Do You Need Dental Insurance? - YouTube

Going to the dentist can be well scary. Americans have a lot of

reasons for not going to the dentist. They include fear of

actually going, inconvenience, and trouble finding a dentist

who's covered by insurance. But the top reason by far is cost

nearly 60% of Americans said cost was the main reason they

haven't visited a dentist within the past 12 months. That's the

case regardless of their age, income level or the type of

insurance they have. That's because dental insurance is

well, wonky. It functions differently than medical

insurance, and that can be confusing for patients.

Dental insurance is a mixed bag. It's a misnomer, it's called

dental insurance because in reality, it's really not

insurance. It's reimbursement.

It is frustrating for a consumer when they visit several

different offices and they find out that the fees are varying

widely.

People may question whether getting dental insurance or even

going to the dentist at all is worth it.

The public may look at dentistry as elective and that's where the

problem therein in lies.

That mindset can actually drive costs up in the long run, there

were roughly 2.2 million emergency room visits in 2016

for dental conditions. According to the American Dental

Association, the American Dental Association estimates that

diverting these emergency room visits could save $1.7 billion

per year.

Preventive care is the key to oral health care, and also a key

to systemic health care.

The system isn't easy to navigate with or without

insurance, but there are ways patients can save at the

dentist.

Access is frequently available, but people are unaware of how to

access the access.

Let's break down what it actually costs to go to the

dentist, whether dental insurance is worth investing in

and what patients and policymakers can do about it.

Dentistry and medicine have always been considered separate

fields in terms of the education system, medical records and

benefits. This separation can also cause some blind spots and

treatment.

My name is Dr. Marie Jackson. I'm a general dentist based out

of Montclair, New Jersey, and I'm the owner of Stellar Smile

Center. A lot of companies cut dental benefits, because the

mindset is that it is an elective care type of issue. So

when these issues come about, people have let it go because

they didn't think of it as essential to their well being.

There's a lot of emerging evidence that what happens in

the mouth can impact a lot of chronic disease management.

Your mouth's part of your body. That's the bottom line.

Dental insurance is a nearly $85 billion industry in the US.

Historically, there have been separate companies for dental

and health insurance but the industry landscape is shifting

more health insurance carriers are now offering dental benefit

options according to a 2020 survey conducted by the firm

West Monroe Partners.

Years ago when I went into practice, the big players were

Delta and Horizon. Now the big players are the commercial

carriers because they've been able to do the formulation to

figure out what they need to charge and premium provide a

quality service but at the same time assure high profitability.

According to West Monroe's data, dental insurers are making plans

to stay competitive with most of those surveyed planning to

either partner or bundle benefits with a health insurer

by 2025. Much of the dental insurance industry is run at the

state level, with some states being more competitive than

others. Now the big publicly traded health care companies

such as MetLife, Aetna and Cigna are offering consumers the

option to supplement their health insurance with separate

dental plans.

Dental insurance is extremely profitable to the insurance

companies, which is why many of the major carriers offer dental

insurance.

Putting the medical component aside when it comes to business,

dentistry and medicine are better off separate.

Think about when you go to the dentist and how that office is

set up versus the office when you go to a physician. When you

walk into a dental office, you sit in that operatory that

treatment room costs over $100,000 to set up and you have

to have more than one treatment. Well, what we provide requires

more specific equipment and supplies, and also hence the

cost. A dental office is operates at a 65% overhead where

a medical office will be considerably lower than that.

These challenges make it very unlikely that dental insurance

will combine with medical insurance because it could cause

problems for dental offices.

The billing systems are totally different. And so providers

would have to switch over to a medical model that's very

daunting to many offices, especially small offices.

Dental benefit plans can sometimes be unclear about

pricing, causing problems for both patients and dental

offices.

It's a lose lose all around when we don't have that transparency

that we can show to the patient. It's gonna be this much. And

that's really that's the bottom line. We always say it, we think

it's going to be this much and then we just cross our fingers

and hope that it's going to be true.

I think it's also important for the dental provider to be very

transparent and let a patient know costs upfront before the

work is done. So if there are any questions, you should be

able to get an answer from your provider. You don't want to be

hit with a surprise

In the area where Dr. Jackson works in New Jersey a dental

exam for a new or returning patient is estimated to be

around $130 without in Insurance according to

fairhealthconsumer.org. Dr. Jackson charges a little over

$100 for an exam for new patients, that's the out of

pocket price. But if a patient goes through insurance fair

health estimates the dental office would receive around $80

from the insurance company for that visit.

When insurance carrier takes 35 or 40% off of your usual fee, it

then becomes very difficult to meet your bottom line in your

practice.

Here are the estimated costs for some other common dental

services. X rays, which are crucial for diagnosis can cost

around $185 for a patient without insurance in Montclair,

New Jersey. A filling for just one surface can run $250, but if

three surfaces on the tooth need to be filled, it can go up to

$385. A root canal for a front tooth can cost around $1,100.

And a crown for a back tooth can range from 15 to $1,600.

Depending on what sort of material is used. It may seem

counterintuitive, but dentists say the best way to avoid high

prices is by going to the dentist more.

I think the solution to patients not having huge out of pocket

dental costs is to stay with the prevention side of it. So if we

can reach consumers, when they're younger college age 20s

they can, we can get the word out that you need to take care

of your teeth so that they don't necessarily break down on you

down the road.

Getting any type of insurance is about risk you're paying upfront

in the event that you're going to end up paying something more

in the future. So the question is whether a person feels like

that risk is warranted when it comes to dental insurance. Most

dental benefit plans have annual maximums or the amount of dental

care the plan will cover for the whole year.

