Most people pick a dental plan during open enrollment by looking at the monthly premium and choosing the lowest one. That’s understandable, since nobody wants to spend an evening reading benefit summaries. The trouble is that two plans with almost the same premium can pay out very differently once you’re in the chair, and the cheaper one is often the one that costs more by the end of the year.
Start with the care you expect to need
Before comparing plans, think about the next twelve months. If you only expect cleanings, exams, and X-rays, most plans will handle that well. If you know a crown, a root canal, an extraction, or braces is coming, the details of the plan matter a lot more. The same goes for anyone in your family who might be a candidate for implants or a larger restoration.
A plan with a low premium that excludes the work you need will cost you more than a pricier plan that covers it. So the right plan depends on your treatment, and the premium is only part of the picture.
What to compare
Line up two or three plans and look at five things.
Covered services come first. Preventive care is commonly covered at or near 100%. Basic work like fillings and simple extractions is often around 80%, and major work like crowns, root canals, and bridges usually drops to 50% or less. Cosmetic work and implants are frequently excluded. Find the actual percentage for the work you expect.
Next is the network, meaning the dentists you can see at the plan’s contracted rates. If you already have a dentist you trust, check whether they’re in the network before you sign up.
The annual maximum is the most the plan will pay in a year, usually somewhere between $1,000 and $2,000. If you have significant work planned, a higher maximum is worth real money.
The deductible is what you pay yourself before the plan starts sharing costs. A high deductible means more out of pocket even on covered work.
Finally, check for waiting periods. Some plans won’t cover major procedures for the first 6 to 12 months. If your work can’t wait that long, that alone can rule a plan out.
For more on how dental coverage is structured and why it differs so much from medical insurance, see our post on how dental insurance works.
In-network isn’t always cheaper
A fee-for-service practice that’s out of network for your plan can sometimes be reimbursed at a higher rate than an in-network office, because it isn’t tied to the plan’s discounted fee schedule. Dr. Smile is a fee-for-service practice that accepts most PPO plans, and our treatment recommendations aren’t limited to what a plan prefers. We go into the tradeoffs in why fee-for-service practices offer better care for patients and in our guide to in-network vs. out-of-network dentists.
A simple way to decide
If you mostly need preventive care, a lower-premium plan with strong preventive coverage is usually fine. If major work is coming, weigh the annual maximum and the major-work percentage more heavily than the premium.
Implants and cosmetic goals call for a careful read of the exclusions, since those treatments often aren’t covered at all. Our membership plan or financing can cover that gap. And if there’s a chance you’ll lose coverage this year, read what to do when you don’t have dental insurance so you have a fallback.
Before any treatment starts, Dr. Smile confirms your specific benefits, so you know what you’ll owe. You can contact us or find the office nearest you in Newport Beach, San Pedro, Torrance, or Lomita on our location page.