Are you someone with no dental insurance in Tigard? Are you contemplating getting dental insurance, but unsure of where or even if to start? Well, depending on your oral healthcare, no dental insurance may even be worth it! Today, we’ll go over why dental insurance may not be for everyone, factors to consider if you decide to purchase an individual plan, and finally how to find a dentist in Tigard that has flexible financing options that work with your budget!
How Does Dental Insurance Work?
First, let’s break down how individual dental insurance plans work. You select a plan based on what you can afford, the providers you want to be able to visit, and what you need covered most. There are some important factors about dental insurance that are critical to your dental plan.
- Premium: The monthly payments you will have to make to have insurance. Typically this ranges from $ – .
- Annual Maximums: The most your insurance will pay for a procedure or treatment. Once your treatment surpasses that amount, the rest of the cost will fall on you.
- Co-insurance Costs: Commonly known in the industry as the 100-80-50% coverage structure. This is the percentage covered by your insurance for each treatment. The remaining percentage coverage is your responsibility to pay out.
- Waiting Period: The amount of time you will have to wait after you purchase insurance before a specific treatment will be covered.
Putting The Pieces Together
If the terms above confuse you, you’re not alone. Insurance is a maze to figure out, and that’s why we’re here to help you. Let’s break down a dental insurance plan and factor in the aforementioned terms to form a picture of a typical plan. For this example, we’ll use Delta Dental PPO.
- Premium: $27.00/month
- Annual Maximum: $1000.00
- Co-insurance Costs: 75%-50%
- Waiting Period: A 12 month exclusion period for those that previously didn’t have dental coverage for more than 90 days before the Delta Dental policy.
So what does this all mean in terms of costs? Well, to expand on this example, we’ll use two made up patients to illustrate our point.
The first patient is Jane. She is a healthy woman that only needs routine cleanings every six months. Based on the plan, she’ll be paying $324.00 per year in premiums. This plan covers 75% of preventive treatments, and a routine cleaning costs an average of $180.00. Her out-of-pocket costs will be $45.00, and she needs two of them per year. In total, Jane will pay $415.00 a year to get the most out of her plan.
The next patient is John. His oral healthcare is subpar. He needs more extensive treatment, and hasn’t had insurance in a year. Like Jane, his premium costs will come out to $324.00. However, John needs dentures and the average cost for that treatment is $2,000.00. His maximum is only $1000.00, and insurance will only cover 50% of the treatment. This means John will have to pay $1500 . However, because John didn’t have insurance for a year prior to this new plan, he will have to wait an entire year before insurance covers any part of the treatment. Add that year of premium charges, and John will pay a total of $2148.
Is No Dental Insurance Right For Me?
The circumstances of the two made up patients mentioned are extreme examples on the dental insurance spectrum. However, this paints a picture of how tedious navigating dental insurance is, and if you’re not familiar with all the terms and clauses, you may end up paying even more than you thought you would.
Ultimately the decision to purchase an individual dental insurance plan and deciding to go the no dental insurance route comes down to:
- What you can afford
- What treatments you need
- How fast you need treatments
- What is currently covered by your current plan
- What dental providers in Tigard you want to see
Finally, you want to make sure the dental provider you choose has flexible finance options if you can’t afford to pay for treatments and procedures upfront. At The Smile Lounge, we understand how difficult it can be to have a dental budget set aside, so we have finance options available for individuals and families here.