Is Dental Insurance Worth It?

Well, that depends. If you can pick a plan that supports well rounded oral health, then it might be. Picking a dental plan that truly benefits you has to cover basic procedures like fillings, and unexpected procedures like dental crowns that may be needed occasionally during your life.

So make sure to ask yourself, is it worth it? And, what dental coverage is important?

Is It Worth It?

On average, Americans pay about $360 a year, or between $15 and $50 a month, on dental insurance premiums. There are pros and cons to purchasing a dental policy, either from your employer or from an insurance marketplace. 

Will Dental Insurance Reduce My Annual Costs?

If it has been a while since you have been to the dentist, then you will be behind on dental X-Rays, exams, and cleanings. In that case, you may also be in need of some other basic procedures like fillings, a root canal, or a deeper cleaning. 

We all know that having health insurance is a good idea, but dental insurance is different. Medical insurance, more often than not, saves you money in the short and long term. If your monthly premium is high, you’ll pay a lower deductible, and vice versa.

Dental insurance works differently. Here’s how:

Insurers use three techniques to limit how much they will cover for preventative, basic, and major procedures.

Dental Insurance has a Maximum “Annual Benefit” or “Coverage Limit.”

The limit usually falls between $1,000 and $2,000. You pay any additional costs out of pocket, even for preventative care – like cleanings! Medical insurance generally covers preventative care and then costs after your bills reach the amount of your deductible. Dental insurance cuts off coverage after your bills reach your annual limit.

  • Many plans cover basic procedures pretty well, but if you have three cavities at several hundred dollars a filling and are behind on dental X-Rays, exams, and cleanings you can quickly use up your dental limit of just $1,000 to $2,000. If any major procedures are needed within the same year after reaching the insurance limit (like a crown, root canal, or an extraction), then they would be costly even with comprehensive insurance. 

Dental Insurance Plans Apply a Reimbursement “Rate” Based on the Procedure:

  • Preventive Care—your exams, cleanings, and X-rays needed during an average dental checkup can be 80% up to 100% covered. Dentists recommend a minimum of two annual cleanings. But, as we age or if we have delayed teeth cleanings, your hygienist may recommend more cleanings in a year to fight gingivitis and plaque.
  • Basic Procedures—like fillings, extractions, and periodontal work (deep cleanings) can be 60% up to 80%.
  • Major Procedures—like crowns, root canals, dentures, bridges, or implants are 50% covered (or less).

Many Dental Insurance Plans Cap Reimburse Per Dental Procedure.

For instance, if your employer plan is based in a state where dental cleanings are typically cheaper, the cap may be as low as $60.00. Your plan may claim to cover 100% of cleanings, but will actually only cover up to $60.00 of that cost. This means that a preventative procedure that you think is going to be 100% covered may only be covered 60% (or less). Especially since teeth cleanings are typically over $100 in California.

What Coverage is Important?

Unfortunately, cost is the #1 reason why Americans don’t get the regular dental care they need. Any dentist will tell you that avoiding general dental care will increase the number of expensive procedures, like crowns or an implant, that you may need over your lifetime. 

Here at Withers Dental,  your Manhattan Beach dentist, we know what works to save you money so you can spend your time enjoying your lovely smile outside of our office: a regular preventative care program managed by a registered dental hygienist combined with an excellent at-home dental routine.

Regular teeth cleanings, exams, and X-rays may seem optional if you normally have healthy teeth and good oral hygiene, but keeping up with them will save you a significant amount of money in the long run. It is not unusual for us to see patients, even young patients, that have skipped regular dental visits for a year or two resulting in cavities and/or early gingivitis. 

Even though you brush and floss, plaque will start to burrow between your teeth and under your gum line if you skip regular cleanings. Fillings and deep cleanings require extra time and money. You won’t need them only at convenient times. Perhaps it is diagnosed just when you are starting a new job (beware of waiting periods) or between jobs (no coverage).

Things to Look Out For

What is a waiting period on my dental insurance?

Exactly what it sounds like: a period of time the insurance company will require you to wait before covering the cost of a procedure you may need, and should prioritize. 

Some plans have waiting periods before you can have basic or major procedures completed. One plan we recently reviewed had a one year waiting period before reimbursing for any major procedures. Try waiting a year to fix a cracked tooth.

What is considered a basic or major procedure according to my insurance?

That depends on how important the insurance company considers different procedures to be. Some insurance plans will shift a basic procedure to a major procedure meaning they will cover less of the cost. For example, a root canal could be considered either a basic or a major procedure.

Will my dental insurance cover orthodontic care or whitening?

Most plans allow you to purchase separate coverage for orthodontic care if it isn’t covered. Very few plans will cover cosmetic care (like teeth whitening). Cosmetic procedures are an out-of-pocket expense.

What Can I Do If I Don’t Have Dental Insurance?

If you are under-insured or uninsured consider joining the Withers Dental Membership Program. The Program covers 100% of your annual preventative care and 15% off all other procedures (excluding Invisalign but including cosmetic procedures like teeth whitening). Do the math yourself! The Withers Dental Membership Program can save you money on your monthly premium and required out-of-pocket costs. (Hint, if your current insurance plan has a $1,000 maximum and/or is based out of a low cost state, with caps, it’s worth it!) A Withers Dental Membership ensures the very best annual care for you and your family, resulting in healthy teeth and avoiding more expensive procedures.

Give Withers Dental a call and we will be more than happy to talk to you about your employer or self-employed insurance options. If your insurance options are limited, Withers Dental, your family dentist in Manhattan Beach, always has you covered.

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