It’s annual benefits enrollment time, everyone! Dental insurance is not something that gets a lot of attention, possibly because it’s an afterthought compared to health insurance, but it can still cost several hundred dollars per year. To aid everybody’s decision-making, I’m going to share with you the numbers I’m looking at for my family’s dental insurance and I’m going to get some input from a dentist friend of mine–let’s call him the Personal Finance Dentist–both on my particular situation and on dental insurance in general.
The good news is that while health insurance is a mess, dental insurance is much less confusing and the calculations are much more straightforward. “Dental plans are a dream for the number-crunchers: concrete annual maximums, limited procedure mixes, easy-to-estimate utilization, and so forth” says PF Dentist. “And here’s a fun fact: 50-60% of the public have dental insurance. Of those people only 2/3 ever use the the benefits.”
I’m fortunate to have an employer that offers dental insurance. PF Dentist has some thoughts on corporate-sponsored vs. individual plans:
Due to volume buying, big companies can get better dental plans than the individual. Also, it’s been my experience that the people that actively seek out individual policies are the ones that have teeth problems. So no insurance company is going to give them a good plan. Most dental insurance is done through employers.
On an annual basis, here’s what my plan costs:
- Employee only: $95
- Employee + spouse / domestic partner: $325
- Employee + children: $252
- Employee + spouse /domestic partner + children: $567
The benefits, in a nutshell: preventive care (2 checkups per year, cleaning, x-rays) is covered. Basic services (e.g. fillings) are covered 80% after the deductible ($50 individual / $150 family), major services (crowns, bridges, orthodontia) are covered 50% after the deductible.
Note that the preventive care is covered only up to whatever your insurer pays the dentist. Dentist reimbursements by insurance companies vary according to a number of factors, but here’s a rough estimate::
- Adult: 2 cleaning, 2 exam, x-rays (routine) $300/year
- Child: 2 cleaning, 2 exam, x-rays $200/year
Let’s look at the economics for my particular situation. If it were just me, the employee-only coverage is a good deal at only $95 per year since you’d certainly pay more than that out of pocket at any dentist. Where it gets a little more iffy is when you throw my wife into the mix. If I add her, the cost jumps by $230 per year, which is about what it would cost to get two checkups anyway.
So adding my wife is a wash assuming she uses the plan. We always make use of our dentist visits but if you’re only of those people who doesn’t visit the dentist… well, first of all, you should visit the dentist on a regular basis, but if you don’t I hope you’re not one of those people mentioned above who have dental insurance but don’t use the benefits.
When you add kids into the mix, I’m paying an extra $157 per year (if it’s just me insured) or an extra $317 per year (if it’s me plus my wife). Isn’t that interesting how adding the kids is more expensive if you’re insuring a spouse / domestic partner? This adds a new wrinkle to the decision-making: it’s actually that extra $317 that’s the break-even point for my wife, not $230. So now I’m at a point where it might be worthwhile for my wife to think about skipping dental insurance. Food for thought.
Whether or not it’s worth it for the kids depends on how many you have. I have four kids so I make out pretty well from having my kids covered by dental insurance. (Economies of scale!) If I only had one kid, I probably wouldn’t bother.
What’s the downside to skipping dental insurance? PF Dentist says, “Adults are higher risk. Broken teeth need root canals, crowns, expensive stuff like that. With kids, the worst that happens is he gets a cavity or needs a baby tooth pulled, cheap stuff. Worst case for a child is a baby crown tooth–and that’s still a fraction of the cost of an adult crown. Pediatric dentists work on high volume.”
That covers my situation, but I had a few more questions. If you forgo dental insurance, can you drive a hard bargain with your dentist for lower rates? PF Dentist says there isn’t much room for negotiation:
Shoppers annoy the hell out of me and most dentists have similar feelings. I don’t go to Target and ask for a discount on socks. If they’re a good patient on hard times, I discount heavily. Preachers and priests get it free. Police get a small discount, but they usually have good insurance. Seniors can as well. If I’m slow that day, or the next, and the patient can do it literally RIGHT NOW I’ll discount a bit.
Are there any scams in dental insurance? PF Dentist points his finger at this sort of thing:
Cigna, and others, will sell you access to their networks. It’s called a “savings plan” but it’s not insurance. It just allows you to go an in-network dentist and pay the negotiated Cigna fees for that dentist (which may vary from doctor to doctor). It reimburses you nothing, and you get to pay $123 a year for this. What a scam! You could find a dentist with an in-house plan and pay less.
So as always, caveat emptor. But according to PF Dentist, most profit on dental comes from people not using their benefits:
For a family of 4, the out-of-pocket costs for regular services is roughly $1,000. Your company’s plan would cost that family of 4 $567, so that family is in the black assuming they actually use it.But that’s a big assumption. I can tell you from experience it’s very difficult to ensure that all family members are here 2 times a year. It’s profit for me to make sure they are here, but most people don’t want to be at a dentist’s office. And the insurance companies know this. Fear, inconvenience, etc. are their source of profit.
PF Dentist told me he’d check on the comments in this thread, so if you have any questions about dental insurance or the fascinating world of dentistry, feel free to ask them below. (And please note that if your dentist ripped you off, it’s not PF Dentist’s fault and he can’t help you out with that.)