Should I Have (or Buy) Dental Insurance?

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.