Dental Insurance vs. Discount Dental Plans

Adequate dental care is crucial for everyone in the family. Children should begin seeing the dentist early so that they become accustomed to the process of sitting in the chair and having their teeth cleaned. Though many people begin to neglect their dental care as they enter adulthood, it's best to continue with your regular visits and diligent care later in life. Proper dental care will improve all aspects of your overall health.

Dental expenses can add up quickly, which is why proper coverage for your teeth is so important. Many people think dental insurance is the only option in this area, but you have other choices. Consider both dental insurance and discount dental coverage carefully to determine which is best for you.

The Decline in Dental Insurance

Both dental and health insurance are changing with the rollout of the Affordable Care Act (ACA). Though pediatric dentistry is considered an essential health benefit under the ACA, adults don't receive the same consideration. While health coverage is required to comply with new ACA requirements, dental care escapes this as well, leaving many Americans to question whether an additional dental insurance plan is really worth the expense.

Even before the ACA, dental coverage was on a downward trend, with dental care use declining among adults between 2000 and 2010. Cost is the primary barrier to dental care. Those who reported that financial concerns were preventing them from getting wanted dental care increased from 8.1 percent in 2000 to 13.5 percent in 2010. According to the American Dental Association, more than a third of adults aged 19–64 do not have dental benefits. Among those aged 65 or older, nearly 64 percent lack these important benefits.

It's clear that the current dental insurance landscape is lacking — patients who are in need of dental care feel that they can't afford it. Regular dental care is critical, but those who don't understand their options beyond a traditional dental insurance plan might not know how they can affordably get the services they need.

The Importance of Dental Care

Dental care is more important than many people realize. If you're neglecting your annual dental checkups, you might suffer health problems that extend far beyond the state of your teeth. People who don't have dental benefits are more likely to suffer from a host of other seemingly unrelated health problems. The National Association of Dental Plans reports that people who have no dental benefits are 29 percent more likely to have diabetes, 50 percent more likely to have osteoporosis, and 67 percent more likely to have heart disease.

Though the connection isn't immediately apparent, there is a reason why your oral health has such a pronounced effect on the rest of your body. Even a healthy mouth is filled with bacteria. Like the bacteria in other parts of your body, many of these are beneficial. However, there are harmful bacteria in the mouth as well. These are usually kept in check with regular dental cleanings and proper oral care. But if these bacteria get a foothold and begin to thrive, you can suffer from a microbial invasion that affects every part of the body.

Oral bacteria can cause inflammation throughout the body, leading to clogged arteries, heart disease, and stroke. If they enter your bloodstream, they can travel to your heart, causing an infection of the inner lining that is known as endocarditis. Pregnant patients who have periodontitis (a serious gum infection) have an increased risk of low birth weight and premature birth.

The connection between oral bacteria and other diseases works both ways. If you have diabetes, your body has a lower resistance to infection, which will make controlling bacteria populations in the mouth more difficult. If you're on medication for osteoporosis, you might be at increased risk of damaging the bones in your jaw.

There's a direct link between oral health and overall health. If you want to protect your body from head to toe, you must address your oral health. Make sure you're equipped to get the regular care and prompt treatments that you need to avoid both oral issues and the bodywide backlash that can occur if you're dealing with poor dental health.

The Rise of Discount Dental Plans

If you're interested in improving your oral health but aren't not sure whether a traditional dental insurance plan is the way to go, consider the unique benefits of a discount dental plan. The following sections will explore the differences between a discount dental plan and a traditional dental insurance plan. Before diving into the details, however, it's helpful to get a broad overview of how a discount dental plan works.

Discount dental plans are provided on an annual or monthly basis for a set subscription fee. The plan operates like a membership program. You'll pay your fee to join, then enjoy the benefits of the program throughout your subscription. The cost of a discount dental plan is usually lower than that of an insurance plan, but it's important to remember that the two function differently, giving you access to different sets of benefits.

A discount dental plan gives you access to discounts for select services, usually in the range of 15–50 percent. You present your discount dental plan at participating providers and enjoy immediate cost savings on your expenses for dental care.

If you choose a plan like Carefree Dental, your discount dental plan will extend beyond your teeth. This plan includes prescription and vision benefits, as well. With Carefree Dental, you'll save 10–60 percent on vision services such as eye exams, glasses, contacts, and even LASIK eye surgery. Through a partnership with Catamaran RX, Carefree Dental subscribers also get discounts of 10–85 percent on their prescriptions at participating pharmacies such as Target, Rite Aid, and CVS.

