Dental: Insurance vs. Discounts
In 2020, many Medicare Advantage plans will offer dental & vision coverage as an extra benefit. But for those who don’t have dental coverage, or don’t like their plan’s option, may want to find a plan on their own.
Choosing either dental insurance or a dental discount plan can save you money, but there are important differences to consider before deciding which route to choose.
Dental insurance versus dental discount plans
Before jumping into details, here’s a quick overview of the two types of dental plans:
Most dental insurance plans operate pretty much the same way. Although benefits vary, plans generally fully cover preventative care, like two cleanings and one set of X-rays per year. They also tend to cover about half the cost of major procedures such as root canals, bridges, and crowns.
Most plans have annual deductibles of $50 to $100 and usually limit annual coverage amounts, with a median cap of $1,000. Some plans may or may not cover orthodontics or have lifetime limits on the amount covered for implants, so that’s also something to consider when shopping around.
Insurance companies often have a “network” of dentists and some plans will only cover work done by this network while other plans may offer flexibility to see dentists outside this network but often at a lesser amount of coverage.
With the high cost of dentistry, it’s easy to see how paying for a plan with a low annual max plus a monthly premium may not make sense. According to their annual survey, the American Dental Association Health Policy Institute says the average cost of a cleaning for an adult in the US is $73 to $130; fillings, $108 to $246; crowns, $959 to $1,650; implants, $1,200 to $2,500; and root canals, from $613 to $1,200.
Dental discount plans
With a discount plan, you pay a monthly or annual membership fee and will receive a discounted price on services. Monthly membership fees for an individual range from about $10-$15.
Dental discount plan networks may be more limited than insurance networks, and compared with insurance, the out-of-pocket costs are often higher for patients. You can get full coverage of preventive care with some discount plans, but it is much less common than it is with insurance.
Discounts range from about 20-50 percent, with routine procedures getting the highest discounts. But unlike dental insurance, with discount plans there are no caps. You keep getting the discount on all services for the entire year and the discounts do not end.
Factors to consider when choosing one option over another
At first glance, you may think the only difference between dental insurance and a dental discount plan is the cost and amount of coverage, but there’s more to consider.
When do you need coverage to start?
Some insurance plans may allow you to get a cleaning or X-ray right away, but there are often waiting periods.
It’s common to see six-month waits for for major services. These waiting periods prevent consumers from abusing the insurance plan — using the insurance for a procedure and then dropping it right away.
By contrast, dental discount plans don’t have any waiting periods. It may take a few business days for your membership to go through. If you have an immediate (non-emergency) need, you may be able to pay for a dental discount plan and get a discount on the procedure a few days later.
How many options do you want?
An important consideration is how many dentists you can choose from, and if there’s a well-rated in-network dentist nearby. If you already have a dentist you like, check with the office to see if it will accept the insurance or discount plans you’re considering.
Which option is best for you?
Compared with having no coverage at all, you can save money with either a dental insurance plan or a dental discount plan.
If you already have a dentist whom you like to visit and are looking to save money, your best bet may be to ask which options your dentist accepts and compare the costs for your general needs. When you don’t have a dentist, it can be a bit easier because you can choose the plan that offers the best coverage and then look at the list of dentists that accept the plan you chose.
For those who regularly get cleanings and don’t have a history of dental problems, a dental discount plan could provide adequate coverage for a low monthly fee. Although you may only break even or save a little money on your twice-a-year cleanings and annual X-ray, you’ll have some added security in knowing you can save money on other procedures. However, since the discount plan isn’t likely to cover the entire cost for major work, you may want to have some savings set aside for an emergency.
More ways to Save On Dental Care
With or without dental insurance, there are many ways to make dental care more affordable. Check out these strategies.
Get covered if you can.
For seniors over 65, Medicare doesn’t cover dental services, but you can buy a Medicare Advantage plan with dental coverage. Some Medicare Advantage plans charge additional premiums for dental and some offer dental coverage at no additional costs.
If you’re a veteran and have a service-connected disability, you may be eligible for free comprehensive dental care from the Department of Veterans Affairs. Other veterans can buy dental insurance at a reduced rate and some Medicare Advantage plans offer plans specifically tailored to compliment your VA benefits.
Time your treatments.
If you need an expensive procedure, ask your dentist whether you can space out the treatments so that you can apply the cost against two annual limits instead of one by starting near the end of one year and finishing in January.
Create a dental emergency fund.
Put aside money you might have used for premiums. Instead of paying an insurance company $50 per month for a plan, transfer that money to a savings account each month and use that money when you need it.
Check out medical expense accounts.
Ask whether your employer offers tax-advantaged accounts to help save and pay for dental expenses not covered by its insurance, such as a health flexible-spending account (FSA) or a health reimbursement account (HRA).
And if you have a high deductible health plan (HDHP), you can fund a Health Savings Account (HSA) with pre-tax money and use it on a range of healthcare costs including dental.
For most dental expenses the IRS will allow HSA payments for “diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body.” As long as the expenses are not eligible for reimbursement through insurance or other sources.
Go to a dental school.
You could pay 30 percent to 40 percent less on dental services at university dental schools compared to a private practice. You’ll get care from students supervised by dentists but the downside is that it’s very time consuming.
It’s much slower because the student is doing work under the supervision of an instructor. Visits are longer and care that could be done in a few sessions in a dental office could take a few months to complete.
Check a community health center.
Some community health centers offer dental care and charge on a sliding scale based on your income. But they may have limited services and, possibly, waiting lists. Call your local health department or state dental association, or go to Tooth Wisdom to find clinics near you.
Do some haggling.
Whether or not you have insurance, you pay a lot for expensive procedures so you should compare prices for big ticket items. Use FAIR Health to research prices where you live.
Dentists are often open to negotiating prices and may offer a discount if you pay for a procedure when you get the service. Some dentists also offer in-office dental plans for people without benefits.
Spread out services.
Many employer plans provide 100 percent coverage for getting a checkup twice a year. But if you’re paying on your own and in good dental health, once a year may be enough according to American Dental Association guidelines.
The ADA also says that adults with generally healthy teeth only need bitewing x-rays every 18 to 36 months. There’s no one-size-fits-all dental treatment though. You can go to the ADA’s MouthHealthy.org site for more information on paying for dental care, preventive care and recommended frequency of visits.