Is Dental Insurance a Good Deal for the Patient?

“When our patients discover the coverage provided by their “brand-name” dental insurance, they are often disappointed. As a Tampa dentist, I recognize the frustration that many patients experience in comparing dental insurance options. In this article, I provide insight into how dental insurance works and share the ways you can compare the benefits of a plan to a dental savings plan alternative.”
Claudia Martinez, D.M.D., M.P.H. 

Is it worth the premiums and co-pays to have dental insurance?

Dental insurance plans vary greatly, yet in most instances it is our view that the savings are small, if any. Most dental insurance programs offer total payment for preventive care services such as yearly exams, cleanings, and X-rays. However, the rest of the services are covered on a percentage basis, where the insurance company pays a percentage of an allowable fee for that service and the patient pays the rest. The services covered on a percentage basis are divided into a couple of categories: basic and major. Basic services include such items as fillings, extractions, root canals, and periodontal cleanings. The percentage paid by insurance for these services range from 35% to 80%. The rest is paid by the patient. Major services include items such as crowns, bridges, dentures, and partial dentures. The percentage paid by insurance for major services range from 35% to 50%. And again, the difference is the patient’s responsibility. Dental insurance does not cover cosmetic procedures and many insurance companies do not cover implants as an option, although this is beginning to change.

There are other important considerations to keep in mind when investing in a dental insurance plan. Most policies require that you pay a yearly deductible from $50 for an individual to $150 for a family. This deductible must be paid by the patient before the insurance company shares in paying any non-preventive service rendered to patient(s) covered. Insurance companies also limit the amount that they will pay in dental work to a maximum per year. This maximum ranges from $1000 to $2500 for most plans. In addition, many insurance companies do not cover the restoration of a tooth that was missing or damaged prior to the date when the patient bought into their insurance program. So those seeking insurance to help cover the costs of a lost or damaged tooth often find dental insurance will not cover the pre-existing issue.

The Tooth Doctor Tampa offers an in-house alternative to dental insurance which is affordable and much more flexible.

We created a more balanced plan that would help our patients afford care without confusion. For a yearly membership of $300/adult, $200/child or alternatively $1000/family of 4, all covered members receive 2 exams (a comprehensive exam for first visit with full mouth series of X-rays and a second exam, 6 months later with X-rays), 2 cleanings with fluoride treatments, and one emergency exam free of charge per year. In addition, and with no limits, the patient receives 15% discount on all services including cosmetic services. Also, Invisalign patients receive up to $1000 discount on their treatment. Our patients enjoy these benefits and savings immediately upon enrollment and nothing is excluded.  There are no waiting periods for our in-house dental discount plan.

To illustrate the savings, let’s say that you are a single individual with good dental health. If you were to purchase dental insurance, you might pay $30/month in premiums, for a total of $360/yr.  Two routine  exams, X-rays and cleanings will be fully covered as part of the plan (fluoride treatment not included for adults on most plans). If nothing else happens during the year and you do not need to visit the dentist for any other reason, you will have paid $60 more a year to the insurance company than if you had joined The Tooth Doctor’s Saving Plan. If in addition, that same year, you develop an oral infection requiring a trip to the dentist, the exam and prescription will be covered by the “one free emergency visit” part of the Tooth Doctor Savings Plan. Should you then require treatment with us, your 15% discount would be subtracted from any treatment you may need. If using an insurance plan, you would then be required to pay for the emergency exam and treatment out of your deductible, plus your percentage share of any treatment cost not covered by your plan.

So, what is my opinion, as a Tampa dentist, on whether or not dental insurance is a good deal for our patients?

Free dental insurance provided by an employer is a valuable benefit; however, dental insurance packages offered by employers that require the payment of a monthly premium or packages bought in the open market may not always be a good deal or provide good value for the patient. As explained above, traditional dental insurance may be a good product for those anticipating a great deal of dental issues, provided that the insurance company’s coverage percentages are generous and that their yearly maximums are not too low. Patients that anticipate a great deal of cosmetic services will be better served by our savings plan. We encourage each of our patients to examine their personal situation thoroughly before making a decision. Many of our patients call us during enrollment periods so that we can provide them with relevant information regarding the specific plan that they are considering. We are happy to provide this service and offer information that you can use in making the best decision for you. Just give us a call.

The Tooth Doctor is privately owned; a Tampa Dentist providing excellent dental care, as judged by our patients (see our reviews). We are invested in providing quality dental care and making it as affordable as possible for our patients. Let us know if we can answer any questions for you!

The Tooth Doctor Tampa
Cosmetic and Family Dentistry