For most people, having health insurance is a no-brainer. Even if you’re pretty healthy, you want that reassurance that if something serious happens, your insurance will pay for most of the outrageous costs of medical care.
But what about dental insurance? There’s usually a coverage cap of $1,000 to $2,000 worth of treatment per year, which might make you wonder what you’re really getting in exchange for your monthly premium. In 2017, about 58% of dental services were paid by private health insurance, while 53% of services were paid out of pocket, according to Statista.
Below, we break down what dental insurance really covers—and who should consider buying it.
How dental insurance differs from regular health insurance
Once you’ve hit your insurance deductible for the year, you don’t have to pay anymore, right? Not when it comes to dental insurance.
Restorative dentist Daniel Balaze explained that the deductible for dental insurance works differently than your deductible for your health or auto insurance. “You have a deductible, yes,” he explained, but he said it’s more like a cost-sharing plan. Beyond the maximum your plan pays per year, you’ll have to pay for your dental work out of pocket.
What dental insurance actually covers
Dental insurance usually covers most of your routine costs of cleanings, x-rays, and the occasional filling or two. But say you slip and fall, knock a tooth out, and need an implant. “You are probably out of luck,” Balaze said. “At best, you get to pay half the costs up to your maximum. Then you are on your own.”
“Dental insurance usually covers preventative care at 100%, basic care, which includes fillings and simple extractions, at 80%, and major services like root canals at 50%,” John Barnes, a CFP and insurance agent, said. “Every carrier is a bit different, though.”
Dental insurance usually comes with a waiting period for major procedures. “Sometimes, the waiting period is waived if you show continuous dental insurance coverage,” Barnes said. But for many plans, if you need to have a cavity filled before the waiting period, for example, you’ll pay 100% of that cost and essentially get no coverage for that work.
How to decide whether to get dental insurance
What about the costs? With all the caveats of dental insurance, it may still feel like a coin-toss is the best way to choose whether to buy it or not. “For the people who need a lot of work, the dental benefits company isn’t going to cover very much, Balaze said. “For those who don’t need much work at all, the dental benefit plan usually costs more than it’s used.”
If you can get dental coverage through your employer for a few dollars a month, it’s probably worth it. Families with children and older people should consider dental coverage, as they’re more prone to needing dental work, Barnes said.
Say you don’t have access to employer-sponsored insurance. If you go to the dentist regularly for cleanings and rarely need additional treatment, you might be fine to skip insurance. “People who have kept their teeth in good shape and can afford the out-of-pocket cost of any major service” are good candidates for skipping dental insurance, said Barnes.
Medicare insurance agent Michael Lovell recommends considering the following to determine if dental insurance is a fit for you:
· Do you go to the dentist for cleanings twice per year?· Is your dentist in network?
· Is your annual premium equal to or less than the cost of two cleanings, two exams, and one set of x-rays?