Why Dental Insurance is So Bad – A Comprehensive Look at the Major Drawbacks

Dental insurance is one of the most confusing and frustrating types of insurance. On the surface, it seems like a good idea – you pay a monthly premium and in return you get coverage for dental care. However, once you start using your dental insurance, you quickly realize that it doesn’t cover nearly as much as you thought. There are several major reasons why dental insurance ultimately ends up being a bad deal for many people.

High Premiums With Low Benefits

The first issue with dental insurance is that premiums are high relative to the benefits provided. Premiums for individual dental insurance average $30-$60 per month. For a family plan, it can be $60-$100 or more per month.

That means you’re paying several hundred dollars per year for the plan. Yet the annual maximum benefit is typically only around $1,000-$1,500. So best case scenario, you’re paying $500 in premiums for a plan that covers $1,500 in dental work. That’s not a great return on investment.

For people who don’t have extensive dental needs, the premiums end up costing more than the services used. You’re better off skipping the insurance and just paying the dentist directly on the occasions when you need care.

Deductibles and Co-insurance

Another problem with dental insurance is the use of deductibles and co-insurance to limit the insurer’s costs. Most dental plans have an annual deductible of $50 or more that the policy holder has to pay out of pocket before insurance kicks in.

After you meet the deductible, the insurance company still doesn’t cover 100% of your costs. For basic procedures like fillings, they may cover 80%. For major work like crowns or bridges, it could be only 50%.

This means you have to pay 20-50% of the cost of treatment as co-insurance, on top of the deductible. So you’re still left with substantial bills, even with insurance.

Low Annual Maximums

As mentioned above, dental insurance plans typically have an annual maximum benefit in the range of $1,000-$1,500. It doesn’t take much in the way of major dental work to hit that limit.

A single crown can cost $800-$1,500. Root canal therapy runs $700-$1,200. Even a filling can be $100-$200 or more. It’s easy to see how you could blow through your annual maximum with just 1-2 procedures.

Once you hit that cap, the insurance covers 0% until your benefits renew the following year. You’re on the hook for the full costs beyond that point.

No Coverage for Cosmetic Dentistry

Cosmetic dentistry like teeth whitening and veneers has grown enormously popular in recent decades. However, virtually no dental insurance plans cover cosmetic treatments. Orthodontics like braces and Invisalign also often aren’t covered.

So if you want to get a bright white celebrity smile or straighten your teeth, dental insurance does nothing to lower the costs. You have to pay the dentist’s full fees.

Exclusions and Limitations

In addition to the major limitations above, dental insurance includes many smaller exclusions and restrictions that further reduce your coverage.

For example, plans usually limit the number of cleanings and exams covered each year. X-rays may not be covered as often as your dentist recommends.

Certain advanced treatments like dental implants or night guards aren’t covered at all. There are often waiting periods before you can use benefits after signing up for a plan.

The list of exclusions and fine print details goes on and on. The bottom line is dental insurance plans are experts at limiting what they’ll actually pay for.

Delayed Treatment and Pre-Authorizations

Another common complaint about dental insurance is delays in treatment due to the pre-authorization process. For any major procedure costing over around $300, your dentist usually has to submit treatment plans and X-rays to your insurance company and wait for approval before starting.

This back-and-forth can drag out the start of care by weeks or even months in some cases. All the while, your dental condition may be worsening.

Insurance companies use these pre-authorizations as another way to control their spending and avoid big claims. But it ultimately compromises your access to timely care.

Limited Provider Networks

Yet another limitation of dental insurance is restricted provider networks. Many cheaper plans contract with only a portion of the dentists in your area.

If your long-time dentist isn’t part of the network, you’ll have to switch providers or pay higher out-of-network rates. Even in-network dentists may be far away from your home or office.

Searching for an in-network dentist who is taking new patients and convenient for you can be challenging. The limited choice of providers runs counter to the goal of making dental care accessible.

Frequent Insurance Changes

One more issue with dental insurance is the frequency with which employers change insurance plans and networks. It’s not uncommon to have a different carrier or network every year during open enrollment.

This can mean your dentist is no longer in-network or that you have to adapt to new pre-authorization rules and limitations. The paperwork and administration hassles continue mounting.

Jumping around plans also leads to periods when you aren’t covered or haven’t met a new deductible. Disruptions in continual care from changing networks creates confusion and headaches all around.

Better Alternatives Exist

Given all the drawbacks above, you may wonder why anyone buys traditional dental insurance anymore. Well, the good news is that better alternatives exist!

Dental discount plans provide similar savings to insurance without all the exclusions, maximums, and waiting periods. You simply pay a low annual fee (often less than insurance premiums) and receive consistent discounts of 10-60% on all procedures.

More extensive dental membership plans are also growing in popularity. For a monthly fee, you get discounts plus perks like free exams, X-rays, cleanings, and even select restorative care. These plans provide way more bang for your buck.

Many dentists now offer affordable in-house payment plans too. For a few dollars a month, you can finance any treatment while taking advantage of the dentist’s discounted fees.

The Bottom Line

While dental insurance made sense decades ago, today it represents a below-average deal given all the limitations and drawbacks outlined above. You have to jump through hoop after hoop only to still face big bills.

Fortunately, the rise of dental discount plans, membership plans, and in-house payment plans provide way better options. Taking a little time to understand the alternatives can save you money and frustration. The antiquated model of dental insurance looks even worse by comparison.

In-Depth Look at The Major Drawbacks of Dental Insurance

Now that we’ve covered the basics, let’s take an in-depth look at each of the main flaws of dental insurance and why they leave many patients underserved:

Premiums Don’t Match Benefits

The first major drawback of dental insurance is the mismatch between premiums paid and benefits received. As mentioned earlier, premiums for individual plans often run $300 to $700 per year.

Yet the annual coverage maximum is only about $1,000 to $1,500 in benefits. Plus you have deductibles and co-insurance to pay before hitting that cap.

So you’re essentially paying $500 or more in premiums for a plan that barely covers $1,000 in care at best. The ratio of premiums to benefits is way out of alignment.

For someone who only needs 1-2 checkups a year and has no other major dental issues, the premiums end up costing more than the services used. You’d save money by ditching the insurance and just paying the dentist’s reasonable fees for occasional exams and cleanings.

When you really look at the numbers, many people would come out ahead by avoiding dental insurance altogether. But we’ve all been conditioned to think paying for insurance equals getting a good deal, even when the math doesn’t add up.

High Deductibles and Co-Insurance Rates

Deductibles and co-insurance are additional tactics used by dental insurance companies to limit their expenditures and shift costs to consumers. The typical deductible is $50 to $100, sometimes even higher for major work.

So you have to pay this amount out of pocket before insurance contributes anything. Then once you meet the deductible, the insurer still only covers a percentage of your costs.

For basic fillings and the like, the co-insurance rate is commonly 80%. More complex procedures like crowns may only be covered at 50%. Orthodontics, dental implants, and other treatments often aren’t covered at all or have very low co-insurance.

Between the deductible and co-insurance, you can expect to pay 30% to 50% or more of costs out of your own pocket, even for essential dental care. Dental insurance only