The Real Cost of Dental Insurance: Best Plans, Myths, and Benefits [2019]
On the search for a good dentist, it’s important to consider your dental insurance. Is s/he in your network? What will be covered? How much will you owe?
I worked for two dental offices as the office manager and was responsible for insurance billing and patient communication. And let me be the first to tell you—dental insurance (and all insurance, for that matter) is complicated.
That’s why I’m here to unravel all the myths, misconceptions, terminology, and coverage for you.
Whether you’re looking for a way to understand your current dental insurance plan, deciding which one to choose, or anything in between…I’ve got you covered.
(See what I did there?)
But first, let’s talk about what dental insurance really is—and what it’s not.
The True Cost of Dental Insurance [+ Common Myths]
The word “insurance” implies an understanding that you’ll be financially protected if the worst case scenario arises. However, you may not be aware that dental insurance is vastly different than most other insurance programs in place.
Unlike medical, life insurance, and home-owners insurance, dental coverage maximums are not hundreds of thousands of dollars. So, when (not if) you end up needing care, your dental benefits will only get you so far.
Most dental insurance plans have a $1500 annual maximum. This means if you get two teeth cleanings per year and a filling or two, you’ve maxed out your dental benefits until your plan renews.
Healthcare is considered (by some schmuck who developed the system) to be a completely separate entity from dental care.
This would only make sense if your mouth was not intimately intertwined with the rest of your body.
Thank God we don’t have to buy car insurance and a separate plan for the steering wheel, right?
Assuming you have a PPO (more on that below), most plans follow a standard 100/80/50 rule.
- Preventive procedures are covered at 100%
- Basic care, such as fillings and root canals, are covered by the plan at 80%
- Major services like crowns are covered at a 50% rate.
The majority of dental health plans also require you meet a $50 deductible before they contribute to basic or major services.
The cost of procedures is also not standardized. If you live in Arizona, your crown may cost hundreds of dollars less than a person getting the same type of crown in Boston.
If you go in for your bi-yearly cleaning and find out you need a root canal and crown, your benefits will certainly be maxed out for the rest of the year. You would be left with hundreds of dollars of out of pocket costs.
That’s the opposite of medical insurance, which typically requires you pay only a small portion of costs after your deductible has been met.
For this reason, I think of dental insurance as more of a discount plan, rather than an insurance.
Finally, many dental insurance plans have waiting periods before certain work will be approved. Need orthodontic work? Your dental plan options may stipulate you be on their plan for six months before a dime can be paid out.
How Different Types of Dental Insurance Work
While they look very similar on the surface, the type of dental insurance you get will drastically impact how much you pay out of pocket. Some of them offer very little benefit to anyone other than the insurance company. Before you pick a plan, make sure you understand your options.
Medicare/Medicaid
Medicare and Medicaid are US taxpayer-funded health plans that require specific stipulations to be met in order to qualify. Instead of being run by a private insurance company, they’re controlled and regulated by a governmental agency called The Department of Health and Human Services.
Medicaid provides medical health coverage for some with low-income, families and children, pregnant women, the elderly, and people with disabilities.
Sadly, dental services are limited and primarily covered only for those under the age of 21.
Since each state is able to set their own coverage limits for those over 21, about half of states offer ONLY emergency dental visits and no preventive care, such as routine cleanings.
As a dentist, this greatly concerns me. Once you’re feeling pain, you’ve likely missed your window to prevent costly treatment—that’s why prevention is vital.
For children, Medicaid is quite comprehensive. However, this is where you have to use your best judgment when consenting to an overzealous dentist’s treatment requests.
I’ve come across a number of instances where parents agreed to treatment since it didn’t cost them anything out of pocket, only to find out later that it was unnecessary, or worse—not performed at all. I encourage my patients and readers to listen to their intuition when consenting to treatment and ask for a second opinion if they feel unsure.
You should be completely aware of what’s caused you or your child’s dental concerns and have multiple options for how to fix it.
Take your time looking over treatment plans and as many questions you need to feel confident in your decision.
A general rule of thumb is this: If you feel rushed into agreeing to a lot of treatment on the spot, seek a second opinion or wait until you’re able to ask all the questions you need to feel more comfortable.
