helps employee retention. When you are doing an analysis of the dental coverage as part of your employee benefits package, you must factor in if it is one of the advantages you have over your competitors for retaining your key employees. It it worth it for the employer dollar for dollar: cost vs. benefit? Not really…

Credit Girl January 29, 2010 at 9:51 am

Growing up, my mother was self-employed and if we didn’t have my father’s insurance to cover health care costs it probably would have been extremely expensive. I can see how it can be very costly for a family (especially w/ small children) to not have the proper health care plans including dental. I think taking some time out to shop for good insurers is important as you’ll be saving money in the long-run.

Craig January 29, 2010 at 9:57 am

No, if you go 2 times max per year just pay it in full.

Erica Douglass January 29, 2010 at 10:50 am

SVB — if you don’t have insurance, you’re going to have to step it up in negotiations. Call around and get prices (esp. in Stockton/Sacto), then request that your dentist match them. If your dentist balks, pack it up and leave for another dentist. There are plenty of good dentists out there.

We (Americans) aren’t taught to negotiate well. It’s your money. Fight for it. :)

-Erica

Aynsley - WrenLife.com January 29, 2010 at 12:27 pm

Just canceled mine today. I’m starting to look into discount plans and dentists that will give good discounts when I tell them I don’t have insurance.

Mrs. Money January 29, 2010 at 6:45 pm

I think I’d skip the dental insurance. We pay like $40 a month and just get cleanings every six months. It seems like we don’t need it. :)

basicmoneytips January 30, 2010 at 6:15 am

When you look at one definition of insurance, it is to protect against something. In this case the loss of money due to dental work. Carrying insurance is a personal thing. If you have a lot of money, maybe a plan with a high deductable is the way to go. Otherwise, normal insurance is better for the average person.

At the end of the day, I like to have insurance against the unexpected – what they may find. I would say get the insurance.

helpfuture January 30, 2010 at 6:56 am

I don’t think that dental insurance is important. Our teeth has a low risk of disease.. :)

Silicon Valley Blogger January 30, 2010 at 7:54 am

@helpfuture,
Eh, tell that to a 60 yo without teeth and who has gum disease.

FinEngr January 30, 2010 at 7:42 pm

First, another alternative could be an HRA ( Health Reimbursement Account). Similar to an HSA, but you as the employer would contribute to each employee’s account.

You could also invest in yourself. There are plenty of home-care dental kits. Promoting strong, and consistent, cleaning habits will limit the number of times you’ll need to take your kids to the dentist.

Second, I was a little surprised with this thread. Erica offered some good suggestions, then dropped the ball with “It’s not worth”. What followed was a string of “not worth” responses until basicmoneytips re-focused the attention.

Preventive care reduces the likelihood of larger problems later in life. Insurance against rainy days provides just that. If you’re waiting (insurance-less) for that rainy day, it will be a monsoon when it comes.

If I told you to let your kids’ teeth rot and wait to get dental insurance when their adult teeth come in, you’d think I was nuts! But that’s essentially the same argument.

I really hope I’m misreading people’s comments. If not, let me say this:
your HEALTH is MORE important than your MONEY.

Suburban Wife January 30, 2010 at 10:34 pm

I understand FinEngr’s point but I didn’t take most commentators to mean don’t get regular preventative work or other dental work done.

We recently faced the same decision. After looking at the numbers, we decided to self-insure. What that means for us is, instead of paying a monthly premium to an insurance company, we’re putting that same amount aside in our budget for dental self-insurance. We’ll still all get regular 6-month check-ups and still get all necessary dental work done and we’ll pay “out-of-pocket” for all of it.

When trying to decide whether or not to get insurance, I asked at the dentist’s office what they thought. They were the ones who pointed out that for a lot of people insurance doesn’t make sense due to the very low annual maximums. Last year we had dental insurance through my employer. The kids and I all had our regular check-ups; I needed my first two root canals and crowns. We ended up paying for all but $200 of the work out-of-pocket due to the very low annual maximums.

If all we need are regular check-ups, then we’ll end up spending less than what we would have paid out in premiums. If we have a bad dental year, we’ll have money set aside to pay for it. I’m sure there are less-expensive dentists in our area but I really like this dentist, and trust him. He does give a discount for cash and a smaller one for credit cards on all bills over a certain value paid in full. I’ll just make sure we all schedule our cleanings at the same time so we qualify for the discount.

If dental insurance maximums weren’t so ridiculously low, it would more likely be worth it but in most cases I think it’s an unsound allocation of funds.

Jane the Window Lady January 31, 2010 at 5:32 am

Thank you to all commentators for pointing out the pros & cons. We own a small window screen company in LA and are considering the dental insurance option for ourselves & employees. It is definitely a fine line of economics to consider, especially in these times. If we can’t offer all the premium benefits of a big company, then which ones are worth it?
Good luck to all.