I think back to when I started practice 38 years ago, the

average dental plan covered 1000 to $1,500 for a patient and back

then that provided the patient with a decent amount of

dentistry and it really increased access to care for

many patients. So they really look forward to having that

dental insurance. Well now if you fast forward 38 years that

insurance maximum is still the same. It's still $1,000 or

$1,500, which has not changed while the premiums have gone up.

A typical plan works like this, patients pay into the plan in

several ways. There are monthly premiums which are typically 25

to $30. According to the data from the National Association of

Dental Plans or the NADP. There can also be deductibles, which

is the amount of money a patient has to pay out of pocket before

their plan starts to cover any care those typically run from 50

to $99. So $360 in premiums per year if you're paying at the

high end of the typical rate, another $100. Again, worst case

scenario totals $460. Most plans cover preventative care, such as

one or two cleanings a year and one set of x rays with no out of

pocket cost to the patient. But the plans vary in coverage when

it comes to major services like crowns or surgery. If a person

decided not to get insurance, had no other issues with their

teeth and just focused on preventative care, such as

getting two cleanings a year and one set of x rays, it would cost

them around $485 out of pocket compared to the $460 a year a

hypothetical dental plan may cost they would essentially

break even if they did get insurance. According to the NADP

95% of Americans do not hit the annual benefit maximum.

It all depends on the patient and what their needs are. So if

someone's getting a lot of work done, it is a benefit to them.

It does give them a break. It works rather much like a coupon

rather than insurance.

According to a study that was put out by the National

Association of Dental Plans, 68% of people that don't have dental

benefits, they'll actually go and get dental care but it's a

whopping 88% that have dental benefits are actually going to

use those benefits.

When it comes to preventive measures, dental insurance is

definitely worth it so you can have some type of method of

getting you in so that you're encouraged to make sure your

dental health is in check.

Patients have this perception that they need dental insurance

to go to the dentist. For many individuals having access to

dental insurance, it does assist them, does it assist them at the

level that it should? It does not. When you're talking about

the maximums that these policies have it does not assist

individuals that truly need it.

It's not just patients who question whether insurance is

worth it, dental offices can sometimes struggle to make ends

meet if they decide to accept insurance.

So when we take on insurance plans, we're taking a break on

fees. So for a small office that has majority insurance patients,

if you're in network, you are literally taking a cut of

hundreds of 1000s of dollars within a year. I've seen figures

went up as much as $600,000 of insurance breaks that colleagues

of mine have taken in one calendar year you'll find a lot

of offices will take insurance plans because if they're a

smaller office or new to an area to bring patients in patients

will often look for an in network provider on their

benefit website. So they'll log in see who's a provider in the

area and it'll draw them to the office.

Dental offices have found ways to help patients who choose to

opt out of insurance.

Typically a membership plan will be a fixed cost per year and

you'll get a certain percentage off of the practice's fees. So

for example, you could end up paying $450 for the year, and

then you would get 10 to 15% off of the practice's fees. There's

no limitations. There's no deductibles, it's just a

straight buy into the practice. They're huge in the dental

marketplace now, because there is such consumer demand for an

insurance alternative.

There's this misnomer that you need dental insurance to go to

the dentist. You really don't, dental insurance is not the

panacea that most people think it is.

There are ways people can access lower cost care without policy

changes. Another option for low cost care is to tap into dental

education programs.

If a patient is able to travel to a dental school, most of the

time, you'll see dental schools accept Medicaid. And if a person

doesn't have Medicaid or Medicare plan, they are able to

usually pay out of pocket at a much lower rate than you would

at a private office.

There's also the option of going to a community health center

which could provide patients with affordable care. These are

federally qualified health centers spread across the

country that mainly provide medical services but some of

them also offer dental care.

There is access to dental services through that community

health center. Primary care associations are agencies that

oversee the function and the efficiencies of health centers

and they help with the very smooth running of health centers

who are needed in a particular area, they help with needs

assessment and patient access to care.

Policy changes can also be used to help those who struggle to

pay dentist frequently say that Medicaid, the government funded

health insurance program for low income Americans, needs to be

overhauled in order to help patients.

Medicaid is a wonderful concept and many offices are able to

work with it. However, there's a lot of changes in the Medicaid

programs. In some years, you'll have adult Medicaid benefits

approved and they're given out. And then when administration's

change or midterms come along, sometimes those adult benefits

are yanked out or the child benefits are pared down. So it's

a very fluid program in most states. And so dentists struggle

with that and they struggle with keeping on top of it.

We know that children do better with their dental appointments

and their preventive visits when parents have coverage. And the

American Dental Association's collaborated with other agencies

to advocate for predictable adult dental benefits and an

opportunity to change some of the administrative burdens so

that it is easier for dentists to participate in a program that

they know is here today and will be here tomorrow. And not here

today and gone tomorrow.

Another issue with Medicaid that I hear very often from dentists

is that the reimbursement is just too low. It's not enough

for them to even recoup their overhead. There's a huge risk to

the livelihood of your practice. If you make that a huge chunk of

your practice.

If I were to take Medicaid, I wouldn't be able to call, cover

my costs of operations and I wouldn't be able to stay open.

Ultimately, the best way to save at the dentist is by putting in

the long term investment and care into your teeth.

I'll see patients who may not come in for years at a time

because nothing hurt but the problem is when a patient does

come in, we hope to catch things well before something is painful

or before something is broken. Preventive care is essential in

keeping costs more reasonable in the dentist.