The Monthly Costs for Dental Care

Both dental insurance plans and discount dental plans have an annual or monthly fee. The monthly cost of dental insurance can vary widely depending on your plan. According to the National Association of Dental Plans, the estimated monthly cost for an individual dental health maintenance organization (DHMO) dental plan is $18.59. A dental preferred provider organization (DPPO) charges an average of $32.12 a month, with indemnity insurance estimated at $24 a month.

If the plan covers both the employee and his or her family, the price increases to $37.09 a month for a DHMO plan, $72.13 monthly for a DPPO, and $55.51 a month for an indemnity plan. While these expenses are notably less than what you'll pay for your health insurance, they're still higher than the average expense for a discount dental plan.

Dental insurance plans are most affordable when you're buying them through an employer or group. If you're buying dental insurance as an individual, as many people now do thanks to the ACA, you'll pay far more. The average individual dental insurance plan runs about $554 a year, which works out to around $46 a month.

You can sign up for a discount dental plan from Carefree Dental for less than $16 a month. You don't have to pay more to cover your family on this plan. A single card covers the cardholder and his or her immediate family. With other discount dental plans, you will typically pay $20–$30 a month for family coverage.

How Dental Insurance Benefits Work

With a traditional dental insurance plan, you'll enjoy discounted rates for select procedures. However, not all procedures are covered, and some plans come with an extensive exclusions list. Before you sign up for a plan, locate the list of exclusions to find out what's notably absent from your coverage. If you don't thoroughly read the fine print, you might invest in an expensive dental insurance plan to help you pay for the cost of an upcoming root canal only to discover that this particular service is excluded from your coverage completely.

Dental insurance plans typically pay for services on a 100–80–50 scale: They cover 100 percent of diagnostic and preventive services, such as your twice-annual checkups and cleanings. You'll get about 80 percent coverage for basic procedures such as root canals or fillings. And when it comes to major dental work like bridges and crowns, coverage drops to just 50 percent.

Pre-existing conditions are covered under dental insurance plans, unlike health insurance plans, which might block coverage for a condition you had before you got coverage. Dental insurance rarely covers cosmetic services, such as tooth whitening or straightening, so you should plan to pay for these expenses yourself.

Though your coverage might seem impressive at first, one of the biggest drawbacks of a dental insurance plan is its coverage cap. Most plans will pay only $1,200 to $1,500 for your dental expenses. Keep in mind that this sum doesn't cover the full expense of the care. While dental insurance plans don't include the cost of preventive care in this sum, they do add in their 80 percent or 50 percent payments for all other care.

You're still paying your percentage for everything but your routine care. However, once the insurance company has reached its cap on payments, you'll immediately be responsible for 100 percent of your dental care costs.

Dental Care Costs

That cap of $1,200 to $1,500 might seem generous if you're not familiar with average dental expenses. However, if your teeth need a significant amount of work, you can hit your limit in just a few visits to the dentist.

Dental caries, also known as cavities, are one of the most common dental problems among adults. According to a study by the National Institute of Dental and Craniofacial Research, a whopping 92 percent of adults between ages 20 and 64 have dental caries in permanent teeth. These individuals have an average of 3.28 decayed or missing teeth. What's more, the prevalence of dental caries increases with age. More than a quarter of all adults have untreated tooth decay.

Fillings for dental caries cost $50–$150 for silver amalgam, $90–$250 for tooth-colored composite, and $250–$4,500 for cast gold or porcelain. The harder a filling is to reach, the more expensive the service. Filling an impacted tooth or back molar, for example, is typically more expensive than filling a front tooth.

Crowns are another option for tooth repair. A single resin crown costs about $328. A single full-cast high noble metal crown averages about $776. If you're considering a porcelain-fused crown, you'll pay about $821 per tooth.

If you can't repair a tooth, the next option is a tooth extraction. A simple nonsurgical tooth extraction costs $75–$300. For wisdom teeth, you should expect to pay $75–$200 per tooth. If you need a surgical extraction with anesthesia to numb the pain, expect to pay $150–$650. Soft tissue and other types of complex extractions run between $185–$600.

Looking at these expenses, you can see how just two or three dental services can put you at or over your maximum coverage with a dental insurance plan. If you have multiple cavities or know you'll need services for several teeth, it's important to consider all the associated expenses with these procedures to determine how soon your dental insurance coverage will stop and how much you'll pay out of pocket.

Discount Dental Plan Coverage

Discount dental plans don't cover a percentage of your services the way a traditional dental insurance plan does. Instead, they give you an up-front discount on your care. You'll save an average of $153 on your dental exam, cleaning, and X-rays with this type of plan. On a basic dental checkup, you'll save about $51. This alone offers $204 in savings per year, while you're paying just $192 a year for your discount dental plan. If you need additional services, such as a root canal and crown, you'll add another $724 to your annual savings.

The savings increase significantly with your family size, while the discount dental plan's price stays the same. For a family of four with a first dental visit and subsequent dental checkup for each person, you would save a total of $816 on your dental care.

