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

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

a. For those who purchase their own insurance, the decision to purchase dental coverage is not always as clear cut as the decision to purchase health insurance.

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While an uninsured patient can incur hundreds of thousands of dollars in medical costs relatively quickly, not having dental insurance will not directly result in that kind of financial ruin. But untreated oral infections can lead to other systemic health problems that can be life-threatening, and access to affordable dental care is much more than just a cosmetic issue.

financial charges

Compared to other health care, Americans are much more likely to skip needed dental care because they can’t afford it. And while the Affordable Care Act greatly improved dental care coverage for children, it didn’t change the rules regarding dental care for adults. (Some adults did get dental coverage as a result of the aca’s medicaid expansion, but this varies from state to state.) check dental coverage options in your state.

While private dental plans generally present better value than self-insurance if a patient ultimately needs dental care, they can leave patients with significant out-of-pocket costs if extensive dental work is needed.

running the numbers

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But how would the costs of your dental care with dental insurance compare to your expenses without it?

A recent insurance industry study of dental hypothetical scenarios compared the cost of self-insurance (paying the full dental bill, without purchasing insurance) with a variety of dental insurance plans and dental discount plans. all three scenarios involved minor, moderate, and extensive dental work and associated costs. In all cases, the most expensive option was self-insurance.

Their model scenarios included biannual x-rays, exams, and cleanings, which some people forego. And, of course, his model scenarios also included getting necessary dental care, when in reality, a not insignificant number of people just don’t go to the dentist at all.

According to the American Dental Association, 100 million Americans (almost a third of the population) do not visit the dentist in any given year. Obviously, for people who don’t seek care, dental costs are zero. But as Christopher Smith’s story illustrates, untreated dental problems can lead to much larger health problems.

Clearly, going without dental care altogether is not a viable long-term solution. Given that virtually everyone needs at least basic preventive dental care, and even with preventive care, most people also need additional dental care, it stands to reason that some type of dental coverage would be beneficial to most people who have it. .

And for some people, the monthly premiums actually serve as an incentive to encourage them to seek preventative dental care and treatment for minor dental ailments before they become major problems.

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But most people who have dental coverage receive it as an employee benefit, with the employer paying a portion of 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 pay the full cost, but the full cost will tend to be more expensive, since individual dental coverage is more expensive. likely to be purchased by people who plan to use it, compared to employer-sponsored dental coverage that employees might select as part of their benefits package, even if they have no plans to get dental care in the near future.

dental insurance benefit limits and waiting periods

Dental plans, including plans obtained through employers or purchased on the individual market, tend to have benefit limits in the range of $1,000 to $2,000 per year, which can easily be exhausted if you need dental work extensive.

And there are also often waiting periods for major procedures, which means you’ll have to pay your premium for a year before you can start receiving those benefits. (These may not apply in some plans if you already had dental coverage in force before starting the new plan.)

You’ll typically receive comprehensive coverage for routine preventive care and minor dental work, but premiums may be essentially the same as a prepaid plan. But again, if having the coverage is what motivates you to seek routine preventive dental care and get treatment before dental problems become serious, the plan may well be worth the premium.

(Employer-sponsored dental hmo plans sometimes do not have a benefit limit, but this type of coverage is generally not available to people who purchase their own coverage and can only be obtained through an employer who purchases it). You can also find individual dental plans available with no benefit limits, but no coverage for very high-cost dental services like dentures, implants, crowns, and root canals).

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinion pieces and educational articles on the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by the media covering health reform and by other health insurance experts.

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