Independent Dental Insurance in NY. Should we? how?

January 24, 2014 6:56 AM

I have really bad, super-terrible teeth. My husband's teeth seem to be pretty ok, but he doesn't go to the dentist regularly enough. Should we get private insurance (neither of our jobs cover it) and what kind of plan should we get?

I'm doing my google-best, but its all super confusing. I'm willing to buy a premium plan for us if it'll actually be premium- but i don't see the vast difference in plans that i am hoping for. We're in new york city if that means anything.

Also, we make too much money to qualify for subsidized stuff.

Questions:

1. Are there premium plans out there that are worth what you pay for?
2. Anyone have any personal experience with private dental plans?
3. what should i look for?

thanks a ton.

posted by Blisterlips to Health & Fitness (13 answers total)

As a rule, dental insurance basically sucks unless your employer is picking up most of the tab. For whatever reason, dentists have resisted the takeover of their billing structure that has entirely swamped the rest of the medical profession. They expect to get paid pretty much what they bill, and they expect to get paid promptly, not sometime in the next quarter. Maybe.

If all you're doing is getting annual cleanings, it's actually often cheaper to just pay cash. And if you need some serious dental work done, you'll run into high premiums, high deductibles, and exclusion periods of up to a year. Adverse selection is an enormous problem. It can be very, very difficult to have an advantageous underwriting ratio from the consumer perspective unless you've been paying for dental insurance for years without needing any serious work done and then suddenly needing a root canal. Knowing you need that root canal going into it is never going to work.

If you need dental work done, you either pay for it yourself, or have your employer pay for it for you. That's about the sum of it. Futzing around with insurance isn't likely to be of benefit unless you know you're going to need a lot of work done now, next year, and the year after that--in which case you may not be able to find anyone to write you a policy at all.

TL;DR: Dental insurance =/!= health insurance. Most people who don't have coverage through work wind up basically paying cash, either directly to the dentist, or through their dental insurer.
posted by valkyryn at 7:23 AM on January 24, 2014 [6 favorites]

This is probably not going to be the most encouraging answer, but in my experience, most dental insurance is pure crap and is not worth the premiums.

On preview: what valkyryn said is pretty much exactly what my experience has been with dentists & dental insurance.
posted by bedhead at 7:25 AM on January 24, 2014

valkyryn is correct by saying that dental insurance isn't usually worth it if you're paying for yourself. However, if you do go down the self-insurance route (which you should), you should make sure to tell the dentist you choose that you are paying with cash. They will probably give some sort of slight discount for you, since their prices are marked up to include negotiation with insurance companies.

It's good to remember that insurance is, in general, only appropriate for expenses that you can't afford out-of-pocket. Health insurance falls under the "good idea" category, because it's easy to get hundreds of thousands of dollars in medical bills. Dental insurance falls under the "bad idea" category, because dental expenses are, in general, quite low. Further, catastrophic dental expenses (like requiring reconstructive surgery) are often covered by your medical insurance. Since dental expenses are quite regular and of known price, it's easy for your dental insurance provider to price that all into the premium, then add on their administrative fees, and then you're now paying more for dental care than you would in cash.
posted by saeculorum at 7:36 AM on January 24, 2014

Dental insurance is basically a way for employers to pay for their employees' dental care. It amounts to pre-paying for care. It's not insurance in the usual sense.
posted by alms at 7:38 AM on January 24, 2014

When my adult daughter got kicked off my employer-provided insurance, the insurance biller at the dental office recommended Aetna's independent plan. Not as good as most employer-provided insurance, but it does pay for basic preventive care such as cleanings and xrays and covereage up to 50% for fillings and other work. The issue to be aware of is that they pay 50% of a certain amount, which is often less than the fee the dentist charges, and some procedures, like crowns or root canal, can still be extremely expensive. It also has a yearly max, above which it pays nothing. In a terrible dental year, that could be a lot of dough.

Still, it has proven to be better than no coverage, as it keeps her in the habit of visiting the dentist regularly for prevention. And, it has paid out more than the policy costs, which is the ultimate test. Not sure if these are state-specific policies - we are in PA.
posted by citygirl at 7:51 AM on January 24, 2014

You're probably better off having your work done at one of the dental schools in NYC.

And/or fully fund your FSA in the year you're going to have all of this work done.
posted by melissasaurus at 8:06 AM on January 24, 2014

I would pay cash and check out "dental discount cards" if you need work done, which strangely have no pre-existing condition rider. When I needed my wisdom teeth out, I was able to buy a month's coverage right beforehand that worked with my provider, and it cut the bill to less than half of the original price (I used Aetna Vital Savings).
posted by susanvance at 8:12 AM on January 24, 2014

I go to a dentist who only takes cash and he is cheaper because he doesn't have to hire anyone to do insurance paperwork.
posted by interplanetjanet at 8:55 AM on January 24, 2014

We could not find dental insurance that made any sense at all, so we went with a dental discount plan and use our FSA. Dental insurance is not at all like health insurance.
posted by peanut_mcgillicuty at 10:36 AM on January 24, 2014

It is not the best but Aflac has dental now. you get paid by Aflac after you go but its better then nothing.
posted by majortom1981 at 11:19 AM on January 24, 2014

I would pay cash and check out "dental discount cards" if you need work done, which strangely have no pre-existing condition rider.

That's because they're not insurance. They're basically affinity programs, i.e., dentists agree to provide a fixed discount to card holders in exchange for the card network routing patients their way. Think AAA for dentists.
posted by valkyryn at 12:00 PM on January 24, 2014

The us health exchange has dental insurance. Not sure if you can only get dental through it or if dental insurance is worth it, but it is one place to look.
posted by Jaelma24 at 3:12 PM on January 24, 2014

The us health exchange has dental insurance.

Kind of. Certain kinds of dental benefits--especially pediatric dental--have some coverage as part of the health insurance policies on the exchanges. But (1) I don't think you can buy just dental insurance, and (2) it would not surprise me if those benefits were not all that different from traditional dental insurance. You'd have to look into it to be sure.
posted by valkyryn at 5:39 PM on January 24, 2014