Since it’s very uncommon for Medicaid procedures to be denied, having an understanding of your child’s needs is paramount. You should feel empowered to ask all the questions you need to understand their needs and how to improve their oral health in the future.
Medicare, on the other hand, is intended for those over 65 years old and are citizens or legal residents of the US, or people under 65 years old with a legally recognized disability.
This benefit primarily covers medical procedures and leaves a lot to be desired when it comes to your dental health. According to Medicare.gov, “You pay 100% for non-covered services, including most dental care.”
Unfortunately, the connection between your mouth and the rest of your body seems to be lost in this system of care.
Medicare and Medicaid are not dental insurance plans in the commonly understood form. Your dentist MUST be in-network, so for adults, you could be in for quite the search.
Think of these more as bare minimum entitlements that can come in handy, but with some kinks to work out. If you’re on Medicare, you may want to consider a supplemental plan to help prevent a dental emergency in addition to your regular coverage.
HMOs (Health Maintenance Organizations)
HMO’s look great on their face!
If you’ve ever started a new job and the HR Coordinator sat you down to show you your dental insurance options, you’ve probably been tempted to check the HMO box.
After all, HMOs are so much more affordable…Right?
Satisfaction with an HMO is, sadly, very uncommon. People who speak positively of their HMO experience typically didn’t use their insurance plan.
The way a dental HMO plans like Deltacare USA work is through a “capitation” system.
To receive care, you have to choose an in-network dentist. This means the dentist has agreed to sign a contract with your insurance company in exchange for being assigned a list of patients who can only use them for dental care.
Each month, that network dentist will be sent a check for a few bucks for each name on that list, regardless if they walk through the door or not.
In the case that you do make an appointment for preventive services (hopefully at least twice per year), your out of pocket cost will be pretty low. However, the dentist is also very poorly compensated for this type of appointment, only making a few dollars for a cleaning, exam, and x-rays.
This type of reimbursement would not even cover the cost of materials used. Dentists may then resort to charting more extensive treatment for issues that may be addressed in a more conservative manner. (If you think this sounds sketchy, you would be correct.)
For example, say you plan to only take advantage of routine cleanings to prevent decay and plaque build up. During this visit, your dentist or hygienist may find areas of concern that the typical dentist may think needs a filling.
Since s/he needs to make money to keep the doors open, you may find yourself with a root canal on your treatment plan instead of a filling. And since you need a root canal, a crown is also necessary to regain your tooth structure.
While this would be bad enough without the dishonesty factor, an HMO plan would pay VERY little of your procedure.
This may leave you with hundreds of dollars of expenses out of your own pocket.
The HMO system is great if you don’t need it, or if you follow my nutritional recommendations to keep stop decay before it starts. The monthly costs are minimal, and as long as you don’t need any additional treatment, you will probably be quite happy.
PPO (Preferred Provider Organization)
The other option you may see from your HR Coordinator is likely a PPO plan. This plan is a more expensive option that’s often overlooked, but once you dig a little deeper and see the complete details, you’ll find PPOs generally cost less in the long run.
Similar to an HMO, a network of dentists is available for your dental care where coverage is least expensive. A PPO plan costs more per month, but if you end up needing dental treatment, you’ll see the savings are well worth the monthly cost when compared to an HMO plan.
For example, if you end up needing a crown, your PPO plan will likely cover 50% of your crown as opposed to about 10% or less on an HMO plan.
If you add up all the money you’ve saved on the monthly premium and added it to your out of pocket costs, you’re very unlikely to come out on the good side of the equation if you had chosen an HMO.
This option is much preferred if you may need more extensive treatment than just preventative cleanings. And, although it’s a sad way to think about it, you’ll be somewhat less likely to get ripped off at the dentist because your dentist is also being paid more fairly.
Delta Dental PPO is one of the largest PPO networks available to employers in the US. If this is an option for you, it means you’ve got the largest network of dentists from which to choose.
Marketplace (Obamacare)
The Marketplace is a month-to-month dental insurance plan that has more stipulations than a traditional public insurance plan. In my experience, unless you are eligible for a tax credit based on income, they are not necessarily less expensive, however.
In order to use your Obamacare coverage, you must use a dentist that is part of their preferred provider network, and there is no coverage for out of network providers.
