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Do I need Dental Insurance?

Dear Dr. Ellis,
My family doesn’t have any dental insurance right now, should we sign up for a plan, or just pay out of pocket?
Bob H

Receiving proper dental care is important — and not just for your teeth and gums. A healthy mouth is essential to a healthy body.

But dental care costs money. Even routine, preventive care can have an impact on a family budget — not to mention treatment for disease or injury. As with other healthcare costs, people often turn to dental insurance to help soften this financial impact.

But is dental insurance right for you and your family? Here are 4 things you should know if you have insurance or are thinking of getting it.

Dental insurance operates differently from other types. We often understand “insurance” as protection against unforeseen expenses. Dental insurance, though, works more like a “discount coupon” to offset dental care costs. It’s important, therefore, that you know what your plan pays for (routine care and treatment, orthodontics, cosmetic enhancement, etc.), at what percentage (50%, 80%) of the usual and customary fee. Find out what the plan refers to as the usual fee as that can be much less than 2016 costs and any annual deductible, the amount you pay before the policy pays. Also, there is always a cap as to the maximum benefit you can receive in one year.

Weigh all the costs if you’re the insurance purchaser. Employers pay the premiums on many dental plans as an employee benefit. If, however, you’re paying the premiums yourself, you need to add that cost to your other out-of-pocket costs for a true picture of what you’re actually spending on dental care. It’s possible a self-paying policy won’t save you money or could even increase what you might otherwise pay for dental care.

Your policy might limit your options. Most plans pay for the “basics”: routine cleanings and checkups, repairs and some restorations. They may or may not pay for orthodontics, certain dental materials for fillings or crowns or restorations like dental implants. Some plans could require you to see a dentist in their network, which may not include the one you prefer. It’s important to find out any limitations in your policy and factor them into your cost vs. benefits evaluation.

Ask your dentist for help managing your dental care costs.
While your plan may seem to you to be written in a “foreign language,” your dentist’s staff works with it and other policies on a daily basis. They may be able to help you figure out the best approach for a procedure within your policy or help you arrange payments and financing that fit your family budget.