Michael A. Kubiniec D.D.S.

Thoughts & Advice from Dr. Mike

Michael A. Kubiniec, D.D.S., or “Dr. Mike,” answers your questions about services, insurance, or simply what’s going on in the office.

Is Dental Insurance Worth It?


Like most things in life, "it depends".

I always say that dentistry is not really that insure-against-able.  What I mean is that dental care does not follow an economic model that works well with insurance.  

Generally, insurance is purchased by people who cannot afford the expense of a worst case scenario.  If your house burns down, insurance steps in and pays for a new one.  If your car is stolen, insurance buys you a new one.  Medical insurance steps in and pays the hundreds of thousands of dollars it can take to cure cancer (heaven forbid).  In all these cases, many people's premiums (the price you pay to buy the insurance each year) are collected together and used to pay out the very few people who have a claim.  Any left over is the profit for the insurance company.

dental insurance often does not make good economic sense.

But in dentistry it is different, because so many people have dental work done regularly.  Not many people have their house burn down, but many people get some dentistry done every year.  We have a situation where many people pay premiums, and many people claim benefits.  To remain profitable, the insurance companies must limit what they cover.  

For instance, most plans we see only cover half of the bill for a root canal or a crown procedure.  The other way insurance companies control the money is to limit how much money any one person can ever receive for dental procedures in one year.  Usually this yearly maximum is $1,000.  After the dental insurance covers $1,000 in expenses, the patient has to pay out of pocket for everything else.  It is very easy to reach this maximum when the national average for a molar root canal is $1,111, a porcelain crown is $1,000, and an implant supported tooth is $3,000 and up (based on American Dental Association averages from 2013).

From my perspective, dental insurance often does not make good economic sense.  Dentists and patients would love it if everything was covered at 100% no matter what, but that would mean that patients would need to pay premiums so high that it approaches the price paid for medical insurance!

So what do you do?

The best situation I see in my practice is when the dental insurance coverage is provided free by a patient's employer.  That's like free money - the patient gets dental care and some of the bill is covered by insurance they did not have to pay for.  But less and less employers are finding it necessary to offer this employee benefit.  

squirreling away a little money every month is the best ‘plan.’

More common are dental insurance plans that you buy from your employer at a reduced cost, which is also nice.  But if you have teeth that are just ok, not perfect, and you expect dental expenses, then you may find that squirreling away a little money every month is the best "plan."  Dental insurance can cost $40 per month in Western New York State, so just set up a savings account and put the $40 in every month to be used for dental care.  It just takes discipline.  So does brushing and flossing twice a day, just saying...