Kosmo @ The Soap Boxers January 31, 2010 at 7:17 am

I can’t speak to costs for small business owners, but my company’s plan is great. A single person pays about 8 bucks a month. As I’ve mentioned in the article, I’ve unfortunately had some issues that resulted in gum surgery and crows and maxed out the benefit quite a few times. But I saved a ton of money.

Yes, things are going quite a bit better now :) . I now go three times a year for cleanings to make sure no problems pop up. The insurances only pays for two, so I pay for the third out of pocket — but the peace of mind is worth it. Gum surgery (taking a chunk from the roof of your mouth and sewing it into your gum line while under local anesthesia) is something to avoid if you can.

Stacey January 31, 2010 at 5:49 pm

Our insurance and deductible costs the same as twice yearly checkups and cleanings, so if we don’t have any problems it’s a wash. We save more than we pay in the years that we have x-rays. In my mind we’re ensuring against bigger problems and just enforcing the six month cleanings. If we paid for it through insurance, we’re going for cleanings!

Something no one has discussed: The self-employed can deduct the cost of insurance, including dental. It’s a straight deduction, right on the 1040. So we’re essentially saving 15% on the cost of insurance. Add that to our HSA savings for deductables (another 15%!) and the picture starts to look much nicer. If you’re in a higher tax bracket it’s even sweeter.

It’s not a simple yes or no answer – there’s a lot to consider when you do the math!

Niki Arinze February 1, 2010 at 2:14 am

Getting your teeth fixed is just plain expensive it seems like. I have spent a fortune on teeth in the past year, and I wonder if any of the stuff you guys are talking about applies to the UK?

Andy Hough February 1, 2010 at 10:59 am

I get my dental work done at the local dental school. It costs about $50 for a filling which is less than what I would pay elsewhere with dental insurance. The main drawback to going to the dental school is that they work slowly, but the trade-off is well worth it to me.

Dave Green February 3, 2010 at 4:06 pm

Dental insurance is a misnomer. With insurance (health, auto, life, home) we all pay a little so that the unlucky few have their big cost covered. Dental is a benefit plan that an employer may purchase for you (if you’re lucky). Everybody is eligible for cleanings, xrays, exams, and then a discounted rate (20-50%) on any work up to a limit (1000-1500 annual typically).

Obviously, I’m simplifying as some people will need root canals and extractions while others won’t. But the $$ use variance is much smaller than for medical where we have many healthy people and a few with massively expensive conditions/accidents

So a typical dental plan costs the employer the benefits plus the overhead and profit of the company that sold it to them. This is why larger companies will underwrite their own employee plans.

Theoretically, it will be cheaper for self-employed people to pay the dentist cash over the long haul as you eliminate the middleman taking a cut. This is why you find it so hard to find dental “insurance” that makes any sense to purchase.

Goran Web Design February 3, 2010 at 4:39 pm

Do the dental insurance, trust me!

Online Shopping For Insurance February 6, 2010 at 12:45 pm

Like any insurance that you don’t have to have it’s a tough one to decide. My personal advice has always been that it’s always best to be prepared for the worst and be insured, you never know when you’ll need it!

Revanche February 11, 2010 at 9:10 pm

Well, my recent visits this past week were of the “emergency or catastrophic” variety and that made me glad I still have dental through COBRA. I currently pay $20/month for coverage and surprisingly no longer pay a deductible. This gives me about $260 worth of insured basic cleaning per year, just a $20 savings over not having insurance.

This recent round of seeing the dentist ($100, exam and xrays), the oral surgeon ($300) and the associated equipment (2 mouthguards, not covered) really put me on the side of insurance this year.

OTOH, my dentist instructed his assistant to bill a 10% discount on the first ‘guard, and a 50% discount on the second ‘guard so I’ve paid ($315+$125 =$450) instead of ($350+$250=600 for ‘guards, +$400 for exams = $1000). The cash discount can makes a big difference, if you can get the discounts hammered out ahead of time on the routine stuff as well.

Patrick February 21, 2010 at 12:19 am

I am self-employed, and I don’t have dental insurance. I haven’t gone to the dentist in over 3 years though, and I think that is pretty bad. I know I should go, but money is kinda tight right now.

Ed Rooney April 14, 2010 at 10:56 am

Ah. I can relate as to how difficult of a decision this is to make. I used to call it “dental roulette”.

For the most part it seems, especially if you have kids, that dental insurance is unfortunately a necessity. You have to be prepared. However; in the end there is still the fact that you may end up paying more than you would have overall if you had just paid per procedure, but that is the price of knowing that you’re covered.

I stopped playing “dental roulette” about a year ago. I’m paying a lot, but I can sleep easier at night now!

Fort Worth Orthodontist June 6, 2010 at 4:20 pm

The challenge with dental insurance is that the maximum amounts the insurance company will pay out are usually fairly low, so for reconstructive dental work you will usually end up paying for a good portion of it yourself. For the more routine dental work, you can easily self-insure.

