{"id":1637,"date":"2020-08-27T14:42:37","date_gmt":"2020-08-27T18:42:37","guid":{"rendered":"http:\/\/blog-2020.opencare.com\/is-dental-insurance-worth-it\/"},"modified":"2021-02-23T11:55:04","modified_gmt":"2021-02-23T16:55:04","slug":"is-dental-insurance-worth-it","status":"publish","type":"post","link":"https:\/\/www.opencare.com\/blog\/is-dental-insurance-worth-it\/","title":{"rendered":"Is Dental Insurance Worth It? Let\u2019s Break it Down"},"content":{"rendered":"Reading Time: <\/span> 7<\/span> minutes<\/span><\/span>

Dental insurance is a way to avoid the high costs of unexpected dental emergencies and to cover routine dental visits. According to the National Association of Dental Plans, about 77 percent of Americans in 2016 had dental insurance.<\/span><\/p>\n

If that many people are insured, then dental insurance must be a good investment, right? The answer is: maybe.<\/span><\/p>\n

Let\u2019s take a realistic look at dental insurance by examining the costs and coverage to determine if it\u2019s right for you.<\/span><\/p>\n

What Does The Insurance Cover<\/h2>\n

First, let\u2019s clarify that dental insurance and health insurance are not one and the same. Health insurance covers your bills<\/span> after<\/i><\/b> you reach your deductible while dental insurance covers your expenses<\/span> until<\/i><\/b> you reach an annual limit\u2014after which you pay out of pocket.<\/span><\/p>\n

Americans pay about<\/span> $360 a year<\/span><\/a> on average for dental insurance, which can range between $15 – $50 per month. How much a person pays depends on the plan they have, what state they live in, and how much they pay in premiums. High premiums mean more coverage and low premiums mean less is covered, and the majority of plans come with a coverage limit that most people don\u2019t exhaust.<\/span><\/p>\n

Your dental insurance is split into three categories: preventative, basic, and major.<\/span><\/p>\n

The divide is usually in a 100\/80\/50 structure. Most dental plans cover 100 percent of your preventative care; such as semiannual teeth cleanings, x-rays, oral evaluations, and sealants for some age groups. Insurers typically cover about 80 percent of basic procedures such as cavity fillings, periodontal work, tooth extractions, and fillings. For major procedures, you can expect your dental insurance to pay for about 50 percent. This category includes implants, crowns, bridgework, major oral surgery, dentures, and more.<\/span><\/p>\n

Cosmetic work like teeth whitening, veneers, tooth shaping, and gum contouring is unlikely to be covered by dental insurance and you will have to pay out of pocket.\u00a0<\/span><\/p>\n

It\u2019s also important to note that there are variations in plans. For instance, one insurance plan might consider a root canal to be a basic procedure, while another may rule it to be a major one. For individual policies, it\u2019s standard to have a one-year waiting period before your plan kicks in\u00a0 to cover orthodontics (braces), prosthodontics (dentures or bridges), and periodontics (scaling or root planning).<\/span><\/p>\n

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Types of Dental Insurance<\/h2>\n

There are several types of dental insurance you can choose from like the ones listed below. <\/span><\/p>\n

Preferred Provider Organization (PPO)<\/h3>\n

When you use a PPO, you pay reduced fees to visit \u201cpreferred\u201d in-network providers. You aren\u2019t required to use in-network providers, but\u00a0 it will save you money.<\/span><\/p>\n

The good news is that the insurance network will pay more than an HMO (Health Maintenance Organization) plan or indemnity plan. However, you\u2019ll end up paying more if you use a provider who\u2019s not within the network. Additionally, dental PPOs often have a maximum amount they\u2019ll reimburse you each calendar year.<\/span><\/p>\n

Just half of PPOs cover over $1,500 each year and the other half only offer benefits<\/span> below $1,500<\/span><\/a>. Premiums tend to be between<\/span> $168.72 to $366.84<\/span><\/a> per year, and family plans are roughly double. Some procedures might have a waiting period before coverage begins.<\/span><\/p>\n

This type of plan might be useful if you don\u2019t need immediate dental care<\/span> and want low premiums.<\/span><\/p>\n\t\t

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Health Maintenance Organization (HMO)<\/h3>\n

Unlike a PPO where seeing in-network providers is just \u201cpreferred,\u201d when you use an HMO, you\u2019re <\/span>required<\/i><\/b> to use only the dental providers in the insurance network.<\/span><\/p>\n

While that means you get a minimal choice in providers, with an HMO preventative work is typically completely covered and you might not even have a deductible or maximum annual limit. Premium payments are also on the lower end. You may, however, have a co-pay for basic procedures. An HMO might cover under 50 percent of the costs of major or restorative procedures or leave payment totally up to you.<\/span><\/p>\n

This type of plan is ideal for people who don\u2019t need a lot of options when it comes to dental providers, have good dental health, and want to focus on preventative care.<\/span><\/p>\n

Indemnity or Fee-for-Service Plans<\/h3>\n

With indemnity dental insurance, you choose your dental provider and your plan will pay a percentage of the provider\u2019s fee.<\/span><\/p>\n

Your deductible might be lower than with other plans and your annual maximum coverage limit might be higher. The downside is that your premiums tend to be higher than other plans and you pay your share of costs upfront.<\/span><\/p>\n

If you anticipate needing significant procedures and want to have the ability to pick from a large selection of providers, this is the type of plan that will allow you to do so.<\/span><\/p>\n

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Out of Pocket (No Dental Insurance)<\/span><\/h3>\n

Instead of using any dental insurance, you can choose to pay all of your dental care out of pocket.<\/span><\/p>\n

Prices vary depending on where you live. If your area has a high cost of living, you\u2019ll pay more. The American Dental Association (ADA) conducts surveys every few years to find the average American costs for various dental procedures. According to their<\/span> 2013 survey<\/span><\/a> (the most recent publicly released data), you can expect to pay around these prices for the following procedures:<\/span><\/p>\n