Do You Need Dental Insurance? What To Know

Whether or not dental insurance in this day and age is needed is one of the most substantial questions you can ask when it comes to your time, money, and treatment involving dental care. One of the first things to understand is medical and dental insurance are different. For whatever reason, teeth continue to be viewed as a separate realm of health, and most experiences with coverage occupy their own exceptional nature, remaining separate from methods many are accustomed to with medical insurance.

One reason is because medical insurance covers unexpected and widespread health issues, such as injuries and illness originating from a doctor’s diagnosis, while dental insurance plans can be a hybrid type of both insurance and benefit plans, with treatment potentially stemming from proposed individual procedure codes. The latter detail is remarkable, because benefit plans can look similar to full insurance, however the extent of coverage can be dramatically different or restricted.

In actual health insurance with a medical doctor, diagnosis codes under the ICD-10 (International Classification of Diseases, 10th revision) are used, and this opens doors to medical care based on a diagnosis. A lot more can happen when a diagnosis is the focal point. In dentistry, CDT (Current Dental Terminology) codes are used, which are specific procedure, or service-based codes.  If a condition is not resolved, or a proposed treatment is not covered, despite a diagnosis being in place, a patient may still become financially responsible. What more, dental plans may only cover treatment results for 3-5 years despite the large out-of-pocket expense a patient may face, or they may not cover second procedures after an initial failed in the first 3-5 years. In my opinion, 3-5 years is not a very long time for something with your teeth to work, and if the result goes a day beyond year 3 or 5, or however long the policy extends, the patient must bear the cost again. I think 10 years would be a nice option, and dentists on their own may offer this for patients as their own “in-house” insurance policy. As a result, some may choose to seek dentists who do not take insurance, have higher fees up front, but cover their work for 10 years or more, saving you money and repeat treatment.

Some ironclad specifics for how dental coverage can be helpful is for people who change dentists often, have frequent cavities, or are managing gum disease and need a lot of cleanings each year. Dental plans can be particularly effective in these circumstances. What more, and in my opinion the best advantage of all, is dental plans can protect patients from dentists who wish to charge excessive fees, perform excessive procedures, or propose aggressive and financially debilitating treatment plans which may not be the most appropriate.

In such cases, dental plans with their negotiated lower fees, treatment reviews, authorizations, and practice audits ensure patient protection and hinder dentists from exploiting those they are entrusted to treat. In the fast-paced world we live in today, it is my personal belief this is an ever-common problem, and dentists need to do a better job looking out for people. The rise of dental insurance and benefit plans may reflect people’s support and need for such an enforcement body to protect their interests, and I don’t think dentists on their own have been able to offer superior alternatives when assessed over large numbers. That being said, many dentists are exceptional and good people, and finding them is worth the drive, even if you have to go past other convenient offices on the way. If not, dental coverage plans will certainly take care of uncertainty.

While dental plans may offer added security, let’s talk about some downsides. Coverage usually applies to certain treatment, such as fillings for cavities, extractions for broken teeth, some coverage for dental crowns, removable fake teeth, etcetera. It is important to know, however, teeth can have many more problems, and these often fall into exceptional areas not covered. For example, teeth get cracks over time, becoming a risk for breaking and then having to get extracted, also known as getting “pulled”. Dental crowns are big restorations which cover the outside of a tooth that has a risk for breaking due to cracks, however dental plans may not cover crowns for such fracture risks. Usually, the fracture has to happen first. And it costs a lot less to pull a tooth than it does to save it with a crown before the break happens. What more, when a procedure isn’t covered, the dental office may have the option to charge its full fee as if negotiated insurance rates don’t exist. So if you’re spending a decent amount of money for dental coverage and have teeth that may break (rather than get cavities), you end up paying for  the non-covered services anyway. If the dental office lowers their fee to match the plan’s negotiated rate, which is a common practice, you still pay without any coverage contribution – however, the overall price could be around 40% lower than what you pay otherwise. So that’s still good, and another nice level of advocacy if trust, financial accountability, or something else is lacking your patient experience without a dental plan. However, you still pay the total amount despite cracks and fracture risks being extremely common in teeth which have dental work.

Let’s talk about specific finances. In terms of the overall expense found with dental plans, dental insurance for an individual can range anywhere from $30-100 per month, or $360—$1,200 per year. That is a lot more than you may spend on cleanings and exams on their own. Without dental coverage, an individual can expect to pay $141 for a standard 6 month cleaning, and around $240 for a yearly exam & x-rays. This amounts to $522 per year, and if you receive your 5 year exam and larger series of x-rays, a little more. Considering the fact that a number of services are still not covered with dental plans, crunching these numbers with your anticipated dental needs can clarify the direction to take. Change dentists often, have frequent cavities, or chronic gum disease in need of a lot of cleanings each year? Definitely worth considering coverage.

Those are some excellent benefits. Now there is one serious concern I want to address. I’m going to say this and it is an ugly one. Some may disagree with me. From the dentist’s perspective, dental insurance doesn’t pay much. Dentists have had reputations of lavish lifestyles, rolling around in money, extravagance. While that was certainly true in generations past, in this day and age, not many dentists are really prospering, and it is an ongoing problem in the profession. Declining work conditions, high debt, dramatically low compensation, and overall physical anguish inherent in the work leads to fewer talented prospects aspiring to join the profession.

Many of the benefits dental plans offer work great for the patient, but not the dentist. Dental offices are EXPENSIVE to maintain, and with the reduced reimbursement, a dentist can offer more services, charge more money, or find additional sources of efficiency and lower overhead costs. Working in this current day and age where dental plans are common, and an increasingly large number of dental offices are becoming “big business” entities, a dentist has to be able to work FAST to stay in business with lower insurance rates. A modern dental office costs around $500 per hour to stay in business, and in my opinion that is a conservative number. Two fillings over an hour with dental plan reimbursement rates may only pay around $400. That means the dentist would lose $100 treating a patient. They go out of business. If they can’t work fast enough, they may be tempted to advance care to more expensive procedures such as crowns, and do much more dramatic work on a tooth than is necessary in past times.

That shouldn’t be a problem without dental insurance, assuming ethical practice. If the dentist owns their own office, they you can buffer these losses with deductions, buying items in bulk, and above all, relying on non-insurance patients to buffer these losses. But nowadays more and more people are going to dental plans and it makes running an office hard. A lot of dentists don’t get such efficiency no matter how long they practice, and there is small room for error. If the dentist works for another dentist, it becomes exponentially more difficult for the employee dentist to make their overhead numbers, let alone accumulate savings to open their own office and take care of people independently. In fact, some dentists who are employed are required to produce a certain amount of treatment each month, and some to even pay their employing company for a deficit of care each month. So you may get advised to have more work done than needed despite the benefits dental plans can offer. If you can afford not to have dental insurance, I think it is better to avoid it.

In my opinion, if you see the same skilled dentist routinely, and they look out for your best interest in terms of conservative treatment and conservative prices, you both will benefit the most. If the dentist wants to charge you a lot of money for work that did not meet performance expectations and doesn’t offer a way to meet you in the middle, absolutely having such a strong third party can make sure you are taken care of. Different mentalities exist with different communities, personalities, and philosophies, and ultimately determining who takes care of you best will yield the result.