With staggering inflation eating away at family budgets, more consumers than ever are asking ”Can I Afford Dental Insurance?” However, affordability touches on more than price. It is entwined with the range of dental services covered, the dentists who provide the care, and out-of-pocket costs charged. This article will review:
It's counter-intuitive but true: The lowest-premium dental plan is not always the most affordable. It might seem logical that the dental plan with the lowest monthly premium is the best deal but, surprisingly, that's not always the case. Here's why: what really matters is your total dental spending over the course of the year — not just what you pay each month.
Total spending includes your:
When you add all of that together, a plan with a very low premium can sometimes end up costing you more overall.
To illustrate this, imagine two hypothetical plans: Plan A has a low monthly premium but higher out-of-pocket costs when you actually use dental services. Plan B has a higher monthly premium but lower out-of-pocket costs.
| Premiums | Dental Plan A | Dental Plan B |
| Monthly Premium | $20 | $40 |
| Total Annual Premiums | $240 | $480 |
| Out of Pocket Costs | Dental Plan A | Dental Plan B |
| Annual exam & teeth cleaning | $0 | $0 |
| White filling | $123 | $49 |
| Crown | $825 | $330 |
| Total Annual Out-of-Pocket Costs | $948 | $379 |
| Totals | Dental Plan A | Dental Plan B |
| Total Annual Spending on Dental Care | $1188 | $859 |
In both examples, we assume you use the exact same dental services during the year. In the above scenario, Dental Plan A has a lower monthly premium, but it charges higher out-of-pocket costs (50 percent of cost versus Dental Plan B's 20 percent of cost) for the same services. The result is that the enrollee in Dental Plan A would spend over 38 percent more than an enrollee in Dental Plan B. If the crown and white filling were not needed during the year and only annual teeth cleaning was done then Dental Plan A, with the lower monthly premium, would have had lower annual costs.
The key takeaway? Don’t judge a dental plan by its premium alone. Look at the full picture to understand what you’re likely to spend over the year.
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While there isn't a simple way to predict the dental premiums available in your area, there are criteria by which you can evaluate the value of those premium quotes. Specifically, the following factors should be reflected within the cost of a dental plan's monthly premium:
Broader and more extensive dental benefits with lower out-of-pocket costs typically is associated with higher premiums. There are exceptions, though. Dental HMOs may have broad coverage and low premiums but they are very restrictive on what dentists may be used and care from out-of-network dentists is uncovered. Dental discount programs may cover most services but their coverage model is a discount applied against retail prices.
A waiting period is a delay before a particular dental benefit is eligible for coverage by the insurance plan. For example, a plan may require an a person to be enrolled in the plan for six months continuously before the plan will help pay for a crown or a root canal. Waiting periods are usually applied to more expensive dental services (as opposed to preventive care).
The annual cap on spending by a dental plan for your covered dental benefits is often referred to as the “Plan Maximum,” “Maximum Benefit,” or “Annual Maximum Benefit.” If your annual dental care exceeds the Maximum Benefit, you will pay out-of-pocket for that excess amount with no cost sharing from insurance.
Plans with higher plan maximums are more likely to have higher premiums than plans with the same benefits but lower plan maximums.
The general rule of thumb is that the more enrollees on a dental plan, the more expensive the monthly premium is for that plan. However, the increase in premium for each new enrollee is not consistent across plans. In some cases, the premium quote for a couple with two children is the same as a couple with one child. It pays to compare prices when looking for family coverage.
In group dental insurance (sold to companies with multiple employees, unions with various members, etc.), the total amount of premiums increases as the number of insured on the policy increases. However, larger groups generally spend less on each individual covered than small groups do.
Our agents can:
Where a dental plan enrollee lives can affect the cost of coverage. In other words, two people enrolled in the same dental plan but living in different states could have different premiums. People who live in high cost-of-living areas (where dentists charge higher rates) are more likely to pay more expensive premium than is the case for the same plan offered in a low-cost-of-living area where dental services cost less.
Some plan features are associated with lower cost premiums. For example, discount programs limit enrollees to a very narrow network of participating dentists who offer services at reduced rates and these programs are known to be very inexpensive. Dental Health Maintenance Organizations, known as dental HMOs, also limit enrollees to in-network dentists and are generally less expensive than dental PPO plans or indemnity plans. In most cases, PPO and indemnity dental plans have the advantage, though, of allowing enrollees to use out-of-network dentists.
Some consumers, given dwindling income and raising inflation, go without dental insurance believing this is the least expensive option. However, lacking dental insurance comes with risks including paying much more than would have been the case with dental insurance.
First, a person lacking dental coverage may be less likely to visit the dentist. Failing to have regular dental check-ups can negatively affect oral health and lead to problems requiring expensive treatment in the future.
Second, if a person lacks dental coverage and visits a dentist for treatment, he or she may face higher prices for the same dental services used by people enrolled in an insurance plan. These lower prices are due to dental plans, such as PPOs and HMOs, negotiating with dentists in the interests of obtaining lower rates for dental services.
Now that you’re better educated on the subject of affordable dental insurance, you can compare dental plan prices in your area by visiting the dental insurance quote page. We also have an article on “Five of the Cheapest Dental Plans in the U.S.” If you're not quite ready to shop, we have additional resources to read such as "Cheap Dental Insurance vs. Affordable Dental Insurance.”
Our knowledgeable customer service team will assist you with any questions you may have prior to enrolling in a dental plan. They can guide you through the process of choosing coverage that matches your needs as well as your budget.
