Discount dental plans: What to know before you buy

The first thing to know about a dental discount plan, also called a dental savings plan, is that it’s not insurance. Instead, it’s a membership-based option (like belonging to a club where you pay dues) that offers discounted services from a network of providers.

You pay a monthly or annual fee, and in return you get a break on the cost of certain services. These can range from the routine, such as cleanings and x-rays, to more in-depth procedures like fillings and root canals.

This type of dental program has been gaining in popularity, according to the American Dental Association (ADA). In fact, the organization reports that patients who have a benefits plan are more likely to seek dental care. And that’s good news, because a recent study found that 1 in 4 American adults have gone without dental care because of the cost.¹

What’s more, many dental offices are now offering patients their own in-office plans. These are independent payment agreements between you and your provider, and you receive preventive services at no charge and other procedures at a discount.² Some insurance companies are offering them, too.

The plan documents should clearly state which services are covered, how many times per year, along with setting out other requirements of the plan. Read all the information and ask plenty of questions before you commit.

You can get all of your questions answered by contacting a HealthMarkets agent at (800) 386-0232. Start by visiting healthmarkets.com.

Do I need both dental insurance and a dental discount plan?

In general, people opt for either a dental discount plan or dental insurance. And in some cases, a discount dental plan may be more economical than insurance.

While the premium (or cost per month) for dental insurance may be a minimal add-on to a plan offered by your employer, for example, that’s not the case for someone who pays for dental insurance by themselves. If you’re one of those people, dental coverage is an extra that can cost hundreds of dollars a year in premiums.

Both insurance plans and discount plans can have limitations that make them more or less appropriate for you. Dental insurance, for example, may have a cap on how much coverage you’re eligible for each year.³ Dental discount benefits might not fully cover certain procedures, such as x-rays.⁴

So your choice really depends on your specific dental needs.

Which dental option is a better deal for me?

A good way to start deciding is to compare the costs of specific procedures you think you’ll need.

For example, if your kids already have had braces, you probably don’t need orthodontia services. Check out the Fair Health Consumer website for average costs of various services.

As another example, let’s imagine you want an annual cleaning and a checkup, including x-rays. Plus, you want to budget for two fillings this year.

First, we’ll look at how that shapes up under a (hypothetical) dental insurance plan:

• Let’s say you pay a premium of $30 a month, for a total cost of $360 a year. The plan pays 100% of the cost for cleanings/checkups and x-rays, 80% for basic procedures such as fillings and extractions, and 50% for major procedures, such as crowns or implants. But it has a $100 deductible.
• So if your checkup costs $130, you have to pay your $100 deductible first, then the $30 overage is covered. Now your cost is up to $460 for the year—the $360 in premiums plus the $100 deductible.
• At your checkup, you find out that you need those two fillings you predicted, and they cost $150 each. At the 80% your plan covers, insurance pays $120 each for the fillings, and you have to cover only $30 each, for a total of $60. That brings your annual cost to $520.

Now let’s imagine the same scenario with a dental discount plan:

• Our hypothetical plan costs $150 a year—no deductibles or copays. It offers 50% off preventive care and basic procedures.
• So that same $130 cleaning and checkup costs you $65, and the two fillings, which are $150 at full price, come in at $75 each.

End result: With the dental discount plan, your total is $365 for the year—$150 for the plan itself, plus $65 for the annual visit and $150 for fillings.⁵

So in this scenario, you would save $155 by choosing a dental discount plan over insurance.

Of course, your situation is your own—you might already know you’re prone to needing root canals, or maybe you prefer to have two cleanings a year instead of one.

The message is: Work out the math (even if roughly) before you make your choice.

What should I consider besides dollars and cents?

Cost shouldn’t be your only consideration. When you’re weighing the pros and cons, think about these issues as well:      

Provider availability: Many discount dental plans are regionally based, so it’s important to assess how wide the network of providers is in your area.

Coverage exclusions and caps: Insurance may exclude certain procedures and treatments, such as orthodontia or teeth whitening. And a cap on insurance coverage may mean that pricey treatments, such as crowns or implants, exceed the limit and make you dip into your own pocket. That can get expensive.

Dental discount plans don’t have caps; they simply offer reduced fees, so you save no matter how many procedures you have during the year.

But it’s important to figure out whether your dental discount applies to specific treatments you may need or want. There could be exclusions.

Waiting periods: Some dental insurance plans have waiting periods of a few months to a year from the time you sign up. During this waiting period, the insurance may not cover treatment beyond preventive care. That’s the insurance companies’ way of making sure that people aren’t just buying coverage at the last minute to cover an expensive procedure.

Dental discount plans, on the other hand, generally start as soon as you sign up or within a few days. But again, always read the fine print and ask about anything that isn’t clear to you.

Find the dental discount plan—or dental insurance plan—that’s right for you. Contact a HealthMarkets licensed insurance agent at at (800) 386-0232, or visit healthmarkets.com.