I’ve found that how many providers you’ll have to choose from depends on where you’re located. If you’re in New York, for example, your ability to find a provider may be easier than in a rural community with only a few dentists to choose from.
On a positive note, there are plenty of plans to choose from that are managed by common insurance companies that you would recognize, including Cigna, Guardian, and Humana.
While they are big names in the medical insurance system, their dental insurance networks are on the smaller side. Before picking a plan, it’s best to ask to see the full details, including in network dentists and exclusions.
Supplemental Dental
If your spouse is also offered dental coverage through their employer, you can join each other’s plans as a secondary insurance.
Supplemental plans are even more intricate than primary ones, but some can end up saving you most (if not all) of your out of pocket expenses.
However, since they’re notoriously difficult to estimate ahead of time, I’d recommend budgeting as if the 2nd plan will pay nothing. That way, you’ll have a pleasant surprise when they cover more than you expected!
4 Hacks for Affordable Dental Insurance
1. Ask your dental office if they accept bento dental.
If they don’t, encourage them to sign up! I’ve been using it for my own employees and have been quite impressed with the financial savings and ease to use.
Bento Dental is a modern alternative to traditional dental insurance. Their network of 90,000+ dentists can join at no cost.
As a private user of Bento Dental, you pay a 7% fee for services through the Bento app. However, the benefits include:
- Flags for procedures that don’t match up with your records: This kind of oversight from insurance companies is one way to avoid getting ripped off or overcharged.
- Guaranteed pricing: Dentists in the Bento network commit to pricing that matches many major employer dental insurance plans. This is important, because if you’re going to a dentist out of your normal dental network, there’s no guarantee whatsoever that you’ll pay a fair price.
- See your cost before your visit: The Bento app shows you the cost for any scheduled procedures before you go in the office so you don’t get taken off guard by a massive bill.
Your employer can also purchase Bento Dental for you and your co-workers at only $5/person per month, which saves you the 7% cost fee you’d otherwise pay. Plus, employers can individually customize Bento plans to match whatever coverage they choose.
Bento is a great alternative for people with no dental insurance, too, since they offer many of the benefits of an insurance plan that will help you save money.
2. Customize your plan to remove coverages that you don’t need.
It may save you some dough—often, plans include extra coverages you may never use. Removing these can save you on monthly premiums.
3. Look into joining your spouse’s plan as a secondary insurance.
It’s very difficult to estimate benefits ahead of time when using two insurance plans, but they’re generally very helpful if you end up needing treatment. I’ve even seen some patients pay nothing out of pocket for extensive treatment using supplementary insurance this way!
4. Talk with your HR Coordinator to find out if your company offers HSA or FSA accounts.
These are accounts that you and/or your employer can contribute to for unforeseen health care expenses. The money will be put into an account monthly before taxes are withheld, making your tax burden less. Plus your out of pocket contributions go further.
For example, if you choose to contribute $100/month into your HSA ($1200/year), you’ll have $1200 available to you on the first day and your contribution will be taken out of your paycheck.
It’s somewhat like getting a negative interest loan (costs less than you borrow) that you don’t have to qualify for and you can use on health care expenses. It’s not limited to dental care, but might be a great alternative when you need extensive treatment not otherwise covered by traditional dental insurance.
The Best Dental Insurance Plans [2019]
The best dental insurance plans actually depends on how much dental intervention you’ll end up needing.
My best recommendation is always to avoid cavities by working on your nutrition. Since cavities turn into the need for fillings, crowns, root canals and extractions, prevention is the best chance of oral and overall health.
If you end up needing dental treatment, and do not have savings to cover the costs, choose a plan that works best for your dental needs and budget.
PPOs are more comprehensive but also cost more upfront, while HMOs cost very little monthly and provide very little coverage as well.
Medicare/Medicaid and Marketplace plans are incredibly limited in scope and coverage, so these kinds of dental insurance should be used only if no other option is available.
A supplemental dental plan can help cover costs if you and your spouse both have accessibility to dental insurance.
Delta Dental is the largest dental insurance provider in the US. Their network contains more than 190,000 dentists, which allows them to keep prices low—theirs is the lowest fee schedule.
As a general rule, the larger the insurance company, the less you’ll have to pay for your treatment. Large companies like UnitedHealthOne, Humana, Cigna, and Ameritas all offer reasonable in-network pricing for PPO plans.
