Resources for Individuals

Is Dental Insurance Worth It? (with examples)

Mar 19, 2020 8:49:50 AM / by Erik Soderborg

You’ve got health insurance.

You’ve got car insurance.

But is it worth it to get a dental plan?

The costs of fixing your teeth won’t put you into bankruptcy like a medical catastrophe could, however, if you don’t take care of your teeth, your future could be full of financial pain and discomfort, not to mention a sore mouth.

How does dental insurance work?

A dental plan protects you against the risk of high dental costs that come from cavities, crowns, or accidents. Your insurance company has network discounts and payment options that are beneficial to you if you need dental work.

Are the network discounts and payments from your insurance carrier enough to offset your premium payments and out-of-pocket responsibility?

We’ll give you some scenarios where dental insurance is definitely worth it, possibly worth it, and probably not worth it.

When dental insurance is definitely worth it

Let’s break this into two important categories that will impact your decision:

  • Dental insurance as part of your job’s benefit package
  • Individual dental insurance (not part of your job’s benefit package)

Employer-sponsored dental insurance (part of your job’s benefit package)
Employer-sponsored dental coverage is a no-brainer. If your employer offers to pay for part or all of your dental premiums, take it.

Here are some numbers from my family of 5 and our dental costs over the past year:

Total billed by dentist: How much a dentist bills for services.
$4,406

Allowed amount: The amount negotiated by the insurance company with an in-network dentist.
$2,284
($2,122 savings)

Insurance paid: Of the $2,284 sent to the insurance carrier by the dentist, insurance paid:
$1,449.20

I paid: The amount I was responsible for paying this past year including premium payments
$1,530.82

Total savings to me: Includes the discount I got between the Total billed and the Allowed amount.
$2,875.18

Not bad.

 

Now, do dentists offer a discounted cash price to people without insurance? Most do. So is the total billed by the dentist in this scenario inflated? Possibly, depending on the dentist you use.

Let’s take the network savings completely out of the equation just to illustrate the point.

With no network discount, I still saved $753.18 by having employer-sponsored dental insurance.

Definitely worth it.

 

Individual dental plan (not part of your job’s benefit package)
Premium amounts are higher with an individual plan being that an employer isn’t covering part of the premiums for you.

Since you are responsible for the full premium amount rather than your employer taking care of part of it, that difference is what we’re looking at when we determine the value of having individual dental insurance.

Using the same numbers from the previous scenario and the premium without an employer contribution, we get these numbers:

Total billed by dentist: $4,406


Allowed amount (the discount that my insurance company negotiated): $2,284


Insurance paid: $1,449.20


I paid (including premiums): $2,082.80

 

Total savings to me (including network savings): $2,323.20

 

Again, if we take the network savings out of the equation, I still would have saved $201.20 by having individual dental insurance.

Best-case scenario using the above numbers, you would save over $2K dollars with individual insurance. Worst-case, $201.20.

$200 isn’t nearly as much as the savings realized with employer-sponsored insurance, but it’s still money in your pocket and makes having individual dental insurance worth it.

The important factor in realizing these savings is the fact that we used our dental insurance. We visited the dentist, got our exams, cleanings, x-rays, and some of my family happened to have work that needed to be done.

 

When dental insurance is possibly worth it

If you have little to no work that needs to be done.

We’ve already established that if your job is paying part or all of the cost, get it. We’ll focus on individual plans from here on out.

The numbers above from my family made sense because we needed a cavity filled and a crown. Crowns are expensive and our insurance helped dramatically with that procedure. Had we only had a couple small cavities, we would’ve broken even on our coverage or probably come just short of breaking even.

The tricky part, and why insurance exists, is you never know when you’re going to need that crown or root canal or other major mouth problem.

Related side-note, when I was a kid, I was walking around blind folded as part of a scout activity and ran into a door. Chipped my tooth and boom, dental insurance is worth it in the blink of an eye.

Even if you don’t have major problems, it’s probably worth it to have dental insurance just to protect you and your family against potential, unexpected problems.

 

When dental insurance is not worth it

If you never use it.

Think of it like auto insurance. If you pay your premiums and never get in an accident, you paid to protect yourself against the possibility of an accident.

Similar with dental insurance except you should get to use the benefit at least twice a year. You get preventive services covered at 100%. That means 2 exams and cleanings every year with x-rays once a year. If you don’t go to the dentist for whatever reason and use this benefit, you’re just wasting money and risking your mouth’s health.

Odds are, if you aren’t going to get regular checkups and cleanings, you’re going to have more major work that needs to be done so start setting aside some money to save for future dental expenses.

 

Waiting periods.

Individual dental plans come with waiting periods.

Before we grab pitchforks and surround the insurance carrier’s building, preventive services are covered 100% with no waiting period (at least with our plans). Things like oral exams, cleanings, x-rays, and fluoride fall into preventive services.

We also wrote an article titled, "What's With Waiting Periods?" that helps explain why they are in place. 

Waiting periods can range from 6 months to 24 months depending on the plan and category of service like basic (cavity fillings, oral surgery), major (crowns, bridges, prosthodontics), and orthodontics (braces).

This means if you are looking to purchase an individual dental plan and then immediately get a crown, well… the cost of that crown will be on you until you reach your waiting period.

Until you meet your waiting period, you are responsible for 100% of your dental costs, with the exception of preventive services (again, covered 100% on our plans).

If you are getting an individual plan, sign up and start that waiting period. This does make it difficult to switch insurance carriers though. If you’re through your waiting period with your current carrier, but you aren’t happy with service, coverage, or network, switching to another carrier means you will be subject to the new carrier’s waiting period.

 

Are there alternatives?

Yes!

There are some nifty dental plans that are called Discount Dental plans. These are not insurance products, meaning the plan doesn’t pay anything on your behalf, but these discount plans give you the insurance company’s network discounts. The monthly premiums on discount plans are super low and you can use these plans immediately (no waiting periods), making these plans a nice, inexpensive option.

To give you an idea, our discount plans range from $5 a month for an individual to $9 a month for an entire family. Our discounts range from 30% off up to 70% off dental services.

Discount dental plans you have access to huge discounts off an in-network dentist’s fees and, if you don’t need dental work outside of cleanings, x-rays, and exams, you aren’t paying much in premiums.

 

To Summarize

This article comes from an insurance carrier so we have our side of the story, but we’ve done our best to give you objective insight into dental insurance and when it is and when it may not be worth your investment.

If you’d like to get more insider secrets on medical, dental, and vision, consider subscribing to our newsletter.

 

Tags: dental, individual

Erik Soderborg

Written by Erik Soderborg

Erik is the Marketing Guy at EMI Health. He is passionate about people, tennis, and reading. He has a dry sense of humor and dabbles in the dark art of table tennis.