Enroll in about 4 minutes
Online Bill Pay

Dental Discount Plans vs Dental Insurance

Anyone who has compared dental discount plans and dental insurance has likely wondered: which one is best? The decision can be challenging because there is no universal recommendation. A variety of factors can affect which one is best for you – most notably your specific location.

However, there are some general truths about the two options that can be useful to know for everyone.

Is dental insurance worth it?

In most areas, an average yearly premium for dental insurance can be around $500. Dental insurance is intended to cover diagnostic and preventive services like exams, cleanings, X-rays, fluoride treatments, etc. Many of these services are included in a typical dental plan and are perfect for individuals who are generally in good health and take care of their teeth. Co-pay amounts vary, but it’s not uncommon to see around 50-75% covered by the insurance plan for restorative services like fillings and 20-50% for other services like crowns, root canals, and periodontics. There may be a waiting period before the plan coverage kicks in for the restorative and emergency services, but it’s better to have some insurance coverage than paying completely out of pocket.

It’s also not uncommon for dental insurance to have a yearly maximum. An average yearly maximum is around $1,000-$1,500, however, most plans cover an exam every six months at no cost or with a low co-insurance amount. For individuals who get regular dental work done, dental insurance is definitely worth the investment.

Does the Affordable Care Act include dental insurance?

Pediatric dentistry is part of the Affordable Care Act (ACA) as an “essential health benefit.” As a result, any health plan for a child is required to include dental insurance. However, this isn’t the case for adults. Some insurance marketplaces do include options for adult dental insurance, but they are not required to do so.

The pros and cons of dental discount plans

At first glance, dental ‘discount plans’ offered by an individual dental office may appear less expensive than dental insurance. If you are only comparing the yearly fee for coverage or discounts, the cost may be less with a discount plan. Remember, though, dental discount plans are not insurance. They’re essentially a membership you buy that gives you discounts on specific procedures.

The discounts available on dental discount plans start around 10% with as much as 30%. Dental discount plans don’t have deductibles, there are no waiting periods, no annual maximums, and there’s generally no paperwork. You simply show your discount card and pay cash for the rest.

Of course, there are downsides to these discount plans. For one thing, many of them are challenging to figure out. Some companies don’t want to release the full benefits until after you’ve invested in them. It’s important to know what you are getting before signing up for any type of program.

Second, the list of dentists you can see can be limited. With dental insurance, you may find you will receive better coverage if you stay within the preferred provider network. With discount plans, you will likely be restricted to a specific dental office. The easy way around this issue is to get detailed information on the accepted dentists before you sign up. If you already have a dentist and they don’t accept the discount plan you’re considering, it doesn’t hurt to ask your dental office if they’d consider working with or matching the discount being offered.

For those who expect to have significant dental work done: Which is best?

Once again, this isn’t an easy question to answer. In some cases, if you’re only anticipating routine care needs in a single year, then getting a discount plan may be the best choice. If you anticipate the need for multiple procedures in addition to your routine care, an insurance plan will generally save you money in the long run.

That said, dental insurance may still be the best choice. Many procedures are covered at 100% and what you pay for a deductible and co-pay could be less than you’d pay with the dental discount plan. It’s up to you to take a close look at both options and decide which one makes the most sense for you and your family.

Momentum Insurance Plans

At Momentum Insurance Plans, we are proud to offer affordable dental insurance to Wisconsin residents and businesses. Please contact us for more information and we would be happy to work with you to see which would be most beneficial for you.

Back to News