Dental Discount Plans Vs Dental Insurance What's Right for You?
Entering “dental plan” into a search engine yields a seemingly endless list of options.
The page 1 results may seem like your best bet. However, upon closer inspection,
you will notice that many of these top-ranked listings are for dental discount plans,
not dental insurance plans.
While both may offer savings, is important to realize these are not interchangeable
terms. Understanding their differences will help you choose the best option for
you and your family.
A dental discount plan is not an insurance plan. It is exactly what it sounds like—a
way to receive dental care at a reduced rate. You pay for all services, from cleanings
to root canals, directly and out of your pocket.
Participation costs – Enrollment fee, annual fee
What’s included – Discounted rates for participating providers,
which typically range from 25 to 50 percent off select services
Who pays for services – You pay the dentist directly for services
Calendar-year maximum - No
Like health insurance, dental insurance covers a portion of your billed treatment
charges depending on the coverage you select.
Participation costs – Monthly premium, deductible, copay
Who pays for services – The insurance company pays the dental provider
directly. You are responsible for paying applicable copays and deductibles out of
What’s included – Typically, insurance plans cover two cleaning
and exam visits annually. Depending on the coverage you select, the cost for services
will be shared by the insurance company.
For example, additional preventive and diagnostic care may be covered at 80 percent,
leaving you to pay 20 percent coinsurance, and major services such as a root canal
may be covered at 50 percent.
Calendar-year maximum – Yes. Most dental insurance plans include
an annual maximum benefit, once this amount has been exceeded, you must pay for
any additional charges.
So how do you choose between the two? Consider what care you and your family require
annually, and crunch the numbers. If you decided to go with a discount plan, make
sure you are setting aside enough funds for regular checkups and cleanings. Visit
Cost Calculator to find the average pricing of dental treatment and care
in your area.
Remember: Knowing how you will pay for health care means knowing how you will pay
for dental services, too. Recent reports from the Pew Center on the States and PBS regarding dental disparities found that many without
insurance seek treatment in hospital ERs where charges can be 10 times that of a
dentist. Oftentimes, an ER visit only temporarily addresses the problem. The Pew
report cited a study of low-income patients with toothaches and found that among
those who sought treatment at the ER, 80 percent needed subsequent care from a dentist.
While some of these cases result from “dental deserts” and others from Medicaid coverage issues,
others are individuals without the means to pay for dental care.
Take time to plan, leave room for the unexpected, and remember that preventive care
helps keep costs and problems low.
Read “Purchasing the Perfect
Plan” for tips on shopping for dental insurance plans.