Do I need dental insurance?
We all know and understand the value of health insurance. A serious illness, injury, hospital visit or surgery may cost tens of thousands of dollars and be catastrophic to many household budgets.
In a similar way, the onset of oral health disease or a dental injury may cost several thousand dollars of care.
So, do you have dental insurance? Looking to get it soon? You’re probably wondering if it’s worth it.
How most dental plans work
Most Americans don’t have dental insurance. Of those who do, nearly all have it through an employer as part of their compensation package. Dental insurance policies often cost about $360 a year per family member. For most Americans with dental insurance, this premium is paid by their employer.
Most plans carry what’s called 100/80/50 coverage, which is the percentage of the cost covered under the plan for preventive, basic and major dental services. The percentage covered is up to a maximum price for any individual service. This maximum price is often called the “usual and customary” price but doesn’t have anything to do with average fees charged by dentists. It is simply the maximum amount the insurance will cover of the dental service fee. Generally, the better the insurance plan, the more it will cover.
As an example, preventative care most typically includes the regular cleanings many people receive twice a year at their dentist office. Many policies cover 100 percent of the “usual and customary price”, which may or may not be the actual price for the service. For patients in good health, many dentists will recommend cleanings twice a year.
Basic procedures make up care like fillings, extractions, and periodontal work. Insurance typically covers about 70 to 80 percent of the usual and customary price, but not necessarily the actual price.
Then, major procedures like crowns, root canals, dentures, bridges, or implants are covered at about 50 percent of the usual and customary price. Again, this might not be the actual price.
There are exceptions to this rule, of course, depending on your plan. Most insurance companies provide a variety of plans. Like we mentioned, typically the more expensive the plan, the more it pays for.
Is dental insurance worth it?
The American Dental Association’s Health Policy Institute released a brief in June 2016 that explored dental spending among adults who have private dental benefits.The researchers examined close to 25 million dental claims across almost six million adults who were enrolled in a private dental benefits plan for 365 continuous days.
They found that overall people are paying more in premiums and co-pays for dental insurance then the insurance benefits are worth. In fact, more than one in three adults ages 19 through 64 did not have a single dental claim in one year. That means the entire cost of the premium was wasted.
Furthermore, a significant amount of insurance policy premiums don’t go to actual treatment. Insurance companies are large organizations. A significant portion of insurance premiums go to administration costs and for insurance company profit, not for care.
Additionally, total copayments and premiums of private insurance exceed the market value of the insurance for nearly 70 percent of people. That means the cost of insurance is more than the actual cost of the services they purchased from their dentist.
These adults, or their employers, are paying for a dental plan that no one is using. And for nearly 70 percent of those that are using it, it would have been less expensive to simply pay cash for the dental services they used.
Insurers aren’t so quick to agree
When the brief was released, dental insurers argued the research used inflated data and flawed methodology, which led to misleading and erroneous conclusions.
For example, the average premium was based on the ACA dental plans, not a typical group plan. If an employee is paying their own insurance premium or even part of it, they’re paying with pretax money.
Further, only about one percent of Americans get stand-alone dental coverage through the marketplace. Most people are getting theirs through group coverage via an employer. The research also didn’t take into account network discounts used by insurers, which are lower than market rates.
Insurance can also help patients make sure they aren’t paying for procedures they don’t need, meaning the medical expense is justified.
Patients with poor oral health may be an exception. For the individual that faces some very expensive care because they’ve fallen into a state of disease, insurance may provide some benefit. But many plans have a maximum annual benefit of $1500 and generally are reimbursing patients for only a portion of the actual cost of care.
So, what’s the bottom line?
For most employees of a large business, dental coverage will be offered as a benefit. About 70 percent of Americans with dental insurance have most or all of their premiums paid for by their employers.
Like all insurance, most of the benefit is when an emergency happens. Nobody wants or expects to need a crown or other dental procedure. But, when it does happen, insurance can be really helpful to save out-of-pocket expenses. So if your employer is paying for the premium and there is no direct cash compensation alternative to employees, dental insurance can be a very good benefit if individuals understand and use it to its maximum value. But remember, the insurance will pay only a portion of this emergency care. At best, insurance is like a coupon that reduces the amount owed by patients on some of their fees.
One of the best advantages of dental insurance is that by simply having the coverage paid for by an employer, it may actually motivate people to go to the dentist regularly to get the care they need. Without it, people are more likely to postpone routine regular care until disease develops and illustrates itself as pain or swelling.
So, if your employer pays for it and there is no direct cash alternative to you, the bottom line is dental coverage can, and likely will, save you money. However, If you have to pay for your own dental policy, either by payroll deductions or direct purchase of a dental policy, you are likely to be far better off maintaining your dental health through vigorous, regular brushing and flossing at home and make regular visits to the dentist for preventive care that will keep you in good health. Paying the dentist directly for service is likely to save you money over expensive premiums.
Simply put, maintaining your health is better for you and cheaper.
From MYDDSOFFICE.com – Keep Smiling!