More than 110 million Americans lack dental insurance -- about the same number of people who live in Mexico -- and about one-third of the U.S. population has untreated cavities, according to the nonprofit organization Dentistry from the Heart.
When it comes to dental care, the longer a toothache or other problem waits, the more complex, painful and expensive it becomes. But with relatively low premiums and attractive deductibles, experts say there are few reasons not to buy dental insurance.
J.C. Preas, vice president of marketing for Companion Life Insurance -- whose offerings include dental insurance -- says dental insurance is one of the most affordable types of insurance on the market. Studies show that people with dental insurance tend to visit dentists more often and have better dental hygiene, he says.
Preas identifies three key types of dental insurance plans: indemnity plans, HMO plans and PPO plans.
• Indemnity plan: Offering the widest range of services, this traditional fee-for-service plan lets you see any dentist. Average monthly premiums are $15 to $25. An indemnity plan does impose an annual dollar limit on benefits.
• HMO plan: This plan requires co-payments for visits. You must choose from a network of dentists to squeeze the most money out of your plan, and you generally get free preventive care. Average monthly premiums are $5 to $15.
• PPO plan: This plan falls between an indemnity plan and an HMO plan. You can pick an in-network dentist, or pay higher deductibles and co-payments to visit an out-of-network dentist. Premiums total about $20 a month.
Unlike health insurance, dental insurance plans rarely impose limits on pre-existing conditions or higher rates for those in older age groups. Consumers are not penalized with higher premiums because they've had previous dental problems or because they might be susceptible to future problems.
"For the most part, it is one rate. It is not based on age or sex. It really has more to do with location than anything, because dentists are going to charge a lot more in New York City than in a rural area," Preas says.
Premiums vary by location not only because they're tied to local dental costs but because they depend on the willingness of dentists to join a network and discount their services.
Policies typically carry deductibles of about $50 for routine visits, with basic services such as root canals and fillings covered at 80 percent. Out-of-pocket maximums can range from $750 to $2,000. In-network dentists also offer discounts. So, for a $3,000 root canal and crown, it may be only $2,500 at an in-network dentist. The patient then would pay a $50 deductible as well as a $500 co-pay (20 percent) for services, for a total of $550.
Chris Pyle, a spokesman for the Delta Dental Plans Association, says people may tend to drop dental insurance during tough economic times. A recent study by Delta Dental found that 10 million fewer Americans had dental insurance at the end of 2009 than did at the end of 2008.
Pyle says that going without dental insurance can cost far more in the long run than paying premiums. Because dental problems only grow more painful and expensive with time, most insurers not only cover but encourage preventive maintenance. Skipping cleanings can lead to plaque buildup. That contributes to cavities which, if they go untreated, can lead to a root canal. At that point, failure to pay for a $125 cleaning two years ago now results in a $3,000 bill.
"Dental benefits are designed to emphasize preventive measures. As a person visits the dentist on a regular basis, they end up saving a lot of money. There are a lot of Americans who suffer the painful and financial consequences of not getting routine cleanings," Pyle says.
Dental insurance typically is offered by employers, with monthly premiums ranging from $30 to $60. While there are few insurance options for the self-employed or those who can't obtain coverage through their employers, one alternative is a dental discount plan. Unlike insurance, a dental discount plan does not charge premiums or provide benefits. Dental discount plans charge an annual membership fee, entitling members to take advantage of lower-priced services at certain dentists.
Jenn Stoll, vice president of marketing for Dentalplans.com, says membership fees start at $79.95 a year, with discounts of 10 percent to 60 percent on services. Stoll says one advantage of a dental discount plan is there's no annual cap on benefits and no waiting period.
"Some dental insurance programs have waiting periods of up to 18 months for (major services). Our plans typically activate in three days, and you could then walk in and even get a root canal," Stoll says.