Dental Price Clubs - Should You Bite?

There's really no such thing as dental insurance.

With traditional health coverage, individuals bet they won't end up paying more in premiums than they get back. The insurer, on the other hand, bets that a policy holder won't have a catastrophe.

Dental is different. For starters, the annual maximum payouts are low -- $1,000 to $2,000. That means with pricey procedures, such as root canals or tooth extractions, one quickly ends up paying out-of-pocket. The actual risk the companies take on is pretty minimal, experts say. Even though regular checkups are fully covered, not everyone goes twice a year as recommended. Dental benefits providers pocket those unused dollars. And those low payout caps? Dentists say they haven't changed since the late 1970s. If they had risen with inflation, they'd be closer to $4,000 to $8,000 today.

To get a better understanding, I called Delta Dental, which provides 56 million Americans with coverage, and asked why their product is called insurance. "We typically refer to it as dental benefits," said spokesman Chris Pyle. While there's no official policy on the term, they "try not to refer to it as insurance," he said, adding, "technically, we're a not-for-profit dental service corporation." What about the low ceiling on annual caps? "We could have a $10,000 annual max, but no one would be able to afford it," said Pyle. Delta, he points out, imposes whatever caps are requested by the companies. The company declined to estimate what the premiums would be for someone in a group with a $10,000 annual cap.

For its part, the National Association of Dental Providers said that less than 3% of enrollees met or exceeded their cap in 2009, according to their most recent survey. Pyle says that percentage hasn't changed much over time. "If people in the 70's weren't reaching their annual max very often, and yet today still are not, it seems to indicate that there's not a big problem with the annual maximum levels."

The stakes are high. Roughly one quarter of Americans over age 65 have lost all their teeth, according to a recent Senate report. But for those who have maxed out their dental benefits -- or are part of the estimated 42% of Americans who don't have any -- there are other options. A few firms operate on the Costco model: customers pay an annual membership fee of $75 to $150 in exchange for access to the network of dentists with whom they've pre-negotiated discounted prices.

Some of the players include Aetna Dental Access, Careington, Cigna Dental Access, and TrueDentalDiscounts.com

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