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Is dental insurance worth the cost?

By Marilyn Lewis/MoneyTalksNews

You need medical insurance, if only to protect against the cost of an accident or illness so expensive that you could be ruined financially. But do you really need dental insurance?

It’s an interesting question, because you can avoid the most likely causes and expenses of dental problems, decay and gum disease, by brushing and flossing your teeth diligently. But some teeth are more prone to problems, and when they have a problem, the costs can mount quickly.

The price of insurance

About 64 percent of Americans have dental insurance. Nearly all of them have coverage through work or a group plan like AARP, Medicaid, Tricare (for military families) and the federal Children’s Health Insurance Program, according to Evelyn Ireland, executive director of the National Association of Dental Plans, in an email interview.

Most dental preferred provider organizations and regular insurance (indemnity) plans have an average deductible of $50 and a maximum yearly benefit of $1,000, Ireland says. Only 2 percent to 4 percent of Americans with dental insurance use up their yearly maximum allowance.

Dental plans offered through a workplace typically are one of three types:

  • Indemnity plan: You choose your provider, and your plan pays a percentage of the fees.
  • PPO: Preferred provider organization plans have groups of practitioners who agree to reduced fees for patients within the network. Your costs are lower with network dentists. You may see out-of-network dentists, but it’ll cost you more.
  • HMO: Health maintenance organizations cut costs by requiring members to use only providers within the network.

Premiums for group dental plans in 2014 (the latest information available) averaged from $19 to $32 a month ($228 to $384 annually), said the NADP.

Is insurance worth it?

The NADP describes these elements of coverage in a typical plan:

  • Preventive care: periodic exams, X-rays and, for some age groups, sealants -- 100 percent.
  • Basic procedures: office visits, extractions, fillings, root canals (sometimes) and periodontal treatment -- 70 percent to 80 percent.
  • Major procedures: crowns, bridges, inlays, dentures and sometimes implants and root canals -- 50 percent or less.

Orthodontics coverage usually can be purchased as a rider, said the NADP. Cosmetic care isn’t covered.

Dental insurance isn’t always worth the cost. It depends on your plan, your needs and the cost of the services available to you.

In deciding if an insurance plan is right for you, weigh:

  • The annual premium
  • The cost of the dental care you need
  • Your policy’s limit on how much it pays out in benefits and whether you can roll over unused benefits from the previous year
  • Policy coverage

“While many dental policies focus on preventive measures by offering two annual visits, you’ll really start seeing the savings with more expensive treatments, like root canals and crowns,” according to Angie’s List.

Help from the Affordable Care Act 

The ACA requires providers to offer dental insurance for children younger than 18. “Although the new act does not require dental coverage for adults, most state marketplaces will also offer dental coverage for adults,” said the American Dental Association. Adult dental coverage may be offered as part of a comprehensive health plan or as stand-alone dental insurance. Here’s more about the ACA and dental coverage:

Dental insurance isn’t the only way to cut dental bills. In fact, 36 percent of Americans have no dental insurance. Here are 10 other ways to cut your costs:

1. Self-pay

It may be less expensive to pay out of pocket than buy a plan. Fees vary by dentist’s office and by geographic region. Here are average costs in the U.S. for several common procedures, from the ADA Health Policy Institute’s 2013 Survey of Dental Fees (the latest data available):

  • Teeth cleaning (prophylaxis) adult: $85
  • White dental filling (one surface, anterior): $149
  • Silver filling (one surface, primary or permanent): $125
  • Porcelain crown fused to noble metal: $1,003
  • Complete series of intra-oral X-rays: $124

    2.  Preventive care

In many cases, the best way to save on dentistry is to take excellent care of your teeth and gums, and to teach children healthy dental routines. For example, did you know that fruit juices, carbonated drinks and acidic foods can help wear away your tooth enamel?

The ADA tells you how to brush correctlyhow to floss effectively and offers more information on dental health.

Delta Dental, an insurer, has more tips on preventive care.

3. Cut back to one cleaning a year

Several studies have shown that visiting the dentist twice a year doesn’t deliver notable benefits compared with one exam a year. If you don’t have serious dental issues, you can probably get by with one cleaning annually.

But don’t skip that one annual cleaning and exam. It could save you from costly and serious problems.

4. Discount dental plans

Discount plans charge an annual fee in exchange for discounted services from network providers. Before you buy into a plan, look over its list of covered procedures to see if they’re ones you are likely to use.

PolicyGenius, an independent insurance broker, compared five dental insurance and dental discount plans. Costs vary a lot depending on where you live and because the state insurance marketplaces created under the ACA offer different plans. It’s hard to comparison-shop for dental plans: Companies don’t easily share information on costs and coverage until after you’ve subscribed, PolicyGenius found. Even so, “all five plans we looked at delivered better value than paying cash outright.”

A tip: The cheapest dental plans don’t offer much value, but don’t just go with an expensive plan -- do some careful research. “If you know you’re going to be spending some time in the dentist’s chair soon -- and especially if you require an expensive dental procedure immediately -- the right discount plan could save you hundreds of dollars,” PolicyGenius writes.

5. Request 10 percent off

Some dentists will take 10 percent off the cost of a visit or procedure if you pay at the time of the visit. Some offer a discount for cash.

If your dentist doesn’t provide a discount, ask (politely, of course) if he/she could do so. Or shop around for a dentist, gathering recommendations from friends and then phoning those offices to find out if they offer a discount.

6. Charitable clinics

Look for low-cost or free dental clinics in your community offered by local dentist volunteers.

Find opportunities in your area through America’s Dentists Care Foundation. Another charitable organization with volunteer dental professionals is Dentistry From the Heart, a global nonprofit organization. Or ask your state’s dental association about low-cost care.

7. Dental schools

Dental schools at many colleges and universities around the U.S. often offer free or reduced-cost care. Accredited programs are listed at the ADA website.

8. Federally qualified health centers

Private health centers offering dental services exist in cities and counties across the country. They receive some government funding and charge according to what you can afford. Use the clinic locator at the federal Health Resources and Services Administration website.

9. Consider dental tourism

Dental tourism -- traveling to other countries to get treatment, often at a fraction of the U.S. cost -- is a huge business. Among the top countries that have a thriving dental industry catering to foreigners are Mexico, Thailand, Spain, Turkey, Czech Republic, Costa Rica, Poland, Philippines and Hungary.

“Dental tourism companies and corporate dental chains are increasingly advertising ‘all inclusive’ travel packages that include dental procedures, hotel room reservations, side trips to tourist attractions, and airline tickets to lure international clients,” said an article in the International Journal of Contemporary Dental and Medical Reviews.

Do plenty of research to ensure that you’re getting safe, high-quality care. Some resources:

“The decision to visit another country for dental care should go beyond simply comparing prices or even evaluating the dentists’ expertise. Countries differ in their standards for infection control and safety. The use of fresh gloves, sterile instruments and safe water are not standard practice in all countries. Without these precautions, patients could be infected with diseases such as hepatitis B.”

10. Get out of town

Dentist fees in rural counties typically are lower than in urban areas. Comparison-shop for the procedure you need by phoning offices of ADA member dentists outside your metro area and asking about fees. Here’s how to locate an ADA member dentist.