The most important thing to know about dental insurance, no matter the company, is that all plans have a very small maximum payout (usually between $750-2000 per year).
If you need major work (orthodontics, bridges, root canal and crown, etc.), expect to be left with a significant cost after insurance has paid out. In these cases, an HSA or FSA is probably a good alternative to save that money if you can.
Look into Bento Dental. They offer employer plans as well as individual plans that cost nothing unless you end up needing dental services. I’ve been using it for my employees and it’s a great way to save us both some money on group plans.
Bento works similar to the big insurance companies, except you don’t pay monthly premiums but you still get access to the discounts that dentist’s give their “in network” patients. In many cases, this comes out to the same you might pay with a huge company like Delta. This saves an average of 30% for most procedures.
One thing I like about it is their mobile app. It’s simple to understand, and if you sign up as an individual, you only pay if you end up using their service. Think of it like the Uber of dental insurance.
Dental Insurance for Seniors
Dental insurance for seniors is an important topic that has been put on the backburner in our healthcare system for some time.
As we age, gum disease becomes more prevalent and in turn our health suffers. Since gum disease is linked to Alzheimers, diabetes, heart disease, and more, it’s important to keep up with your oral health into your golden years.
Its best to consider a supplemental plan, margarita fund, or Bento Dental since you’ll need to keep up with your preventive services and it’s likely you’ll need dental treatment at some point. But as always- prevention is your best defense against painful and expensive dental work.
Should I get dental insurance?
Having some form of dental coverage is the best decision for most. If you’re self paid at any doctors office, including a dental practice, there’s no guarantee you’ll be charged fair prices.
“In network” patients save an average of 30% over patients with no coverage.
For this reason alone, it’s a great idea to have coverage if it’s available to you. However, if you’re good at saving your money and don’t want to pay monthly premiums, there are alternatives out there that get you the network rates without being tied down to yet another monthly bill.
Remember, dental “insurance” is truly more of a discount plan to keep up with preventative care. All conventional dental insurance plans cover just a small portion of what you might pay for extensive work.
People who benefit most from the savings from dental insurance include:
- Employees with very low-cost insurance options (preferably for PPO plans)
- Children who qualify for Medicare and need regular preventative care
- Those with access to an HMO plan who are able to keep additional funds in a savings account, FSA, or HSA for dental care (since the HMO will cover very little)
- People who need a great deal of dental work in the next 1-2 years and want to save some of the up front cost
If, on the other hand, you fit in one of the categories below, joining Bento Dental and foregoing normal dental insurance might be the best route:
- Employees who can afford to save money in a savings account, FSA, or HSA for dental care
- Self-employed individuals
- Those who follow proper nutrition and habits to prevent cavities and gum disease
- Anyone looking to save on a dental insurance premium who only needs bi-yearly cleanings and no major work
- Employees not offered dental benefits
FAQs on Dental Insurance
Which is the best dental insurance to choose?
Do I need dental insurance?
In that case, you will likely have no problem skipping a traditional “dental insurance” plan and opting for something like Bento Dental instead.
If I end up needing treatment, will I know how much my out of pocket costs will be ahead of time?
I’ve seen numerous times where an “approved” treatment was completed, only to find out that the insurance policies “changed,” which raised the patients out of pocket contribution.
Additionally, waiting for pre-authorization to be completed by an insurance company can take weeks, which can cause unnecessary pain and risk to the patient.
It’s best to read your policy thoroughly and consult with your dental office’s insurance coordinator for their expertise. S/he works with insurance companies day in and day out and knows how to decipher your plan to offer valuable insight into your options.
Key Takeaways: Dental Insurance
Dental insurance, like health insurance, is a broken system that many times negates the pursuit of health altogether. However, it’s beneficial in the unfortunate case you need costly treatment.
Your best option is to become intimately informed about your plan’s limitations and take advantage of every prevention measure available to you, including reversing and preventing cavities naturally.
Got more questions on dental insurance? Send me an email at angela@askthedentist.com!
Read Next: No dental insurance? Here’s what to do.The post The Real Cost of Dental Insurance: Best Plans, Myths, and Benefits [2019] appeared first on Ask the Dentist.
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