Check your SMILE!

So I talked last week about vision insurance, and how it makes sense if you wear glasses or contacts, however, dental is a completely different story.

Dental insurance is like a vision in the fact that it doesn’t require you to follow open enrollment. We can enroll you in dental insurance at any point.

Top tip: you really need to evaluate if dental insurance makes sense for you.

There are a few offerings of dental insurance on the Marketplace. It essentially covers basic services, all cleaning, and checkups. It doesn’t cover any treatment work (unless something new is going to be offered this year).

Dental insurance can be very expensive, and not end up covering the treatments you need.

Finding someone who accepts it could also be a challenge.

One misconception that people have regarding dental insurance is related to being in-network. I will hear people ask dentists’ offices if they take their insurance, who then say they don’t take insurance. They make it seem like they don’t take any insurance, when in fact, usually, they should file insurance, they just may not be in-network for you.

Even if they’re out-of-network, your dentists can still file your insurance for you. If you have a PPO, then something will get paid. If the dentist is in-network, usually your cleanings and exams are covered 100%. But if they’re out-of-network, you’re going to pay the difference between what the insurance pays and what the dentist charges because they don’t have to discount it for a network discount.

Did you know that you can also file it yourself, particularly if you have a PPO? If the dental office doesn’t file claims, they may not want to file any claims. In that case, they should be able to give you an itemization so that you can send it to your insurance yourself.

Dental insurance is very different from medical insurance.

Dental insurance has a maximum of what they will pay out per year. The average is $1500 a year they will pay out per person. Some plans are $1000, and there are some plants that are $2000. But for the most part, the average is $1500.

What do you get for that $1500?

Usually, if you’re in-network; your exam and X-rays are covered, as well as your cleaning. The question is how much are you paying for that coverage? You know, there’s one company in particular that charges individuals $42 a month per coverage. There is a one-year waiting period for any major treatment and a six-month waiting period for some minor things like fillings. That means you’re paying $42 a month for 12 months before treatment has even started.

Regarding the treatment covered, you would presume, that if you needed a crown, they will pay out the $1500 maximum. Well, no. Because crowns are considered major work and the fee schedule will say they will only pay 50%.

This is the problem: 50% does not mean 50% of what the dentist charges. It means 50% of what the insurance company thinks is a fair fate. And I will tell you that what the insurance company thinks is a fair rate is NOT a fair rate. For example, they think that a fair rate for a crown is $300. Meaning that at the end of the day, you’re not getting a whole lot of benefits. When you think of the cost of the premium, the waiting times, and the $1500 maximum, of which the amounts paid per treatment are low, it often doesn’t make much sense to sign up for dental insurance.

What can you do?

If you know that you need a whole lot of dental work done, it might make sense to do a dental savings plan, which is a one-time, yearly fee. For an individual, it’s about $100 or $120 for the year. How it works is that you get discounts on everything. The discounts more than pay for the $120 you’ve paid, and there is no limit on how much treatment you can get, you will always receive the discount. The discount is what an insurance company would have paid.

Overall, you need to weigh up the options and make the smartest decision for your family based on your needs. As an agent, I try to help people evaluate what makes sense for them. It’s not just the cost, it’s also comfort level – if a person feels better having dental insurance, I am happy to give you dental insurance. I just like people to understand the differences between what you’re paying for and the limitations that dental insurance has.

Schedule a Free Consultation


(512) 827-8117


[email protected]


Austin, Texas

Schedule it

Ready for a free consultation? Schedule 30 minutes today.

  • This field is for validation purposes and should be left unchanged.

Recent Posts