Dental insurance vs. dental discount plans compared
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Updated June 18, 2019: Over the past decade, one in four Americans put off seeing a dentist for necessary treatment because they couldn't afford it.
Dental fees rose by 20% during that time, while insurers grew stingy with coverage. And while the rollout of the Affordable Care Act has made it technically easier to shop for dental insurance, it doesn't mean a state marketplace plan is any better than elsewhere.
So is dental insurance even worth the trouble? Can it actually save you money on dental care? Or does it make more financial sense to join one of the dental discount plans that have become so popular in recent years? (A dental discount plan is like a membership program - you pay an annual fee to join and you get access to discounted services at participating dentists).
We compared five dental insurance and dental discount plans to see how much they'd save us in a handful of year-long hypothetical scenarios.
It's difficult to make a universal recommendation because of how greatly costs can differ depending on where you live. Also, state's insurance exchange will offer different adult dental plans (or even none at all, in which case you can shop in the open market). Still, there are few general findings on dental insurance vs dental discount plans.
If you have healthy teeth and don't expect any serious trouble, a basic dental insurance policy will likely suffice, because the small savings you might see from a good discount plan probably isn't worth the extra time it will take you to shop for one. On the other hand, 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 dental plan could save you hundreds of dollars a year. (Here's how to avoid buying scam insurance.)
We also found the cheapest dental discount plans aren't of much value, meaning you need to compare specific procedure discounts in order to find the plan that best suits your needs.
Be prepared to do some research to uncover a plan's exclusions and limitations before you buy, or you might be surprised by unexpected expenses later.
Freelancer? Here's how to shop for dental insurance.
In order to compare plans, we came up with three hypothetical dental patients with specific treatment needs over the course of one year.
All three patients had an initial x-ray at the start of the coverage period along with an examination and a follow-up cleaning, then a second exam and follow-up cleaning at the 6-month mark.
On top of that, we added procedures ranging in cost from a few hundred to over a thousand dollars. (The costs below reflect the amounts each would have paid out-of-pocket if they were self-insured, i.e., no insurance or discount plan).
James had a cavity filled, which along with the basic procedures brought his yearly total to $893.
Mary had a cavity filled, a deep cleaning instead of a second regular cleaning, and a surgical tooth extraction, for a total cost of $1,488.
Kevin needed the most expensive work, which included a root canal on a molar and an accompanying porcelain crown. His bill came to $3,888.
To determine average costs we used data from government report on dental services, and filled in any gaps by looking at a couple of online consumer pricing tools. We didn't include any related work that might accompany these procedures.
The first insurance plan we looked at was Healthplex's Dentcare Adult, an $11/month offering on the New York health insurance marketplace.
Dentcare Adult's annual cost is comparable to a dental discount plan and has no waiting period for procedures. A patient under the plan pays $48 per visit regardless of the type or number of procedures suffered and the annual out-of-pocket expense is capped at $480 (10 co-pays).
The downside to such a bargain plan is that it offers limited to no coverage for more expensive treatments. While the procedures cleanings, cavities, and an extraction would likely be covered, Kevin's root canal would not, and he'd have to accept a cheaper stainless steel crown or pay full price for a more natural looking porcelain version.
The troubling part about the plan is that this exclusion is only mentioned once, on page 16 of the 40-page contract, while all the rest of Dentcare Adult's literature implies the exact opposite by listing root canal therapy as a covered treatment. (We called to confirm that it is indeed not covered.)
For our second test insurance plan we looked at EssentialSmile 111, a $26/month policy from Solstice that's sold off the marketplace. EssentialSmile 111 also has no waiting period, and unlike Dentcare Adult would help cover Kevin's expensive molar troubles. (We called to confirm.)
But its premiums are more than twice as high as Dentcare Adult. So it wouldn't be the best deal for James and Mary. We break down the costs by plan in the table below.
For our discount plans, we chose three products at random from a couple of aggregator sites that we found through a Google search. (We used DentalPlans.com, a Pg partner, but there are other equally good sites.)
We found that the cheaper the discount plan, the less likely it was to offer any real savings. The more expensive plans, Careington Plan 504 and Affordable Family Health Services, placed higher than the cheapest plan, Aetna Vital Savings .
However, we also found that the most expensive discount plan didn't offer the best discount for every procedure. This means the ideal way to determine a discount plan's value is to look at the rates for specific procedures you think are likely to occur in the coming year — which unfortunately isn't always possible.
A quick aside: we also looked at Brighter.com, a discount plan service that doesn’t charge a membership fee. Its prices were comparable to the three subscription plans we tested, so it’s worth a look if you live in an area where Brighter is available.
We break down the costs for all five of the plans in the table below.
The biggest impediments to obtaining quality dental care comes from the dental care industry itself.
It's hard to find a full schedule of benefits or discounts before you make a plan purchase. You're encouraged to buy first and look at the fine print later.
Dentists are reluctant to offer price quotes over the phone.
Price comparison sites restrict access to DIY pricing tools.
The American Dental Associations's standard codes and names for dental procedures, which are the best way to make sure you're comparing apples to apples, are kept out of easy reach of the public.
But despite these annoyances, all five plans we looked at delivered better value than paying cash outright. Just keep in mind that each of them requires that you use a dentist in their network, which limits your choices. If you want to see any dentist whenever you choose, you'll have to pay for that privilege with cash.
Here are some tips on how to find your way through the thicket of plans, policies and procedure codes to discover a plan that works for your budget and dental needs.
If you have kids who need dental insurance, here's how to save hundreds of dollars on dental work per year.
Find a list of dental codes so you can speak the same language as industry insiders when you're checking on prices. We managed to find some recent lists (which are good enough for comparison shopping) by searching for "medicaid dental codes" on Google.
Use these sites to find average prices for procedures in your area:
Some discount plans cover cosmetic procedures like veneers, but it's rare with insurance policies. Expect to pay for cosmetic dentistry out of your own pocket.
Expect restrictions on the dentists you can use, regardless of insurance or a discount plan. If you already have a dentist you want to keep, talk to him or her about your options. All of the insurance and discount plans we looked at listed their network of dentists, so you can check there first too.
Find out whether the plan has a waiting period before it will pay for something and whether there are time limits for specific procedures (e.g., the amount of work on one tooth in a 5-year period).
Ask whether the plan pays for lab and material costs for crowns or bridges.
You can learn more on how to shop for dental care here.
Include insurer sites when searching for discount plans. Although our selections all came from aggregators, we also found some contenders offered directly by insurers.
Don't forget to include any "activation" fee for a discount plan when you compare costs. We saw fees as high at $45 at both insurer and aggregator sites, which translated into a markup of more than 30% over the price displayed in large bold type.
Most of the payment schedules you see for discount plans only show "suggested savings." If you're seriously considering a discount plan, choose a dentist from the plan's network and then call the insurer or aggregator to ask for an accurate quote.
Please share your experience with either dental insurance or dental discount plans. What other plans have you found provide great value for money?
Looking for health insurance? Compare plans and learn more here.
And, if you're a dentist, here's why you should get disability insurance.
Disclosure: This post contains references to products or services from one or more of our advertisers or partners. While these codes earn us a small commission at no additional cost to you.
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