You have dental insurance so why did you wind up with a huge bill? Is there any point to dental insurance at all?
Types of Dental Plans
There are different types of dental plans. Let’s talk about DHMOs and PPOs. A DHMO is a dental HMO.
If you are currently enrolled in a DHMO and your dentist is out of network, that may explain your rather large bill. PPOs offer coverage in and out of network. However, an out of network dentist will be more expensive than in network so again that’s another reason for a larger bill.
If you have a dentist you love, find out which plans they accept and make the switch. If you are more flexible, just make sure that your dentist is in network before you make the appointment.
Benefits
Another reason for larger bills has to do with the benefits covered by your plans. For example, xrays are covered right? But how often are x rays covered? Maybe you’ve switched dentists and now they want another round of xrays. Well these may be out of pocket. Need a filling? Perhaps your plan only covers metal as opposed to porcelain.
Your plan may not offer great benefits. It may be that you can avoid some of these big bills by understanding your benefits and coverage to make appropriate decisions.
Plan Limits
The biggest problem with so many dental plans are the low plan limits. Most plans top out somewhere around 1K. So if you need more than 1K of work in a given year, you’ll be on the hook for the rest of the bill. On average a crown costs somewhere between 1-2K so even if that’s the only procedure you needed that year, you’d likely wind up with a pretty big bill.
If you need dental work, you need a plan with a bigger limit!
So Why Bother with Dental Insurance?
So, why bother with dental insurance? First let’s talk numbers. Usually a dental plan will run you somewhere between $20-$50 per month. A dental cleaning will run somewhere between $75-$200 and that’s twice per year. Of course you can find plans and treatments for more or less.
Let’s say you have a plan for $20 and your dentist charges $75 for a cleaning without insurance. Your total premiums for the year would be $240 that would cover cleanings at no charge. If you went without insurance that would be $150 for the two cleanings.
It’s already not a huge difference. Now if you were to factor in something as little as one cavity, here’s where you see the difference.
Numbers are pretty all over the place, but looking at prices for a silver filling- the much less expensive option, you’re still looking at about $150 for a single filling without insurance. So, add that to your $150 for your two cleanings without insurance and you are at $300 for the year.
If you had a PPO plan, it would cover 80% of the cost. So your coinsurance would be $30. Added to your $240 in yearly premiums and your total for the year is $270.
Basically if you are someone who absolutely never needs dental care, then you will spend less paying out of pocket. If you need any type of dental care, insurance will help. The problem is that most dental plans really don’t help enough.
That’s why most of our clients end up enrolling in a plan through NCD. They offer PPO plans with MUCH higher limits including a plan with a 10K limit. That is huge in dental insurance.
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
