Most Americans don’t understand the difference between dental insurance versus and a dental discount plan. This mainly applies to individuals or seniors who don’t have group coverage. *Group Dental Insurance is different and not part of this blog)
The major difference is one is insurance and the other is not. Dental insurance has these components within the policy. It has a deductible, an annual maximum out of pocket and three tiers for preventative, basic services and major services. Plan maximums run from $750-$2500 per year. I don’t recommend anything lower than $1500 as those plans are not worth the monthly premium.
There are three sections to the insurance.
Section 1 is for Preventative services. Usually without any cost and you get two cleanings per year, one exam by the Dentist and one set of X-rays. No waiting periods.
Section 2 is for basic services. Most plans don’t have a waiting period, but some do. Usually for about 6 months. Some plans have a small per person deductible around $50 annually. These services vary by the plan and usually pay 80% of the fees. The balance is owed by the patient.
Section 3 is for major services. All individual plans have a waiting period of up to a year before you can use these services. The reason is simple, people used to buy these dental plans to have a crown put in and then drop the plan. By having a 12-month waiting period the insurance company recoups the cost of these services and doesn’t lose money on the policy. Once you have reached the out of pocket maximum, the plan will not pay anything else for the remainder of the year.
My preference for individuals is a dental discount plan. It is less expensive than dental insurance and has no waiting periods or maximum out of pocket to worry about. You simply play the contracted rates negotiated between the discount plan and the Dentist. The only restriction is you must use a dentist in their network.
The cost of the discount plan is around $10 per month per person with no waiting periods or maximum out of pocket. I needed $6904 worth of work a few years ago and the discounted rate was $2904. So, using a dental discount plan saved me a considerable amount of money. When compared to the dental insurance using a $1500 max out of pocket, I would have paid the difference between the maximum out of pocket and the actual cost of the care. $5404 would have been my cost using dental insurance. I used my discount plan and only spent $2904. Quite a savings.
I forgot to get a cleaning so called the dentist afterward and was told the cleaning was $35. That’s the benefit of using a discount plan. The plan I use is on my website until Dental Insurance where an explanation of the differences in coverage is also explained. By scrolling down to the bottom of the page you will find a link to Avia Dental. That’s my discount dental plan.
Len Barend, broker
The Barend Agency Inc.