With that said, if you can find a good policy with a reasonable maximum, solid benefits and fair premiums, then it may make sense.

Mitchell June 7, 2010 at 1:08 pm

The comments have been great! Most dentists will offer a discount for cash, also if you know of any dental schools or dental hygiene schools, they will do checkups and cleanings for free or very inexpensive. Some schools even do the necessary work that needs to be done!

allison August 27, 2010 at 7:36 pm

I need denal work done…should I buy dental insurance or not?

Jun September 29, 2010 at 8:06 am

The best thing you can do is prevent. Prevent dental problems before it hits you.

Bobby @ Midtown Manhattan Dentist December 20, 2010 at 7:29 am

Hey, love the pic :) I must agree with the comment above that the best thing is to take a good care of your teeth.

Aaron December 12, 2011 at 11:16 am

This is timely.. my wife has been having some teeth issues and have discovered that coverages is only good up to the first $2k. This stinks as the more complicated stuff can get pretty pricey!

Silicon Valley Blogger December 12, 2011 at 11:24 am

@Aaron,
I agree — I think that after reviewing actual insurance or coverage options, the tax advantaged accounts (if they have not yet been changed or phased out by government policies) may be our best bet. But it’s something we need to analyze with care. It would all be based on estimated payouts throughout the year and I tend to want to go with the simplest set up (even if it’s not the most financially beneficial option)!

Bridgette Dozal December 12, 2011 at 1:21 pm

Buying dental insurance also depends on the size of your family. My husband and I have a combined total of 9 children, so it is cheaper for us to buy dental insurance, which costs the same for +1 or +9 kids, and get cleanings every 6 months. If we were to pay for cleanings for everyone we would be paying significantly more than we do for the coverage, which is 100% for preventive services.

Silicon Valley Blogger December 12, 2011 at 1:38 pm

@Bridgette,
That’s a pretty good tip — economies of scale works. I wish it was much more definitive for us but some policies show that things are a wash. So we’ll keep hunting around but as mentioned, the FSA/HSA approach may work better for us. It begs further analysis and ensuring that the tax breaks continue to hold.

Based on the comments here, there is no one size fits all solution and it really depends on your lifestyle and family set up. People without dependents may do best with a discount card and just going for low-cost dental services (e.g. through an educational facility) whereas people with larger families will require full-fledged insurance. Dental insurance is more compelling to those with a more complex family or health situation — but this is the case with any form of insurance.

If your employer offers this benefit, then you’re in luck!

alanc230 December 12, 2011 at 1:42 pm

As Mitchell suggested above, our local university dental school has a clinic that will perform services at reasonable rates. However, the catch is that they have a months-long waiting list. If you have a dental school in your area, you might want to look into making an appointment for a checkup well ahead of time.

Kosmo @ The Soap Boxers December 13, 2011 at 2:18 pm

Lots of good comments here.

I was definitely looking at this from the perspective of an employee with a plan being subsidized by an employer. Whether it makes sense from the employer’s perspective is a completely different questions, and it may very well make sense to self insure.

If you never have any expenses beyond cleanings, dental insurance probably isn’t a good fit for you. Nice job of keeping your teeth and gums healthy.

The annual maximums are definitely much lower than what you’ll see for medical coverage. One way to work around this a bit is to push some expenses into the next year if you need to have a lot of work done (although this might cause you to hit the limit next year).

I’d always suggest at least entertaining the possibility of a tax-advantaged account.

I definitely should have mentioned dental students. One things to take into account is that a student working on your teeth isn’t going to have decades of experience. This certainly doesn’t mean they will do a bad job, of course.

Funny about Money December 26, 2011 at 10:05 am

I did sign up for my own Delta Dental plan after I was laid off. Quickly discovered that between its lengthy waiting period, its high deductibles, its copays, and its piddling coverage, it was costing as much as out-of-pocket dental coverage cost me. I canceled the plan.

It doesn’t cost that much to get your teeth cleaned, especially if you tell your dentist you have no coverage and ask for a discount. Many will give you a 10% discount on services when they learn you’re uninsured.

Meanwhile, take the amount you would have paid on premiums for the useless insurance and drop it into a sinking fund. Before long you’ll have enough to cover crowns and whatnot.

CJ Cole July 12, 2012 at 10:07 am

It is outrageous for the cost of anything these days whether it be for dental, medical or a gallon of milk. My girlfriend has no insurance whatsoever and when she goes to the pharmacy, my jaw drops with some of the numbers they hit us with. Lucky for me I get dental through my workplace, looks like we are gonna have to get married so she can get my benefits : ) If you plan on needing frequent dental visits, you should definitively consider dental insurance, or just chew a lot of Orbit Gum. I’m kidding but it does help. It is sugar free. Stay away from sugar, it will rot your teeth!

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