Health insurance doesn’t cover your teeth. Your teeth can cause pain, get infected and need treatment, just like any other part of the body. But when it comes to actually getting treatment the standard health insurance doesn’t cover it. Instead, you need specialized coverage to pay for a trip to the dentist’s office.
The specialized coverage comes in two main forms. The first is dental insurance. This is standard insurance that covers most of the cost of treatment in exchange for a monthly premium and co-payments. The second is a dental savings plan. This is a discount program that gives you a percent off your bill in exchange for an annual membership fee. We’ll discuss how it works.
A financial advisor can help you plan for future healthcare expenses.
What Is Dental Insurance?
Dental insurance works like standard health insurance. It is accepted at dentists’ offices, including specialists such as orthodontists and endodontists, although depending on their range of services, some medical practices might accept it as well if they have dentists on staff. It pays for care that involves your teeth and gums.
With dental insurance, the insurance provider pays for a portion of each treatment. The exact amounts range based on the nature of the treatment and the nature of your insurance plan. For example, many if not most plans will pay for 100% of preventive treatment like routine cleanings and checkups, while the same plan might not pay for any part of a cosmetic procedure like teeth whitening.
What Do You Have to Pay?
You have to pay any amount that your insurance doesn’t cover, which are out-of-pocket expenses. For example, if your insurance covers 50% of a $700 treatment, that means the plan would pay $350 and you would pay the remaining $350.
Like other forms of health insurance, dental insurance is structured around three main forms of payment from the customer:
Premiums – Monthly payments that you make for the plan
Co-payments – Payments that you make when receiving any given service
Deductibles – The amount you pay before your insurance covers costs
Premiums are fixed. You pay the same amount each month for a given plan. Co-payments and deductibles will change based on the nature of the treatment you get. Your insurance plan will have different co-payments for any given treatment and will apply different rules about deductibles.
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Types of Dental Insurance
Like with other forms of medical insurance, there are different major categories of dental insurance. The three main types of dental insurance are:
Dental Health Maintenance Organizations – this offers lower premiums. But it has more restricted coverage options.
Dental Preferred Provider Organizations – Midrange premiums and more treatment options, but fewer providers.
Dental Indemnity Insurance – Higher premiums, but more options and coverage.
Pros and Cons of Dental Insurance Pros
The main advantage to dental insurance is coverage. This works the same way as all other forms of medical insurance, in that your insurance company pays for a portion of your treatment. They will pay for dental services in whole or part, and your spending for covered services is capped each year.
That doesn’t mean your out of pocket expenses won’t be high. Dental insurance isn’t subject to many of the same rules as health insurance, so if you need specialty services like braces, a retainer or a root canal you can still expect to spend thousands of dollars out of pocket. That’s still far less than you would spend without insurance or with a dental savings plan though. It’s also far more likely that any given dentist will accept your insurance, as fewer providers accept dental savings plans compared to insurance.
The main disadvantage to dental insurance is the costs involved when you don’t need treatment. Dental insurance isn’t nearly as expensive as health insurance, but this will still cost a lot more than something like a dental savings plan. Depending on how much coverage you need and how many people are in your household, you can expect to spend anywhere from $20 to $200 per month on dental insurance.
An individual looking for decent, but not comprehensive, coverage should expect to spend at least $50 per month.
Another way of looking at it is this: Dental insurance is better if and when you need treatment. You will spend less money and find care more easily. A dental savings plan is better when you don’t need treatment because it will cost you less.
What Are Dental Savings Plans?
A dental savings plan, otherwise known as a “dental discount plan” is different than health insurance. Instead, it could be thought of as a membership. With a dental savings plan, you pay an annual fee, typically $150 or less for a family, to enroll. In exchange, you receive a discount on services at participating dental providers.
For example, you might receive 40% off a routine cleaning or 25% off the cost of filling a cavity. Unlike insurance, the savings plan doesn’t pay for these costs. Instead, they are negotiated discounts for plan members.
You are responsible for paying for the rest of the costs of any given service. For example, if you have a $1,000 procedure and your dental savings plan gives you a 20% discount, you will pay the remaining $800.
The details of a dental savings plan can vary widely. Each program will have different dentists who participate, different costs for membership and will offer different discounts for services. Generally, fewer dentists accept a savings plan membership than insurance, so you will usually have a smaller provider network to choose from.
Who Should Consider a Dental Savings Plan
There are several situations in which it makes sense to consider a dental savings plan.
If you’re on Medicare. Such plans don’t cover most dental care (including procedures and supplies such as cleanings, fillings, tooth extractions, dentures, dental plates or other dental devices). Original Medicare may pay for some dental services that are closely related to other covered medical services. Medicare Part A will also pay for certain dental services that you get when you’re in a hospital.
If you’re unemployed. These plans are relatively inexpensive and, unlike many dental insurance plans, you can access the benefits in two or three days.
If your teeth are in great shape. People who consistently floss, brush and gargle several times a day and have a history of zero cavities, may not need coverage.
Pros and Cons of a Dental Savings Plan
The main advantage of a dental savings plan is the up-front cost. Typically one of these programs will cost several hundred dollars per year in membership fees. By contrast, dental insurance can cost several hundred dollars per month (if not more) in premiums.
You also have no coverage caps with a standard dental savings plan, meaning you don’t have maximums or deductibles. And you simply receive the set discounts for any given service.
However, the downside here is that you will almost always pay more for the actual services. Despite co-pays and deductibles, insurance will typically cover more costs when it comes to receiving treatment, so you can expect a savings plan to cost more out of pocket.
The result is that a dental savings plan can often fill a role similar to catastrophic insurance. If you are healthy enough that you only need occasional cleaning and checkups, this might be a good option. If you will need real treatment, this may end up costing you more in the long run.
Dental insurance is health insurance that applies to your teeth. In exchange for premiums and a co-pay, the insurance plan pays for the rest of your treatment. A dental savings plan is a discount program, in exchange for an annual payment, that gets you a negotiated percentage of your treatment at the dentist’s office.
Tips for Managing Your Healthcare Costs
Just as you would consult a healthcare professional to assess your well-being, be sure to consult a financial professional to assess your fiscal well-being. Finding the right financial advisor who fits your needs doesn’t have to be hard. SmartAsset’s free tool matches you with three vetted financial advisors who serve your area. If you’re ready to be matched with local advisors that will help you achieve your financial goals, get started now.
Considering alternatives to health insurance is important for maintaining a healthy budget. A comprehensive budget calculator can help you understand which option is the best for you.
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