Whether you need emergency service, or just a routine exam, X-rays and a cleaning, dental costs can quickly escalate; especially if you’re not insured.
About 108 million people in the U.S. have no dental insurance, according to the U.S. Department of Health and Human Services. Some consumers like Angie’s List member Kristy Alagna of Chicago question the value of the investment, skeptical of what it will provide when they need it.
Alagna says she hasn’t had dental insurance for more than a decade. She says she favors paying for dental care when she can afford it because the plans she could afford as both a small business owner and employed with a part-time job cost more than routine checkups and close to one-third of the annual benefits she’d receive. Alagna adds that she doesn’t like that some of those plans required her to wait a year or more before insurers would pay for major procedures and that their networks didn’t include her preferred dentist. “When I checked out the cost, it didn’t seem worth it,” she says.
Dental insurance premiums vary depending on the number of people the plan covers, the type of plan and the geographic market served, says Darci Shaw, spokeswoman for Delta Dental Plans Association, which provides dental benefit programs to more than 60 million Americans.
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Shaw says premiums can be as low as $10 a month for an individual enrolled in an HMO-style insurance plan that restricts patients to a specific dentist in a smaller network, or as much as $50 monthly for a preferred provider organization (PPO)-style plan that allows patients to use their choice of dentists in multiple states. Regardless of the plan type, annual benefits are usually capped at $1,500 a year and cosmetic procedures such as veneers aren’t covered, Shaw says.
“Dental plans are designed to encourage preventative care,” she says and adds that waiting periods and caps on benefits provided help keep premiums low by preventing people from obtaining coverage only when they need major work, then dropping it after the care is completed. Shaw says patients who use dentists in their plan network can’t be charged more than the rate the insurer negotiated with the dentist.
Member George Cohen of Ocala, Fla., says he relies on dental insurance to keep expenses predictable. Without it, “You’re at the mercy of the doctor,” he says.
A typical employer-sponsored or consumer plan covers 100 percent of the cost of diagnostic exams, teeth cleanings, X-rays and sealants, says Dr. David Guarrera, vice president of MetLife Dental Products, which sells employer group dental plans. Group plans often pay most of the cost for fillings, root canals, treatment for gum disease and emergency tooth removals upon enrollment.
More comprehensive plans with higher premiums may pay more for the cost of major procedures like crowns, bridges, implants and braces, he says. “It makes sense to enroll in the high option [plan] if you know or anticipate you will have greater dental health care needs,” Guarrera says.
The purposefully uninsured Alagna says she trims her dental expenses by using discounts highly rated Dr. Katherine Gerginis in Chicago offers her uninsured patients. “Her prices are reasonable. She put in a temporary bridge for $178,” says Alagna, who plans to replace it with a permanent bridge for about $3,800.
Still, Alagna admits that she’s delayed minor treatments like fillings because she couldn’t afford them, which resulted in the need for dental treatment that cost several thousand dollars.
That’s why dental insurance is worth the investment, Guarrera says. “We know that people who have insurance for dental care go and seek care more often than those who don’t or [who] save the money to cover the cost,” Guarrera says. He adds that oral health problems seldom get better without treatment and dental health problems may be a sign and a cause of disease elsewhere in the body.
Highly rated A Dental Touch in Greenwood, Ind., accepts insured and uninsured patients, says office manager Amanda Abell. Most insured patients, however, don’t know what their plan allows and therefore, aren’t taking full advantage of it. Abell says the staff at A Dental Touch helps educate patients by calling insurers to verify their benefits and out-of-pocket expenses.
“If a patient is getting a crown or implant or [braces], we ask patients to wait until we get verification for large expenses,” she says.
Guarrera says patients shouldn’t assume their dentist checks their coverage or understands their benefits because insurance plans change and the consumer is ultimately responsible for the bill.
Since getting some crowns replaced, a root canal and tooth removal in recent years, Cohen says he makes it a priority to know what his plan covers so he can prepare for emergencies and other treatment. “When you’re in real pain, you have to do something,” he says. “We need to have that predictability of knowing that if something happens we wouldn’t have to pay twice as much.”