Several medical students recently have asked about dental insurance. Dental coverage is becoming less and less common as a part of health insurance plans. In fact, the IU School of Medicine student plan does not carry a dental option. Medical students with the Medicare plan may be surprised to find that dental care is not included. There was a time when a good, comprehensive healthcare package offered dental coverage. Children’s dental coverage is considered an “essential benefit” that a qualified health care plan must cover, but oddly enough, you are not required to purchase it for your kids.
Reasons to Get Dental Coverage
If you have extensive dental health care needs that go beyond the annual checkup and regular cleanings, dental insurance can help you save on costs, covering expensive dental care such as fillings, root canals and even orthodontics.
Reasons to Not Get Dental Coverage
Dental insurance may not be a good idea for everyone. Estimates on private dental insurance premiums can cost between $225 to $396 per year. Deductibles and co-pays may add to the cost. Many dental insurance policies have an annual cap of $1,200 to $1,500. If you’ve spent more than $1,500 a year on dental health care in the past, or have ongoing dental conditions, paying for dental insurance may be a good idea. Otherwise, depositing the money you’d spend on premiums into a personal savings account may be a better use of your money.
The Three Types of Dental Insurance Available
Dental HMO (Health Maintenance Organization) – As with health plans, this is negotiated by an employer or group. HMOs restrict you to a specific provider network. As a tradeoff for limited choice, you usually have lesser waiting periods for coverage, fewer benefit limitations, and fixed payment amounts.
Dental PPO (Preferred Provider Organization) – Not as strict as a HMO on choice, but with higher fees for out-of-network services. Waiting periods can be long – this is to prevent people from buying coverage for known impending work like a root canal and dropping coverage immediately thereafter.
Dental Indemnity –More of a traditional fee-for-service with partial reimbursement. There are no restrictions on dentists, but they often have a higher policy cost, more exclusions, or lower percentage of reimbursement.
Non-Insurance Dental Discount Plans
Discount Dental Plan – Not insurance at all, but a monthly or annual fee you pay in exchange for discounted services throughout the year. The plan offers a network of dentists – similar to a PPO – who agree to treat you for preset discounts of 20% to 50% on a wide range of dental services, including oral surgeries and orthodontics. The typical cost for such a plan is $100 to $175 per year per family. Unlike dental insurance, you pay for your own checkups, x-rays and cleanings, but at significantly discounted rates. Coverage is typically tiered based on the type of procedure required. A common policy is a 100-80-50, covering 100% of routine preventative visits like cleanings and checkups, 80% for simpler procedures like fillings and root canals, and 50% for crowns, bridges and more complex work.
Cosmetic dentistry is rarely, if ever, covered. Orthodontia is usually covered under the most expensive plans and only for children. Most dental insurance policies cap annual payouts on services provided to you, so check this cap carefully before you select a policy.
Group plans can negotiate plans with lower costs than individual plans, but all negotiations come with tradeoffs. To truly assess pros and cons, you have to look in detail at the exclusions, deductibles, percentage of a claim paid, yearly numerical limits (like the number of cleanings or fillings covered per year) and lifetime maximums for certain items such as orthodontia. Employer-sponsored benefits should be run through the same cost analysis, regardless of the ratio of employer/employee contribution.
Check for deals with your current dentist. They may have suggestions or be affiliated with particular insurance plans. Remember your insurance premium could also be affected by your credit rating. The confidence in your ability to make the monthly premium payments is determined by how well you maintain your credit score.
So, Is Dental Insurance Worth It?
Aside from peace of mind, it is arguable. A 2009 study by the Robert Wood Johnson Foundation found insurance to be almost a draw – with estimated premium costs factored in, the average household spent $978 on dental care if they had insurance and $1,007 without insurance. However, those with unusually high dental expenses were generally saved from financial hardship by dental insurance. If you need it, you really need it.
If you have some reason for high risk – for example, you are a weekend hockey player – you may want to consider dental insurance. Another reason would be expected orthodontia bills for your children. Aside from that, dental insurance is probably a peace-of-mind purchase more than an economic one. If it helps you to sleep at night, go for it. And, try not to grind your teeth while you’re sleeping!
Of course, dental insurance is no different from most specialty forms of insurance – you don’t think much about it until you need it. In most cases, the dental insurance through an employer is general a better deal. Get information about dental plans in your area.
The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
Jose Rivera Espada is the director of financial aid at IU School of Medicine, a nine-campus allopathic medical school in Indiana. Jose’s experience includes working as an assistant director of financial aid at Butler University and a financial aid coun...