Should I Have (or Buy) Dental
Insurance?
Have you often wondered “Should I
Have (or Buy) Dental Insurance?”? If so (or even if not) this two
part series will answer that question for you, or at least point you
in the way of answering the question intelligently. In Part 1, we'll
tackle the idea alone, then in Part II, show you what to look for in
the event you decide “having dental insurance is right for me”.
So to repeat the question, “Should I
Have (or Buy) Dental Insurance?”......
The answer in a nutshell is “depends”.
Seems vague, but there are so many answers to this this question,
and no one answer applies to every reader, so we might say “first
depends on who you are” and “who you are” will vary in general
with things such as age, financial means, and even current dental
health or history. Pardon the pun, but seems like a mouthful!
Another thing in answering this
question, and possibly quite basic, is the definition or purpose of
insurance. In essence, and with due apologies to Messers Miriam and
Webster, would be the more-or-less true purpose of “insurance”:
To protect one's financial asserts from sudden and unexpected major
financial expenses... in this case, major dental expenses.
Are there differences between expected
and unexpected? The answer should be “yes”, at least for someone
who has had some basic oral health education.
Expected expenses should at minimum
include regular cleanings and checkups. If these are done on the
regular basis, one could argue that there should be very few major
and unexpected major expenses.
In the checkup phase, those potential
major expenses are caught and prevented before they become major!
This at least is for organic or non-accident related dental or oral
expenses. And in this sentence lies one of the tips to follow as
you ask the question, “Is a dental insurance plan available that
covers dental expenses due to accident?” The answer it may well
be, but it could be something you all ready have hidden within your
MEDICAL insurance plan.. but if not, it's something possibly to look
for.
Dental insurance plans come in a
variety of “flavors” formats, the two most popular being called a
discount plan and the second type is generally a defined benefit
plan, also known as a PPO plan.
Within most of these plans one will see
these fairly standard terms and conditions: Waiting period(s), max
benefit cap; age limitations on insurance, possible provider
limitations, and of course, the benefit type as just mentioned.
All will be discussed., and as they
are, the reader should be asking “is what I'm thinking about in
terms of a dental insurance plan truly INSURANCE, or is it just a
“pre paid services” plan hiding under the umbrella of insurance ?
? ? That is probably one of the most important questions to ask; in
fact, we'll go as far as to say it is THE most important question to
ask.
You see, we are coming back to the
circle of “depends”. If one thinks or feels that they might be
susceptible to unexpected dental expenses, then probably insurance
is a good idea, and this is a catch 22 as by definition we generally
can not anticipate the unexpected. Well, we can.. almost. To a
degree.
You see, if a person fails to maintain
dental and oral health, it's almost a certainty that major dental
expenses will follow! Begs the question doesn't it!!!! These
extractions, root canals, bridges, etc really now become expected.
The thing we might not know is “when”?
So let's say, dear reader, that you do
have a concern (in the future) that anticipates a major dental
expense, and you purchase a dental insurance plan. It good either be
a discount plan that says you will only pay X% for a procedure, or
you may receive an insurance check back for “70% of the billed UCR
fee charge”, or in a defined benefit plan, you may be assured of a
cost of “X dollars” for a certain procedure, usually defined in
the insurance documents by the dental procedure billing code.
So the questions become “Is this
insurance... or is this really a pre paid plan for these procedures,
in that in this scenario, your need for these dental procedures is
somewhat predictable and anticipated, based on …. and again.. a ton
of variables!
What is your dental history? Your
family dental history? How does your mouth and teeth build calcium?
Are there predictors as to IF and WHEN YOU will need these
procedures?
If you start out with a relatively
healthy mouth, and we are not talking about misalignment, less than
ideal enamel coloring, etc and you maintain a fairly regular regiment
of oral health, the probability of needing work is minimal.
If you are either starting later in
life and have not done a particularly good job of prevention, than
you probably can expect a need for work, ie, a “predictable”
expense.
So could we answer the “should I have
dental insurance” question with this first answer' “Depends on
if you have predictable major expenses” or if you don't. This is a
“toss the dice” question in many cases, as we never know, so now
we factor in RISK, the whole basis behind insurance, and ask our self
what is the balance between risk and insurance pay out.
The Predictable Expense Model
If we can and do predict some MAJOR
expenses, we can handle it this way: We can set aside money and plan
for it; we can negotiate costs in some cases or at least estimate
them, and in short, we can be self insured, and in general, at less
expense than buying insurance that we may or may not use. All the
insurance companies are doing is saving up for you, spreading the
risk among a larger pool, rather than just you having the risk all
your own, and when a procedure comes, they are paying out. Your
problem in doing things this way is that in essence, you are betting
and hoping you have enough time to pay into your own and personal
insurance funding, which is really setting a prepay fund up in your
own name. If you start young or early enough, probably this is the
most cost effective option, and you really don't need to buy
insurance.
The Unpredictable Expense Model
For a large number of readers,
particularly those who practice good oral health, major dental
procedures (at least those based on health, vs those based on
selective and often cosmetic or appearance wants or needs), are not
real predictable. Yet we are buying insurance and paying each month
for dental work that in all probability, we won't ever use or need to
have done.
This is the bet that the insurance
company is looking at in “reverse”. They are saying to you,
we'll take your money every month and if you do have to have
something major done, we'll pay for all or a part of it... but we are
pretty certain, and have the data to back it up, that in all
probability you won't ever have to have this done! Then they “cover
their bet” by giving you “FREE” cleanings and checkups.
Do you think that this is because the
insurance company is a “nice guy” and really giving you
something? Of course not! They are hedging their bet big time
because everyone knows, that short of an accident if you have your
regular checkups, cleanings, etc you are going to prevent the
majority of those major expense! ! !
So What Are you Really Getting
when you Buy Dental Insurance?
In most plans, you are getting built
in, a couple cleanings a year, checkups, etc and maybe even very low
cost simple “fillings' .
The company hopes and gambles you will
do this.
Then somewhere built into the plan is a
fee to reduce the cost to you for major work.
Let's break this down. Let's say you
are paying $40 per month for your dental insurance plan and you
have it for a year, so you put out $480. In the year, you have two
cleanings, one set of x rays, and possibly one minor
filling. Had you gone out on your own to have these things done and
paid for them, you might have spent $250.
If you are a senior and on one of the
more popular Medicare Advantage plans, you have this done at no cost
to you as it's a benefit built into the plan. (Hint: this is
something you should look for if you are Medicare Eligible)
In this case, if you are comfortable
managing your own risk and feel that major expenses are not likely at
all, then it may well be that buying a dental insurance plan is NOT
for you. Go out and find a dental facility or dentist that will
provide 2 cleaning, 2 checkups, one annual mouth x ray for well less
than the cost of the dental plan! In this case, it's just not a
viable expense. (PS: You should budget for this if you are not
covered in a MA plan, and it's less money to set a side on a per
person basis than setting aside and making that insurance plan
payment!)
On the other hand.. if you are not
comfortable managing your risk, then an insurance plan should really
be considered. If your dentist has said to you (more likely to apply
to senior who possibly have had teeth with fillings in them for 20
years), “Mrs Smith, that filling in tooth #4 is deteriorating and
should be replaced, possibly may require a root canal.. or maybe will
need to be extracted, and you'll need a bridge.. but this could be X
months off as you are currently not in pain”.
So you either budget for it, or
possibly can find an insurance plan that will cover that.. but now we
will get into more specifics of selecting a dental insurance plan in
another article or post.
For now, we hope that we have put the
general subject in a light that starts you thinning about the general
subject of buying dental insurance.
