Do you need dental insurance? Ask yourself these 8 questions

If you don’t have dental insurance coverage through an employer, here's what you need to consider.

By Stephanie Thurrott • August 26, 2020

If you don’t have dental insurance coverage through an employer, you might wonder if it’s worth paying for it on your own. Even if it’s been a while since you’ve needed anything more complicated than a cleaning and checkup, dental insurance still might be a good idea. 

Here are eight questions to consider, according to our experts. 

1. Do you have a lot of fillings?

Dental fillings don’t last forever, and sometimes need to be replaced with more expensive crowns and bridges. “When fillings make up the majority of the tooth it is time to think of a crown,” says Eugene Gamble, a periodontist and dental implant specialist based in the Caribbean.

Talk to your dentist about replacement costs for your fillings. “Dental plans have annual maximum benefits,” says Alice Stevens, a content strategist who specializes in dental insurance for Best Company. So, it can be smart to develop a plan for replacing your fillings that maximizes your benefits. 

She points out that some plans have annual maximums that may increase over the first few years. “If you foresee needing significant dental care in the next few years, buying and renewing one of these plans now can also be a smart move,” she says.

2. Are you missing teeth?

“The average American has lost 12 permanent teeth by the age of 50,” says Mike Golpa, a dental surgeon who specializes in high tech dental implants. “Hence, a lot of people need implants or prosthodontics to still smile and bite.”

And if you’ve lost teeth, you’re placing a heavier workload on the teeth that remain, Gamble points out. 

3. Do you have gum disease?

For people with periodontal disease, the dental insurance premiums will likely be much less than the cost of treatments and maintenance, says Mark Burhenne, founder of AsktheDentist.com.

4. Do you anticipate needing dental work?

“When you get to your fifth decade and beyond you should have an adequate idea about your likely dental treatment needs,” Gamble says. If you’ve had a lot of dental work in the past, it’s likely you’ll need more work going forward. 

Don’t wait until you lose a filling or break a tooth to purchase dental insurance. “Dental plans often have waiting periods for certain services, and may also have exclusions for pre-existing conditions,” Stevens says. “If you want dental coverage, it’s smart to buy a good plan before you need it.”

5. Would you struggle to cover the cost of a dental emergency?

“Dental insurance can be very helpful if you need emergency dental care,” says Stevens. “When unexpected expenses arise, it can be helpful to have insurance to help defray the costs.” 

6. Do you have Medicare for your health insurance coverage?

Many people incorrectly believe that Medicare also covers dental care.

Last year, DentaQuest and KRC Research commissioned a survey which found 62% of patients are either unsure if Medicare includes dental benefits, or incorrectly believe it does. And a Kaiser Family Foundation survey found that nearly two out of three Medicare beneficiaries have no dental coverage. Medicare beneficiaries who needed dental care spent an average of $922 on those costs in 2016.

7. Do you want access to in-network rates for your dental care?

Your insurance may cover 50 to 80% of certain treatments. But that’s not the only thing to consider. “It’s often not just the benefit dollars that are helpful, it’s the reduced fee schedule the dentist has to use by being in network with your insurance company,” says Ryan M. Jones, a dentist with Nashville Restorative Dentistry in Tennessee. 

Your insurance company will have negotiated rates with your dentist. “That means you actually pay less than someone having the same procedure performed that isn’t insured,” he says.

8. What’s the cost of the premiums, compared to routine cleanings and exams?

“Preventive care is typically covered by dental insurance at 100%,” says Kelly Hancock, a registered dental hygienist and oral health writer. “Oftentimes you will find that the price of preventive care alone is worth the cost of the insurance.”

Preventive care is important, since with regular exams your dentist can often identify and treat problems before they become more extensive. “If tooth decay is caught in early stages, it may be able to be simply filled with a small filling.  As the cavity progresses, the procedures get bigger and more costly,” Hancock says.

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