Over the past decade, one in four Americans put off seeing a dentist for necessary treatment because they couldn’t afford it.
The reason the number is so high won’t surprise anyone who’s had to pay a dental bill lately. Dental fees rose by 20% during that time, even while wages flatlined and dental insurers grew stingy with coverage. And while the rollout of the Affordable Care Act has made it theoretically easier to shop for dental insurance, it doesn’t mean that a plan you find on a state marketplace is any better than what’s for sale elsewhere.
Which may lead you to wonder whether dental insurance is 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).
To help answer these questions, 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.
The quick takeaway on dental insurance vs dental discount plans
It’s difficult to make a universal recommendation because of how greatly costs can differ depending on where you live, and because each 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, a few general findings stood out on the question of dental insurance vs dental discount plans.
The only way to make the cash option a better value is if you don’t go to the dentist for regular checkups and preventative care, which sort of defeats the purpose.
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 plan could save you hundreds of dollars.
We also found that the cheapest dental discount plans aren’t of much value, and you need to compare specific procedure discounts in order to find the plan that best suits your needs.
When it comes to insurance plans, be prepared to do some research online and over the phone to uncover a plan’s exclusions and limitations before you buy, or you might be surprised by unexpected expenses later.
Our test subjects
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 that ranged 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 a 2013 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.)
First up: dental insurance plans
The first insurance plan we looked at was Healthplex’s Dentcare Adult, an $11/month offering on the New York health insurance marketplace. It also happened to be the only plan on our state’s marketplace during the recently ended enrollment period, appearing twice under different names.
Although we didn’t have much choice, we were legitimately curious about Dentcare Adult because its annual cost is comparable to a dental discount plan, and likewise it 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 for James and Mary—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—and why we say you should do some digging before you choose any coverage—was that we almost missed the part about how Kevin would have to pay for his molar root canal by himself. This exclusion is 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 but in partnership with a marketplace participant. EssentialSmile 111 also has no waiting period, and unlike Dentcare Adult it would help cover Kevin’s expensive molar troubles. (Again, we called to confirm.) But because its premiums are more than twice as high as Dentcare Adult, it would actually increase the overall annual cost for James and Mary. We break down the costs by plan in the table below.
How do dental discount plans compare?
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, 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 ($200 per year) and Affordable Family Health Services ($140 per year) placed first or second when compared to our insurance choices, while the cheapest plan, Aetna Vital Savings ($115), came in fourth or fifth out of all five options.
However, we also found that while the “more expensive = better savings” formula was a good rule of thumb, the most expensive discount plan didn’t offer the best discount for every procedure. For example, the Affordable Family Health Services plan ($140) actually provided better overall savings than the Careington Plan ($200) in the James and Mary scenarios, yet when it came to Kevin’s root canal, the Careington Plan ($200) offered the best price out of all five options.
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 (parts of California as of mid-2014).
We break down the costs for all five of the plans in the table below.
What we learned about dental insurance vs dental discount plans
While estimating the cost of these procedures, we realized that one of the biggest impediments to obtaining quality dental care comes from, of all places, the dental care industry itself. Again and again we ran into obstacles that prevented the transparency a consumer needs to make an informed decision. For example:
- 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.
See for yourself: dental care plan shopping tips
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.
General tips for researching dental care options
- 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 recently-dated 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, and almost unheard of with insurance policies. Expect to pay for cosmetic dentistry out of your own pocket.
- Expect restrictions on the dentists you can use, regardless of whether you pick 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.
Tips for evaluating dental insurance plans
- 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.
Tips for evaluating dental discount plans
- 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?