Is dental insurance really worth it? Some call it a “scam”

About 76% of Americans under the age of 65 have dental insurance, but not all policyholders are satisfied with their coverage. In fact, social forums like Reddit are filled with comments from disgruntled patients questioning the value of their plan, with some even calling dental insurance an outright scam.

“Dental insurance is 100% a scam,” one Redditor wrote in response to another claim that they had to pay $2,200 to fix a chipped tooth despite having coverage. “It’s never worth it,” they said, adding that premiums cost more than annual cleanings, and plans often don’t fully cover more expensive procedures like surgery.

Learn what’s driving this negative public perception — and how to determine if dental insurance is worth the cost for you.

Why can dental insurance be frustrating?

Customers often expect dental insurance — with its shiny white ID cards and familiar terminology — to work similarly to health insurance, but in reality, the coverages are very different.

“Health insurance is designed to protect against high-cost catastrophic events, such as hospitalizations or surgeries,” said Dr. Sandeep Sachar, DDS at Sachar Dental in New York City. “Dental insurance is designed to be a prevention and maintenance plan.”

The best dental plans use a 100/80/50 payment structure, which means they cover:

• 100% preventive care, such as annual or semi-annual checkups, cleanings, and x-rays
• 80% of basic procedures such as filings, extractions, and root canals
• 50% off advanced treatments, including crowns, dentures and onlays.

But many plans cover less than that. Investopedia’s research of 17 independent dental plans found that the average coverage level for primary care is 54%, and for major care, just 34%.

On top of cost sharing, policyholders pay monthly premiums, deductibles, and copayments. These costs vary by plan, but Humana sets premiums (your monthly bill for dental insurance) at around $20 to $50 per month for an individual or $50 to $150 per month for a family.

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To complicate matters, some dental insurance plans come with waiting periods of three to six months before they cover basic procedures and three to 12 months before major care is covered.

Additionally, once you reach your plan’s annual maximum coverage, you’ll pay out of pocket for all additional services until the new benefit period begins. This caveat is in direct contrast to Medicare health plans, where reaching the maximum out-of-pocket means your health insurance company pays 100% for services.

Maximum annual benefits for dental plans typically range from $1,000 to $2,000 per year.

“There is definitely confusion,” said Dr. Sarah Stuyven, a general dentist in Vinton, Iowa, and spokeswoman for the American Dental Association. She said it helps to “think about it.” [dental insurance] As a coupon…you will incur some of the cost but not all of it.

When dental insurance makes sense, and when it doesn’t

Despite its limitations, dental insurance generally makes sense for families with children, patients with chronic periodontal needs, and older adults, given the costs associated with multiple or repeat procedures.

It doesn’t make sense for your plan’s maximum benefits to exceed the amount you’ll pay in premiums over the course of a year. In other words, if a plan’s premium is high, but its maximum annual benefit is low, “the calculations may not make sense,” Dr. Sachar said.

Beyond that, people with higher incomes may consider self-insurance, which involves using savings to cover future dental costs rather than paying for insurance to achieve the same goal. So do young people or others who expect to only need a routine cleaning or two, which costs an average of $125. People who think they will only need preventive care may choose to skip the extra monthly bill and pay for the cleaning themselves.

However, keep in mind that it is often difficult to predict the level of care you will need. And while dental insurance may be imperfect, there aren’t many great alternatives when it comes to paying for expensive procedures.

For example, the Redditor said at the beginning of this article that they would have paid $4,000 for their procedure instead of $2,200 without coverage.

“Although dental insurance may not offer the same financial safety net as health insurance, it still provides meaningful value,” Dr. Sachar said. “A well-organized plan can help reduce the direct costs of cleanings, X-rays, and even major treatments as they arise.”

Tips when considering dental insurance

However, the key phrase is “well-organized plan,” as not all dental plans are created equal. To find a worthwhile policy during open enrollment season, keep these tips in mind.

• Take advantage of employer-sponsored dental insurance if you have the option. These plans “usually offer better coverage because employers subsidize a portion of the premium, making it less expensive for employees to purchase a plan,” Dr. Sachar said.
• Avoid long waiting periods. Some plans have no waiting periods, while others may have concessions you can take advantage of. For example, you can sometimes get a waiting period waiver if you switch plans without any interruption in coverage.
• Look at network restrictions. PPO (Preferred Provider Organization) plans offer more flexibility to providers, but charge a higher premium. HMO (Health Maintenance Organization) plans are cheaper, but have more restrictive networks. “Check to make sure your dentist accepts your new plan,” Dr. Sachar said.
• Understand what is covered. Comprehensive dental plans help cover both preventative care and more expensive procedures, such as tooth extractions, root canals, and dental implants. Basic preventive plans cover only routine tests and cleanings. Make sure the plan you’re considering actually provides the care you want.
• Check for costly caveats. Some policies, for example, will not replace teeth lost before you get coverage. Or the plan may specify that it only covers amalgam (silver) fillings rather than composite (tooth-colored) fillings. “A lot of dentists don’t even do silver fillings anymore,” Dr. Stuyven said.

Start your search for quality coverage with the best dental insurance companies.

Dental insurance alternatives

If you can’t find worthwhile dental insurance options or don’t have good options, these alternatives may help you cover and afford care.

• Consider dental discount plans: These plans, also called dental savings plans, offer discounts on common dental services, such as cleanings, crowns and fillings, for an annual membership fee of usually about $150. They can be an option for young or healthy individuals with limited dental needs.
• Click on Health Savings Account (HSA): You can use the money in these tax-deferred accounts, which are typically associated with high-deductible health plans (HDHPs), to cover most dental and orthodontic services.
• Visit low-cost providers: “Dental schools are a great place to get discount dental care,” Dr. Stuyven said, adding that local clinics may also “provide care on a sliding fee scale depending on income.”