Chew on this: Dental coverage gives protection within limits
By TOM MURPHY
Sep. 13, 2017
Don't forget about your teeth when you start considering 2018 insurance needs later this fall.
The annual sign-up window for many types of health insurance also is a good time to think about dental coverage. Many employers offer a chance to sign up for it during their open enrollment period for benefits. Dental protection also can be purchased with private Medicare Advantage coverage or through the Affordable Care Act's public marketplaces.
There's a big market for it. About 74 million Americans have no dental coverage, according to the National Association of Dental Plans. That's around 23 percent of the population, or more than double the percentage that lacks health insurance.
Here are some things to consider when shopping for dental plans.
WHY DO SO MANY PEOPLE LACK DENTAL COVERAGE?
The main reason is limits on government health programs.
Medicare provides health coverage for people who turn 65, but the federal program offers no dental option unless you buy it through privately-run Medicare Advantage plans. Likewise, dental coverage is spotty for adults in Medicaid, the federal-state health insurance program for the poor.
Shoppers also cannot use tax credits to help pay for most adult dental coverage sold on the ACA's marketplaces or exchanges.
WHAT SHOULD I EXPECT FROM MY COVERAGE?
You won't have to pay for preventive care like teeth cleanings. Your insurer also will grab the bill for the occasional X-ray. Coverage tends to shrink from there.
Basic work like cavity fillings might come with co-insurance, which requires you to pay a certain percentage of the bill.
That co-insurance may be as high as 50 percent for major work like crowns or dentures. Many plans also pay only $1,500 or less annually for care per person. After that, the customer has to pick up the rest of the cost.
Coverage for a kid's braces also may be limited to a maximum lifetime payment of $1,000 per person, depending on the plan.
WHY ARE THERE LIMITS?
Dental coverage is designed to encourage people to get regular care that keeps tooth decay and other costly problems from developing.
"The idea is you pay more out of pocket if you let things go south," said Evelyn Ireland, executive director of the National Association of Dental Plans.
If the insurer covered more, then premiums would rise, and that might dissuade people from getting regular dental checkups, Ireland said.
The dental plans association estimates that more than 90 percent of patients do not hit their plan's annual maximum.
However, research suggests that some people start avoiding care before they reach their plan's limits due to the costs they face even with coverage, said Marko Vujicic, chief economist for the American Dental Association's Health Policy Institute.
SHOULD I BOTHER BUYING COVERAGE?
The answer can depend on whether you expect to need more than basic care and if your dentist offers a discount program. Patients can use tax-advantaged health savings or flexible spending accounts to cover dental bills.
Consider how your projected expenses compare with the monthly premium you'd pay for coverage and whether you have the resources to handle an unexpected bill of $1,000 or more. Monthly premiums can top $50 for a family plan, which is much less than a typical health premium. Your employer likely will pay some of that for any plan purchased through work.
Insurers also can help their customers by negotiating discounts with dentists that still apply even if a patient has to cover the whole bill for a procedure, Ireland said. Those discounts might reduce the cost of a crown from around $1,200 to $960, but you have to have coverage in order to get them.
Ireland said these insurer-negotiated discounts are generally bigger than what a dentist may offer a cash-paying customer.