One of the most notable benefits of a discount dental plan is the coverage's ongoing nature. You're not limited to a certain amount of care, after which you have to pay full price for services. A discount dental plan gives you unlimited discounts on all the services you need. This makes it the ideal option for any patient who expects to face ongoing dental repairs throughout the year. You won't hit a cap on your benefits. The discounted rates are always there to help make your care more affordable.

Complementary Care

One of the benefits of dental insurance is complementary care. Dental insurance plans provide 100 percent coverage for your twice-annual cleaning and checkup. If you have healthy teeth with no problems, these might be your only visits to the dentist all year. A checkup typically includes a cleaning, exam, and X-rays and costs about $288. This means your dental insurance will give you around $576 in coverage if you use your full benefits and see the dentist twice a year for preventive care.

If you're paying around $25 a month for your dental insurance plan, your annual expenses will total about $300, saving you $276 on your two dental cleanings. If you have healthy teeth and only need to visit the dentist for this type of preventive care, dental insurance might meet your needs well. If you're buying individual dental coverage, however, your annual expenses might exceed $500 a year. In many cases, the cost of the dental insurance is nearly on par with what you would pay for the cleanings without coverage.

However, keep in mind that if you take advantage of only one of those annual cleanings, you're paying more for dental insurance than you would if you paid out of pocket. You need to be vigilant about your dental care to get the most out of a dental insurance plan if you don't need additional services.

Scheduling Your Care

Once you sign up for an insurance plan, you probably expect immediate benefits. After all, you've paid your monthly premium and received your card. Surely it's time to cash in on the perks of your plan. Unfortunately, many dental insurance plans don't work this way. They make you wait a set amount of time before you qualify for certain types of repairs or restorative services. You might have to wait six months to get even basic repairs and up to 12 months before you qualify for major services such as crowns or root canals.

If you need any type of dental care, the waiting period can be painful. Putting off a filling or crown for too long gives the affected area time to deteriorate. By the time you're covered under your dental plan, you might be looking at a more extensive procedure, such as a tooth extraction.

The upper limit on dental coverage with insurance plans also forces many patients to space out their care over several years as they wait for their limit to reset at the beginning of the year. This is frustrating and uncomfortable for many patients. Putting off dental care is dangerous. If you avoid the treatment you need, you might suffer from gum disease, lose your teeth, and increase your risk of developing other diseases like heart disease.

For the sake of your health, it's important to get prompt care for any dental issues you're having. Waiting because you can't afford a particular procedure is often counterproductive, because the necessary procedure becomes more complicated and expensive in the time that it goes untreated. Your best option is to invest in a plan that will help you get the care you need immediately.

Choosing Your Provider

Both dental insurance plans and discount dental plans have their own lists of approved providers. Before choosing a plan of any kind, examine the list of approved dentists. You want a plan that will cover providers you're comfortable with. If you already have a family dentist you're accustomed to seeing, look for a plan that includes his or her practice. If you want to make sure your provider is within a particular driving distance, check a map of your local choices.

A discount dental plan such as that offered by Carefree Dental will give you access to an extensive network of providers across the country. The Aetna Dental Access network honors the Carefree Dental plan, giving you a wealth of choices when it comes to your care. The coverage networks available with dental insurance plans vary greatly from one provider to the next, so it's important to research your options if you're considering this route.

Making Your Choice

Dental insurance plans and discount dental plans work very differently. It's important to understand the fine points of both options before you commit to a care plan for yourself and your family. While the basics of dental insurance and discount dental plans are the same across providers, there are always differences in the fine print. This is particularly true of dental insurance plans.

As you're comparing dental insurance plans, you should consider the following:

  • Monthly or annual cost of the plan
  • Coverage provided for basic and advanced services
  • Exclusions list
  • Provider list
  • Waiting period for care
  • Annual cap

When you research discount dental plans, you'll have a similar list of considerations. As you compare different providers for discounted care, make sure you note the following:

  • Monthly or annual cost of the plan
  • Length of membership if the plan is not from month to month
  • Length of time before you can access your discounts
  • List of excluded services
  • Available providers

Though doing the research might seem tiring, it's worth laying out these details side by side to determine which type of coverage is best for your dental needs. Once you've determined the annual cost of coverage for your family members, you might be able to estimate the cost of their care.

For instance, if you have family members who are prone to dental caries, as many people are, consider the cost of fillings. If you've been waiting for a crown, tally this up as well. The final numbers might give you a very clear indication of which type of plan is the more affordable choice.

If you're looking for a low-cost discount dental plan for the whole family, consider Carefree Dental for your health care needs. Our comprehensive plans will help you manage your family's health affordably.

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