Is dental insurance worth it?

We all know that having health insurance is a good idea to protect against the cost of an accident or illness so expensive that you could be ruined financially, but how about dental insurance? How much are your teeth worth? Make sure to ask yourself, is dental insurance coverage worth it?

There's no question that dental insurance premiums is extremely costly. It is much more expensive than simply paying out of your own pocket for routine cleanings and checkups.

Is dental insurance worth it?
 Those having a nice routine visit with your dentist every six months all know that most dental policies emphasize the importance of wellness checkups - prevention and diagnostics. They typically cover two annual exams and cleanings, plus X-rays and, for children and older adults, fluoride treatments, says Evelyn Ireland, executive director of the National Association of Dental Plans, or NADP. But being covered for bigger-ticket procedures, such as fillings, root canals, crowns, and more invasive oral surgery is the real benefit. Without insurance, it costs an average of $300, with prices ranging from $250 - $400 to get a root canal and an average of $1,675, with the cost ranging from $1350 - $2250 for a ceramic dental crown.

According to a report from the National Association of Dental Plans and Delta Dental Plans Association, at the end of 2014, about 205 million Americans, roughly 64% of the population, had dental benefits and at the end of 2016, the percentage of Americans having dental insurance coverage is approximately two-thirds of the population — about 164 million people. For those who are in the other third and are considering buying their own dental insurance, be aware that the policies can significantly vary and costs will vary depending on your state. Remember to brush twice a day and floss your teeth diligently is much easier than choosing the right one.

What’s covered, what’s not?

 People with dental insurance commonly have many dental insurance policies what’s described as “100-80-50” coverage. It means they cover 100 percent of the cost of preventative (annual) work - routine preventive and diagnostic care, such as cleanings and checkups; 80 percent of the basic procedures like fillings, root canals, extractions, periodontal work, and other basic works; and 50 percent of major work (crowns, root canals, bridges, and major procedures), Ireland says.

The vast majority of private coverage (90%) is provided through an employer or a group program such as AARP, plans that charged about $360 a year, or between $15 and $50 a month, according to NADP estimates.

Expect to pay about $350 a year for a typical individual policy.

Meanwhile, according to a 2016 report from the American Dental Association’s Health Policy Institute, in 2013, the average American paid out-of-pocket dental expenses was $544 in 2013 and in 2016, families spent on average $714 or 1.6 percent of their take-home income on out-of-pocket health care spending.

For care that goes beyond the “traditional” stuff, most plans cap coverage at $1,500 yearly, even though you can pay a higher premium to arrange higher annual limits.

Dental insurance is a little different from health insurance. Even though some policies may restrict coverage for people with missing teeth, dental plans don’t bar coverage for pre-existing conditions.

If you have ever covered by private dental insurance, cosmetic dental procedures are rare. So if you’d like to have some of that work done, you might want to have a good credit card handy.

HMO, PPO, or indemnity plan?

HMO, PPO, or indemnity plan?
Only 10 percent of people with private coverage do not get benefits through employee and group policies. Dental insurance offered through a workplace typically comes in three varieties: HMO, PPO, and indemnity plans.

The HMO, or health maintenance organization, cuts costs by offering members option coverage restriction to dental professionals within a limited insurance network.

The PPO, or preferred provider organization, policies – These more popular ones are similar to HMOs but allow groups of practitioners to see dentists outside the “preferred” network. However, patients who see an in-network dentist are typically charged reduced rates. With network dentists, your costs are lower. Co-pays are higher for those who see out-of-network dentists.

A third option called an indemnity plan, allows a patient to choose their provider of choice and typically pays a percentage of the fees.

Why are some 70 percent of dental policies through PPOs? Their advantage over indemnity plans is that insurance network pays more than they might with an indemnity plan or HMO plan. Dentists within the PPO network typically agree to accept lower fees for procedures. Thus, patients are not required to see in-network providers, but save money when they do.

Waits are a drawback to individual plans

If you are considering buying any self-insured dental, one disadvantage is that they often come with waiting periods that typically don’t apply to full-time workers in group plans.
For example, most patients those individually purchase policies rarely cover orthodontia for the first six months and may not offer coverage especially for major procedures for up to 18 months.

Insurance alternative

Paying out of pocket may be less expensive than buying a plan. Discount plans charge an annual fee in exchange for discounted services from network providers. But the choice of dentists can be very limited and fees vary by dentist’s office and by geographic region. Look over its list of covered procedures to see if they are ones you are likely to use before you buy into a plan. According to the CostHelper website, expect to have your teeth cleaned for from $70 to $200 and to have X-rays for from $20 to $250 or more.

Believe it or not, while private dental insurance premiums can be pricier than paying out of pocket, they may provide peace of mind for some.

Can you name your own price?

Ask your provider to take a bite off the bill by reducing the overall fee or your out-of-pocket costs if you ultimately decide against buying dental insurance, or even if you are already covered.

Ask to set up a payment plan if you’re paying completely out of your own wallet. Request a 10 percent off the cost of a visit or procedure if you can pay in full at the time of the visit.

If your dentist doesn’t provide a discount, ask (politely, of course) whether he/she can do so or not. Particularly if you’ve been a patient for a long time, your dentist will be more than happy to work with you.

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