Is it better for me to pay out of pocket for dental care and not worry about dental insurance? | healthinsurance.org

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Compared to other healthcare expenses, dental care is often overlooked due to its high costs. Many Americans are unable to afford the necessary dental treatments, which can have serious consequences for their overall health. Although the Affordable Care Act improved dental coverage for children, the rules regarding dental care for adults remained largely unchanged. While some adults gained dental coverage through Medicaid expansion, this varies from state to state. Therefore, it is crucial to explore dental coverage options available in your state.

Private dental plans generally offer better value than self-insurance in the long run. When extensive dental work is required, self-insurance can lead to substantial out-of-pocket costs.

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Running the Numbers

But how do the costs of dental care with dental insurance compare to expenses without it? An insurance industry study recently compared the cost of self-insurance (paying the full dental bill without purchasing insurance) with various dental insurance plans and dental discount plans. The scenarios included minor, moderate, and extensive dental work and associated costs. In all cases, self-insurance proved to be the most expensive option.

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This study also considered biannual x-rays, exams, and cleanings, which some people may choose to forgo. Additionally, the scenarios included necessary dental care, whereas a significant number of individuals do not visit the dentist at all. Astonishingly, the American Dental Association reports that nearly a third of the population, or 100 million Americans, do not seek dental care in any given year. However, untreated dental problems can lead to more severe health issues, as exemplified by Christopher Smith’s story.

The Importance of Dental Coverage

Clearly, going without dental care is not a viable long-term solution. Since almost everyone requires at least basic preventive dental care, and additional dental care is often necessary even with preventive measures, it makes sense for most individuals to have some form of dental coverage. Furthermore, for some people, monthly premiums serve as an incentive to seek preventative dental care and address minor dental issues before they escalate into major problems.

However, most individuals obtain dental coverage through their employers, with the employer partially paying the premiums. When you have to pay your own premiums for an individual market plan, the numbers may not be in your favor. Not only will you be responsible for the full cost, but individual dental coverage tends to be more expensive since people who purchase it are more likely to utilize it, compared to employer-sponsored dental coverage.

Dental Insurance Benefit Limits and Waiting Periods

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Dental plans, including those obtained through employers or purchased individually, often have benefit limits ranging from $1,000 to $2,000 per year. If you require extensive dental work, these limits can be easily exhausted. Additionally, there are usually waiting periods for major procedures, meaning you must pay your premium for a year before receiving those benefits (although this may not apply if you already had dental coverage before starting a new plan).

While routine preventive care and minor dental work are typically covered comprehensively, premiums may be similar to those of a prepaid plan. However, if having coverage motivates you to seek routine preventive care and address dental issues before they become serious, the plan may well be worth the premium.

It’s important to note that some employer-sponsored dental HMO plans do not have a benefit limit, but they are usually not available to individuals who purchase their own coverage. These plans can only be obtained through an employer. There are individual dental plans available with no benefit limits, but they do not cover high-cost dental services such as dentures, implants, crowns, and root canals.

Louise Norris, an experienced individual health insurance broker, has been writing about health insurance and health reform since 2006. She has authored numerous opinion pieces and educational articles on the Affordable Care Act for healthinsurance.org. Her expertise is highly regarded by the media and other health insurance experts, and her updates on state health exchanges are frequently cited.

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