At least 8-10 times each year, I have a patient ask me: "do you think I should buy dental insurance?". Often, it is a patient retiring from their job who will suddenly be without a comfortable safety net. There are a lot of people in this position. For them, it is unfamiliar territory and the prospect of not having dental expenses covered is concerning.
Now, I am absolutely not supposed to answer this question. Keep in mind that, for me as a Dentist, it much easier if everybody has dental insurance. People are more willing to undergo necessary treatment when all or a large portion of associated costs is kicked in by their insurance provider. So, what I often do is share some facts with my patients so that they can make a better-informed decision for themselves. Now every patient operates under different circumstances so, purchasing private insurance might make sense for some but not others. And, secondly, there are 2 main types of factors that I find relevant to the decision: a) Financial and b) Psychological.
Before I start, I will make the point that my job as a Family Dentist is probably easier if all patients have dental insurance. Secondly, you have to way a number of factors related to purchasing private dental insurance and decide what is best for you. This post is not meant to direct anybody toward or away from purchasing private dental insurance. For some people it is probably a good idea, while for others it makes little sense from a financial perspective. Below I will explore little known facts that may help you to better evaluate if purchasing private dental insurance is right for you.
This is a really, really important piece of the puzzle. You can easily find out how much private dental insurance will cost you each year. But, most people have no idea what the average Canadian spends on dental care annually. Well, the number is close to $600. This includes cleanings, x-rays, diagnosis and any necessary treatment. This amount works out to roughly $50 per month. So, take a look at available dental plans and compare to this amount first.
I would strongly recommend that you get quotes from multiple providers. You can do this easily online, or with the help of a broker. I have seen numbers starting at $80/month up to $120/month depending on yearly maximum amount and percentage covered by your plan (i.e. 80% of treatment costs for example). That range translates to $960 to $1,440 yearly. Again, it is important you do your research on this as there may be less expensive rates available.
There are details built into private insurance plans that you should learn about. Some might not affect the value that your plan provides. Others will. For example, some plans will not cover replacement treatment for any teeth extracted prior to the initiation date on our plan. Other private plans do not cover any portion of major expenses such as dentures, dental crowns, dental bridges, etc.,. Make sure you know the "ins and outs" of the dental insurance plan you are planning to purchase.
I have a few patients that have private dental insurance plans. They are retired, and decided that they would like to continue maintaining the safety net that health insurance provides. Every year, they pay far more for private dental insurance than they get back in coverage for treatment. Mathematically, maintaining their private dental insurance makes no sense. However, as one patient explained, "there is value in knowing that, if I need a lot of treatment or major treatment in a given year, I'm covered". For them, the psychological benefit and piece of mind they get from having a safety net is well worth the price.
If you are considering the purchase of private dental insurance, make sure to research available plans and associated costs. Make sure a plan has value to you (either financially, psychologically, or both) prior to purchase. Don't hesitate to get a copy of your dental ledger from your Family Dentist. This way you can look at your average annual dental expenditures for a specified period of time. Doing so will help you to better understand what type of coverage, if any, will be right for you.
Here's a bit of background information to help me provide the best answer. Dental plans either cover "major" dental expenses, or they don't. Dental fillings, cleanings, check-ups, extractions and root canal treatments are "basic" dental expenditures. In contrast, dental bridges, crowns, dentures and dental implants are "major" expenses.
Now, to find out if your plan covers dental implants, you'll first need to make sure that they cover "major" dental expenses like dental crowns and bridges. After, you confirm this, you'll want to ask your Dentist to send a pre-determination for implant costs to the insurance plan provider.
Here's where it gets a bit tricky. Most dental plans don't cover implants but they may give you the amount they'd provide for a comparable dental bridge solution to use toward the dental implant. Usually, a provider that covers major expenses will provide 50% toward a dental bridge. For a bridge to replace a single tooth (which costs about $3,500), they'll provide $1,750. If a dental implant is going to cost you $4,500 (for example), your insurance plan may allow for you to use the same $1,750 toward the implant treatment. Of course, with the implant being more expensive than the bridge, the $1,750 is far less than a 50% subsidy. But, you are likely to still find this extra amount helpful.
Most insurance companies will offer a dental insurance product that covers orthodontic treatment. They all have multiple levels of coverage and the plans that cover more expensive treatments (think dental implants and Invisalign) will cost you (or your employer) more on a monthly basis.
If you are pursuing Invisalign tooth alignment, have your Dentist or Kitchener-Waterloo Orthodontist send an estimate of treatment costs to your plan provider. You will then receive a response from you insurance provider outlining what treatment subsidy they will provide. Orthodontic coverage is typically given as a lifetime amount. That is, your dental insurance provider may allot $2,500 lifetime for you to use toward orthodontic treatment (including Invisalign). Once you've used this amount, it does not reset in future years. For some plans, the lifetime amount will be $3,000 while for others it may be significantly lower.
There is certainly variability between dental insurance plans with regard to lifetime orthodontic subsidies. The best practice is to send them an estimate for treatment costs to find out about insurance funding in advance of treatment.
This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your Dentist in Kitchener or other qualified healthcare provider with any questions you may have regarding a dental condition or treatment.
