Ask the Advisor: October 2020

Ask the Advisor: October 2020

Is Low Cost Dental Insurance A Good Reason to Switch Health Plans?

Q:  I don’t have dental insurance and pay out of pocket.  I know I will need to get some expensive work done at some point in the next year or two.  Is dental insurance worth the cost?  How do you go about getting a good dental plan?

A:  Almost 53% of retirees say they don’t have dental insurance, and more than 55% of that group say they have postponed dental procedures due to costs, according to TSCL’s recent Senior Cost Survey.  Despite limits on what dental insurance covers, it may provide some help, especially for routine preventive care, but finding the right coverage takes some shopping around, and you may need to wait for more than a year before coverage starts for more extensive services like crowns and bridge work.

Dental insurance works differently than health insurance.  Standard Medicare, for example, has an 80/20 structure.  Traditional Medicare pays about 80% of the Medicare approved cost, while the patient, or the patient’s supplemental insurance, pays most, or all of the balance.  On the other hand, dental insurance can follow a 100-80-50 structure.  If you use in-network dentists, dental plans may pay 100% of routine preventive services, such as x-rays, cleanings and exams.  The plan may pay only 80% for basic procedures such as fillings, root canals, and extractions.  And major procedures such as crowns, implants and gum disease treatments may only be reimbursed at 50%, which can set you back with significant out-of-pocket costs.

Here are some questions to consider in shopping for dental insurance:

  • Which dentists and dental specialists in your area are in the plan’s network?  Does the dental plan require you to use a network of dentists, or do you have the freedom to choose any provider who accepts your insurance?  Are you willing to switch dentists in order for your care to be covered?  It’s especially important to learn what periodontists and other specialists in your area are in the dental plan’s network.  If you need to get a tooth pulled and an implant, but no periodontist accepts your dental coverage, you may wind up needing to spend $5,000 or more out-of-pocket for an implant.
  • What are the waiting periods and exclusions?  You can find dental plans that cover two cleanings and check-ups a year, but it’s not uncommon for dental plans to require a year or two waiting period before covering basic fillings, or crowns and implants.  Some plans will not cover pre-existing conditions, so if you are switching dentists and you are in the middle of getting bridge work done, the new dental plan may not cover prior dental work in progress.
  • What does the policy cover?  In addition to basic services, make sure you learn about tooth removals, root canals, periodontal gum treatments, dentures, crowns, bridges and implants.  Read details carefully.  For example, your dental plan may only cover one implant a year, even though you may need to get two or more done at one time.
  • Is the annual amount of coverage capped?  Dental plans often cover only a certain amount of dental services, up to a cap such as $750 to $1,500 per year.  The cost of preventive services such as cleanings and X-rays is generally not subtracted from the maximum, but it’s important that you find out.  If you think you will be needing pricey services soon, then look for the plan that offers the highest amount of coverage at the lowest cost.
  • Are there any plans without an annual maximum?  These plans fall into two main types, dental health maintenance organizations (DHMO), and discount dental plans.  A DHMO will require you to use in network dentists, and to get referrals from your dentist when you need a specialist.  You pay nothing extra when you receive preventive services that are covered by your plan premium.  There are also discount dental plans that negotiate discounted rates with a network of dentists.  Patients get discounts at dentist’s office, but pay their dentists directly at the time of service.  There is no waiting period for this type of plan.


Some Medicare Advantage plans offer low cost dental insurance as an additional benefit.  Before adding the coverage, always look into the details.  Coverage can be very skimpy for the money, and you might be able to find better coverage for the same amount of money from a stand-alone dental plan.