Millions of Americans don’t have access to a dental plan, approximately 36% of the population according to the National Association of Dental Plans (NADP.) Of the 64% that has dental benefits, 7.2% buy dental insurance on the open market while a vast majority (92%) receive dental insurance through an employer or social program.
If you’re contemplating becoming part of that 7.2% and looking into dental insurance, here’s what you should know about the types of plans commonly found in the marketplace and if you should purchase one.
Types of Dental Plans
- HMO: HMO (healthcare management organization) plans restrict your coverage to dental practices within their chosen network.
- PPO: PPO (preferred provider organization) plans allow you to go out-of-network but with reduced rates for in-network. NADP claims 70% of dental plans are PPO.
- Indemnity: Indemnity plans allow you to see any dentist and they pay a percentage of the fees. PPOs are preferable to indemnity plans because they can negotiate better rates for in-network dentists.
Understanding Your Annual Maximum
Dental benefits have not indexed for inflation in 30-40 years. Ergo, dental plans have an annual maximum that averages about $1,500-2,000 for the entire year unless you can find a plan that offers extended coverage for a higher premium.
There are different levels of coverage with every plan so be sure to read the fine print as to what counts towards your annual maximum and what does not. Routine care like cleanings and x-rays usually don’t count, but fillings would.
Should I Get Dental Insurance?
The answer to this question ultimately depends on two factors: personal finances and your dental health.
NADP found that the average cost of dental insurance is $360 per year. This cost may be worth it if you’re at-risk for gum disease or prone to other oral health issues from genetics. However, if your teeth are in excellent shape and you just need one or two checkups a year, most dentists give self-pay patients a discount or offer package deals for cleanings and x-rays which costs less than paying a year’s worth of premiums.
Once you’re past your annual maximum, you still have to pay premiums and the remainder of your dental work out of pocket for until the next calendar year. If your oral health is poor, extended coverage is worth it since one tooth can easily put you past the average maximum.